Concerns Taking Wellbutrin For Panic Attacks

Quick Answer

Wellbutrin (bupropion) isn't typically prescribed for the treatment of panic disorders due to the lack of available evidence proving its effectiveness.

While side effects such as agitation, anxiety, and insomnia have been reported with essentially all antidepressant drugs (including SSRIs like Zoloft), these types of side effects are seen more commonly in those taking Wellbutrin, especially when starting therapy.

If you are concerned about the potential side effects of Wellbutrin or are worried it may not appropriately treat your condition, I highly urge you to speak with your doctor to discuss your options.

Detailed Answer

Wellbutrin (bupropion) is an antidepressant medication and while its exact mechanism of action isn't completely understood, it likely works by increasing levels of the neurotransmitters norepinephrine and dopamine in the brain.

While it is commonly used to treat major depressive disorder, seasonal affective disorder, and smoking cessation, it is not typically prescribed for the treatment of panic disorders and is not FDA-approved for treating them.

One reason for this is the lack of scientific evidence proving its effectiveness for these particular conditions. Most studies investigating the use of Wellbutrin have been focused on its use in treating depression, and the data on its efficacy for anxiety disorders, such as panic disorder, is limited.

The following excerpt is from the 'Practice Guidelines for the Treatment of Patient With Panic Disorder':

Bupropion (including extended release formulations) was effective in one small trial and ineffective in another. Although it might be useful in some cases, given the limited and mixed systematic data regarding its efficacy, bupropion cannot be recommended as a first-line treatment for panic disorder.

The trial in which bupropion was found to be effective, referenced in the excerpt above, was published in "Psychopharmacology Bulletin" and can be found on PubMed.

However, this was a small trial of only 20 patients and was an 'open' trial, meaning both the researchers and the participants were aware of the treatment being given and there was no placebo group. 

It's also important to note that medical guidelines generally don't explicitly state that bupropion can't be used to treat a panic disorder, it just isn't recommended as a first-line agent and there is very little evidence to support its use in this regard. It may still be an option for some individuals.

Be Cautious: Wellbutrin Can Worsen Anxiety & Agitation In Some Individuals

Some studies have found that Wellbutrin can cause side effects such as agitation, anxiety, and insomnia, which are symptoms commonly associated with panic disorder. Clinical trials note these types of side effects are more likely to occur when starting therapy.

It is certainly true that all antidepressants have a precaution regarding the potential to cause these types of side effects, but they are far more common with Wellbutrin. In fact, the prescribing information for the drug reports that during treatment initiation in a clinical trial, 31.9% of individuals reported symptoms of agitation, and 3.1% experienced anxiety.

The mechanism behind these side effects is not fully understood, but it is believed to be related to the increase in norepinephrine and dopamine levels in the brain. Norepinephrine is a neurotransmitter that is involved in the body's "fight or flight" response, which is activated during times of stress or danger. One theory is that by increasing norepinephrine levels in the brain, Wellbutrin may exacerbate these symptoms.

Similarly, the increase in dopamine levels may also contribute to the development of anxiety and agitation.

Other Treatment Options?

There may be other antidepressant medications that are better suited for treating panic disorder, such as selective serotonin reuptake inhibitors (SSRIs) like Zoloft, Prozac, or Lexapro.

These drugs (SSRIs) work by increasing levels of the neurotransmitter serotonin in the brain, which can help to regulate mood and reduce symptoms of anxiety. They are often considered a first-line treatment for panic disorder and may have fewer side effects than Wellbutrin.

However, you did mention that you already tried Lexapro and were bedridden. You don't get into details about what side effects you were experiencing, so it's tough to provide guidance on that point. It may be an option to try a different SSRI, or drugs in other classes that are recommended to treat panic disorders, such as Effexor (venlafaxine) and Elavil (amitriptyline).

In addition to medication, other treatments for panic disorder may include cognitive-behavioral therapy (CBT), relaxation techniques, and lifestyle changes such as exercise and a healthy diet.

Other Thoughts From The Pharmacist

It's a challenge to give more specific guidance in regard to medication options as I don't know your medical situation.

Based on what you wrote in your question, it sounds like Wellbutrin is having positive effects, but you're worried about what could happen in regard to your symptoms getting worse based on what you've been reading.

My thoughts here are that taking medication to treat a condition comes down to a decision of risk versus benefit.

Every drug has the potential to cause side effects, and it's important to be aware of what those side effects are, what to look out for, and how to respond to them should they occur.

Healthcare providers are there to guide us and provide us with the information we need to make informed decisions about our health. It's crucial to understand that every drug has potential side effects, but that doesn't necessarily mean we shouldn't take them. Often, the benefits of a medication outweigh the potential risks.

Ultimately, the decision to take medication is a personal one that depends on a variety of factors, including an individual's health, the severity of their condition(s), and their personal values and preferences.

Therefore, it is important to work with your healthcare provider to develop a comprehensive treatment plan that addresses your condition and overall concerns.

Final Words

Thanks for reaching out to us! I hope this answer was helpful and I'm always more than happy to provide additional information.