Here’s What Experts Say About Wellbutrin Side Effects

The most common Wellbutrin side effects, according to FDA drug data, include nervousness, trouble sleeping, dry mouth, tremor, headache, dizziness, nausea, vomiting, and constipation. Many of the activating side effects settle after one to two weeks, according to Tara Fuller, a Psychiatric-Mental Health Nurse Practitioner at Charlie Health, and rare but serious side effects such as seizures, suicidal thoughts, or a severe rash need prompt medical attention.

Wellbutrin, the brand name for bupropion, is an atypical antidepressant that mental health clinicians prescribe to relieve symptoms of major depressive disorder and seasonal affective disorder. Outside of these FDA-approved indications, providers may prescribe Wellbutrin off-label for attention-deficit/hyperactivity disorder (ADHD), antidepressant-induced sexual dysfunction, and more.

Regardless of why you’re prescribed Wellbutrin, you may be curious about the side effects of the medication and wondering what to expect in your early days of taking it.

Read on to learn more about Wellbutrin side effects, how long they last, which side effects are most common, and when to contact your provider.

What are the side effects of Wellbutrin?

The side effects of Wellbutrin vary from gastrointestinal side effects like nausea and constipation to more activating side effects like nervousness or insomnia. Some people may experience multiple adverse effects, while others may experience none.

According to FDA drug data, the most common side effects of Wellbutrin include:

• Nervousness
• Trouble sleeping
• Dry mouth
• Shakiness (tremor)
• Headache
• Dizziness
• Nausea
• Vomiting
• Constipation
• Sweating
• Fast heartbeat
• Blurred vision

It’s important to note that there are different formulations of Wellbutrin and its generic bupropion. These include:

• Wellbutrin XL (Wellbutrin brand name extended-release tablets)
• Bupropion XL (Generic extended-release tablets)
• Wellbutrin SR (Wellbutrin brand name sustained-release tablets)
• Bupropion SR (Generic sustained-release tablets)
• Bupropion IR (Generic immediate-release tablets)

All brand-name and generic versions of Wellbutrin contain bupropion hydrochloride (or bupropion HCL) as the active ingredient, regardless of whether the medication is immediate, sustained, or extended-release. 

“Side effects are generally dose-dependent and more common with immediate and sustained release formulations than the extended release formulation, especially when taken late in the day,” says Tara Fuller, a Psychiatric-Mental Health Nurse Practitioner (PMHNP) and Director of Advanced Practice Psychiatry at Charlie Health. 

Wellbutrin side effects in the first week

“Insomnia, dry mouth, nausea, and headache are among the side effects most likely to occur during the first week of treatment,” Fuller says. These side effects may be most apparent at the beginning of treatment, as your body adjusts to a new medication. Providers often prescribe a lower dose of the medication to start with to minimize intense side effects and give your body time to adjust. 

When do Wellbutrin side effects go away?

Many of Wellbutrin’s activating side effects settle after one to two weeks, Fuller says. There is no one-size-fits-all answer for when Wellbutrin side effects will go away, since everyone is different and some people may experience more intense side effects than others. 

An important consideration is that bupropion side effects are often dose-related rather than duration-related, Fuller adds, meaning if you’re on a dose that’s too high for your body, you may experience the side effects even after more time has passed. This is especially common for people experiencing irritability or anxiety at higher doses of Wellbutrin, Fuller says. 

Additionally, if you experience insomnia as a side effect, you may need to take your medication at a different time, she adds.

How do Wellbutrin XL, SR, and IR side effects differ?

All forms of Wellbutrin contain bupropion, and the FDA labels don’t report a head-to-head difference in side effects between them. The forms differ mainly in how often you take them: immediate-release (IR) is taken three times a day, sustained-release (SR) twice a day, and extended-release (XL) once a day in the morning, with a usual target dose of 300 mg for XL. Seizure risk rises with dose, according to the Wellbutrin SR label, which reports about 0.1% at up to 300 mg a day and about 0.4% at the maximum 400 mg a day. Your prescriber chooses the form and dose that fit you.

Form	How often you take it	Seizure risk in the label
IR (immediate-release)	Three times a day	About 0.4% at doses up to 450 mg a day
SR (sustained-release)	Twice a day	About 0.1% at up to 300 mg a day; about 0.4% at 400 mg a day
XL (extended-release)	Once a day, in the morning	Not formally studied in trials; the label cites the SR figure of about 0.1% at up to 300 mg a day

Never chew, cut, or crush Wellbutrin XL tablets. The medicine is then released too quickly, which can make side effects, including seizures, more likely, according to the Wellbutrin XL label.

Are Wellbutrin side effects different for men and women?

The FDA labels don’t report a different pattern of side effects for men and women. A study described in the Wellbutrin XL label found no sex-related differences in how the body handles bupropion, although average exposure was about 13% higher in men, and the label says the clinical significance of that is unknown. For pregnancy, the label says studies have not identified an increased risk of birth defects overall, but a pregnancy registry suggested a possible increase in heart defects and other findings are inconsistent. The label also notes that women who stopped antidepressants during pregnancy were more likely to have a relapse of major depression, and that seizures have been reported in breastfed infants, although the relationship to bupropion is unclear. Tell your prescriber if you are pregnant, planning to become pregnant, or breastfeeding, and don’t stop taking Wellbutrin on your own.

Does Wellbutrin cause constipation or nausea?

Both are listed among Wellbutrin’s common side effects. In the SR label’s depression trials, 13% to 18% of people reported nausea, compared with 8% on placebo, and 5% to 10% reported constipation, compared with 7% on placebo. In the XL label’s seasonal depression trials, 13% reported nausea, compared with 8% on placebo, and 9% reported constipation, compared with 2% on placebo. These numbers come from different trials, so they can’t be compared directly. Nausea is among the side effects most likely to show up in the first week, and you should let your provider know if either one is severe or doesn’t ease.

Does Wellbutrin cause weight loss or weight gain?

It is more likely to cause weight loss than weight gain. In the SR label’s depression trials, 14% to 19% of people taking Wellbutrin SR lost more than 5 pounds, compared with 6% on placebo, and 2% to 3% gained more than 5 pounds, compared with 4% on placebo. Wellbutrin is not approved for weight loss. It is approved for major depressive disorder and, for XL, for preventing seasonal depression in people with seasonal affective disorder. If weight loss is already a major sign of someone’s depression, the label says prescribers should consider Wellbutrin’s weight-reducing potential.

What are the long-term side effects of Wellbutrin?

For most people, Wellbutrin is considered safe and well-tolerated when taken long-term. 

However, some research shows that chronic bupropion use can lead to high blood pressure. It’s important to have regular check-ups with your primary care physician to monitor your blood pressure and overall health whenever you’re taking any prescription drug long-term.

Additionally, as Fuller mentioned, some side effects may be dose-related rather than duration-related. So, if you’re on a higher dose that’s causing you anxiety, this might occur until your prescriber adjusts the dose to be lower. Or, insomnia could persist long-term if you are taking the bupropion at night rather than in the morning. 

Does Wellbutrin raise blood pressure?

Yes, it can. The Wellbutrin XL label says treatment can result in elevated blood pressure and hypertension, and that blood pressure should be checked before starting and monitored periodically during treatment. In a trial of people using bupropion together with a nicotine patch, hypertension was more common than with either one alone, and most cases occurred in people who already had signs of high blood pressure. The labels don’t say whether blood pressure returns to normal after stopping, so ask your prescriber or pharmacist.

Does Wellbutrin cause long-term brain effects?

The FDA labels don’t describe lasting brain damage from bupropion taken as prescribed. The brain-related risks they do list are seizures, which rise with dose, and rare reactions such as confusion, hallucinations, or paranoia, which in some cases eased after the dose was lowered or the medicine was stopped. Long-term brain-specific research is limited, so talk with your prescriber if you have concerns.

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Does Wellbutrin cause sexual side effects?

It is not common for Wellbutrin to cause sexual side effects. In fact, many clinicians prescribe Wellbutrin to combat sexual side effects that people experience from other antidepressants. 

For example, SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors) are two common antidepressant classes that may cause sexual side effects, including:

• Decreased libido
• Difficulty orgasming
• Inability to have an orgasm
• Erectile dysfunction

For some people, adding Wellbutrin to an SSRI or SNRI, or switching to Wellbutrin, can increase sex drive and counteract these sexual side effects.

It’s possible for Wellbutrin to cause sexual side effects, but it isn’t common, and much less likely to cause sexual dysfunction than a selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor.

How long does it take for Wellbutrin to work?

When you first start taking Wellbutrin, it doesn’t act on symptoms immediately. It takes a bit of time to build up and cause changes in neurotransmitter activity in your brain. Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI), which means it affects levels of the brain chemicals norepinephrine and dopamine. 

You might notice a minor improvement in your symptoms as early as one to two weeks. But to experience a clinically significant reduction in depression symptoms, it could take around six to eight weeks. 

Try to stay patient during this time, and remember that the medication doesn’t work magically overnight. Plus, it might take some time to reach the clinical dose that’s best for you. 

Wellbutrin drug interactions

If you take certain medications, Wellbutrin might not be the best fit due to drug interactions. It’s crucial to tell your provider about all prescription medications you take so they can ensure that Wellbutrin is safe for you.

Some known drug interactions for Wellbutrin are:

• Certain HIV medications (ritonavir, lopinavir, and efavirenz)
• Certain anticonvulsants/seizure medications (carbamazepine, phenobarbital, and phenytoin)
• Certain antidepressants (venlafaxine, nortriptyline, imipramine, desipramine, paroxetine, fluoxetine, and sertraline)
• Monoamine oxidase inhibitors (MAOI) antidepressants (selegiline, isocarboxazid, phenelzine, and tranylcypromine)
• Certain antipsychotics (haloperidol, risperidone, and thioridazine)
• Certain cardiac medications (metoprolol, propafenone, and flecainide)
• Certain medications used for treating Parkinson’s (levodopa and amantadine)

Does Wellbutrin have a boxed warning?

Yes. Wellbutrin, Wellbutrin SR, Wellbutrin XL, and generic bupropion carry one boxed warning, titled “Suicidal thoughts and behaviors.” In short-term trials, antidepressants increased the risk of suicidal thoughts and behavior in children, teens, and young adults up to age 24, and the Wellbutrin XL label says this increase was not seen in adults older than 24. Watch closely for new or worsening depression, unusual changes in behavior, or thoughts of suicide, especially in the first few months of treatment or after a dose change, and contact a provider right away if they happen. Call or text 988 in a crisis.

Can you drink alcohol while taking Wellbutrin?

The FDA label says drinking alcohol during treatment should be minimized or avoided, because of rare reports of neuropsychiatric problems and reduced alcohol tolerance in people who drank during treatment. MedlinePlus adds that alcohol can make bupropion’s side effects worse. If you usually drink heavily, talk with your provider before suddenly stopping alcohol, because stopping suddenly can raise the chance of seizures.

What happens when you stop taking Wellbutrin?

Never stop an antidepressant without first talking to a healthcare provider, because stopping suddenly can cause other symptoms, according to the Wellbutrin XL label. That label says people taking 300 mg once daily should decrease to 150 mg once daily before stopping, and MedlinePlus says your doctor may lower your dose gradually. How often bupropion causes withdrawal symptoms is not known, so talk with your prescriber about a plan for your situation.

Who should not take Wellbutrin?

While Wellbutrin is safe for many people to take, people with certain health conditions may be advised not to take it due to an increased risk of serious adverse effects, including increased seizure risk.

These contraindications include:

• Seizure disorder
• Bulimia or anorexia nervosa (current or past diagnosis)
• Abruptly stopping drinking alcohol if you drink excessively
• Abruptly stopping benzodiazepines, barbiturates, or antiepileptic medications
• Taking an MAOI antidepressant medication within the last 14 days

Your prescriber should be aware of your medical history to ensure your safety while taking Wellbutrin. If the risks outweigh the potential benefits, your provider might recommend a different medication instead of bupropion.

When should you call your doctor about Wellbutrin side effects?

While it’s normal to experience mild side effects like nausea or headaches when you first start taking Wellbutrin, it’s important to contact your provider if the side effects are severe or worsening over time. You want your medication to make you feel better, not worse.

Additionally, some more severe and rare adverse effects are possible when you take Wellbutrin. Fuller says to contact a healthcare provider if you experience any of the following:

• Suicidal thoughts
• Psychosis
• Mania
• Severe agitation
• Seizures
• High blood pressure
• Severe rash
• Hives (or any other sign of an allergic reaction)
• Eye pain or vision changes

Although these are possible side effects, they’re uncommon with Wellbutrin treatment. Still, it’s important to be aware of the possibility and reach out for medical advice ASAP.

Additionally, the risk of suicidal thoughts is highest in children, teenagers, and young adults under the age of 24, so these younger patients need to be closely monitored during the first few months of treatment or after any dose changes. 

If you’re experiencing suicidal thoughts, don’t hesitate to reach out for help ASAP. Call or text the 988 Lifeline for 24/7 support from a crisis counselor.

Frequently asked questions about Wellbutrin side effects

How Charlie Health can help

If you or a loved one is struggling with mental health, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for people dealing with serious mental health conditions, including major depressive disorder and seasonal affective disorder.

Our compassionate care team incorporates evidence-based therapies into individual counseling, family therapy, and group sessions. We also offer medication management to clients as needed. Our clinicians can prescribe psychiatric medications (like Wellbutrin), monitor for adverse effects, and adjust dosages as needed. With a combination of medication and therapy, feeling better is within reach. Fill out the form below or give us a call to start healing today.