What can be paired with Wellbutrin for anxiety? (3 known combinations) 

In this blog post, we are going to answer the question, “What can be paired with Wellbutrin for anxiety?”. Wellbutrin is an atypical antidepressant which can be used to treat mild to severe episodes of depression. 

In some practices, Wellbutrin is combined with some anxiolytics to achieve better therapeutic response. This blog will cover such combinations and we will talk about safety and efficacy related to them. 

What can be paired with Wellbutrin for anxiety?

Wellbutrin can be paired with the following medications for anxiety:

• Selective serotonin reuptake inhibitors (SSRIs) 
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) 
• Short acting benzodiazepines

Selective serotonin reuptake inhibitors (SSRIs) 

Several researchers have performed clinical trials in order to determine the safety and efficacy of the concomitant use of SSRIs and Wellbutrin (Bupropion). SSRIs work by inhibiting the reuptake of serotonin from the synaptic cleft (space between a neuron and its target cell). 

They increase the availability of serotonin in your brain. Some studies have indicated that this combination is usually well treated. Wellbutrin can help control weight gain associated with the use of SSRIs and can help enhance their antidepressant effect. 

However, benefits of this combination can only be achieved at low doses. As both of them are antidepressants, higher doses can cause significant complications. It can increase the risk of serotonin syndrome and can also cause mental confusion and hallucinations. 

This combination should only be taken when prescribed by the healthcare provider. Doses should be taken accurately in order to prevent any possible interaction or harmful side effects. Examples of SSRIs include:

• Zoloft (Sertraline) 
• Lexapro (Escitalopram) 
• Celexa (Citalopram) 
• Paxil (Paroxetine) 
• Prozac (Fluoxetine) 

These meds are also associated with some side effects including:

• Nausea 
• Vomiting 
• Diarrhoea or Constipation 
• Acid reflux or heartburn 
• Abdominal pain 
• Loss of appetite 
• Weight gain or loss 
• Excessive sweating or night sweating (nocturnal/night hyperhidrosis) 
• Frequent urination 
• Polydipsia or excessive thirst
• Tremors 
• Muscle twitching and pain
• Drowsiness 
• Dizziness 
• Excessive tiredness or fatigue 
• Insomnia or inability to fall asleep 
• Xerostomia or dry mouth 
• Dysmenorrhea or heavy periods
• Flu like symptoms including irritation in eyes and runny nose
• Loss of libido in both male and females. Males may suffer from inability to release, while females may suffer from inability to have a climactic experience. 

SSRIs are also associated with some serious side effects, which may include:

• Allergic reaction associated with symptoms like redness of skin, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc. 
• Auditory or visual hallucinations 
• Nose bleeds
• Severe headache
• Arrhythmia or abnormal heartbeats
• Impaired memory and concentration 
• Convulsions 
• Swelling or tenderness in different parts of the body.

Serotonin-norepinephrine reuptake inhibitors (SNRIs) 

Wellbutrin can also be paired with SNRIs. These meds not only inhibit the reuptake of serotonin, but also inhibit the reuptake of norepinephrine by blocking their transporters, SERT and NET respectively. Several studies have indicated that this combination can be helpful. 

However, more research is still needed to determine the safety and efficacy of this combination. Some experts believe that Wellbutrin can help to overcome some of the side effects caused by SNRIs including sexual side effects. Examples of SNRIs include:

• Effexor (Venlafaxine) 
• Pristiq (Desvenlafaxine) 
• Ixel (Milnacipran) 
• Fetzima (levomilnacipran) 

SNRIs, just like every other medication, also cause some side effects. These include:

• Nausea
• Vomiting 
• Abdominal pain 
• Sleepiness or somnolence 
• Fatigue or excessive tiredness
• Muscular pain
• Joint pain 
• Nightmares 
• Insomnia or inability to fall asleep 
• Headaches 
• Loss of appetite 
• Weight loss
• Tremors
• Excessive sweating 
• Diarrhoea 
• Acid reflux 
• Tinnitus 
• Mydriasis
• Infections including sore throat, ear and eye infections etc. 
• Bad or metallic taste in mouth
• Loss of libido in both male and females. Males may suffer from inability to release, while females may suffer from inability to have a climactic experience. 

SNRIs are also associated with some serious side effects. These include:

• Allergic reactions associated with symptoms like redness of skin, hives, itching, burning sensation, blisters, blue-purple patches, tightness of chest, wheezing, difficulty in breathing, hoarseness etc. 
• Irregular heartbeat or arrhythmia 
• Convulsions 
• Chills and fever with confusion, hallucinations and inability to recognise one’s surroundings. 
• Impairment of motor coordination 
• Coma

Make sure you use this combination only if prescribed by your healthcare provider. It is strictly prohibited to start using any medication on your own. 

Short acting benzodiazepines

Short acting benzodiazepines can also be paired with Wellbutrin for the management of anxiety. However, the treatment with benzodiazepines can not be continued for a longer period of time because of the ability of these meds causing addiction. 

Make sure you only use this combination if prescribed by your healthcare provider. Benzodiazepines act on gamma aminobutyric acid (GABA), which is an inhibitory neurotransmitter. 

This results in decreased neuronal firing in your brain and controls the frequency of anxiety attacks. Short acting benzodiazepines include:

• Xanax (Alprazolam) 
• Ativan (Lorazepam) 
• Serax (Oxazepam) 
• Halcion (Triazolam) 

Benzodiazepines are not free from side effects. Some of these include:

• Dizziness
• Tiredness or fatigue 
• Drowsiness 
• Muscle pain
• Vision problems 
• Headache 
• Hypersomnia 
• Forgetfulness 
• Troubled or intrusive thoughts
• Impairment of motor coordination 
• Constipation or diarrhoea 
• Nausea 
• Vomiting 
• Increased or decreased appetite 

Serious side effects include:

• Allergic reaction associated with symptoms like redness of skin, itching, painful blisters, blue-purple patches, burning sensation etc. 
• Serious respiratory depression which lowers down breathing rate and can decrease the availability of oxygen in the blood. It could be life-threatening for people suffering from asthma or chronic obstructive pulmonary disease (COPD) 
• Dementia 
• Abnormal behaviour
• Blackouts 

Make sure you don’t start using any of the above mentioned combinations on your own. Drug interactions should be an important consideration before taking two or more medicines together. 

Yes, drugs in combination are often used to achieve better therapeutic response but this is not the case with every interaction. Some drugs are highly incompatible with one another. 

They often cancel out each other’s effects or antagonise them. Some drugs are so incompatible that they end up changing the entire chemical composition of one another. 

Some interfere with metabolism or bioavailability (the rate and extent at which the active drug moiety enters systemic circulation/blood). This can lead to drug accumulation in different parts of the body. 

It is always advised to inform your healthcare provider of any medicine you take before getting a new prescription. Your doctor will make sure not to prescribe any such drug which might interfere with those you are already taking. 

How to ensure the proper use of Wellbutrin? 

• Take as directed by your healthcare provider. Do not take more or less than the prescribed dose. 
• If you fail to understand how to use the drug properly or have any other question, ask your doctor or pharmacist.
• In case of overdose, immediately reach out to the hospital. Make sure you properly guide them about how much drug you have taken and when.
• If you have missed a dose and you’re way past the usual time at which you take your med, do not take it. It will cause you to overdose when you take your next dose, which is not too far away. It’s better to skip the missed dose and take the next one. If you remember your missed dose earlier, it’s safe for you to take it.
• Report any problems with bleeding or bruising to your doctor. If you see any unexplained blisters or rashes on your body, or experience any problems with urination, or if you feel changes in your vision, immediately report to your healthcare provider. 
• Ask your doctor before taking this medicine if you are pregnant, trying to conceive, or if you are a breastfeeding mother. 

Wellbutrin comes with a black-box warning issued by the Food and Drug Administration (FDA). This antidepressant is capable of causing abnormal and suicidal behavior in people less than 24 years of age. 

If you have someone who shows suicidal behavior or you see hopelessness in them, make sure you keep an eye on them and get medical attention as soon as you can. 

Conclusion 

In this blog post, we have discussed the meds that can be paired with Wellbutrin. By the end of this blog, we have learned that selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs) and short acting benzodiazepines can be paired with Wellbutrin.

However, these combinations should only be used if prescribed by your healthcare provider. You should not take more or less than what your doctor has recommended. 

We have also learned that all of these combinations possess a risk of side effects and they may not suit every other individual taking it. Report to your healthcare provider right away if you begin to exhibit any sign of an allergic reaction or any unusual side effect. 

FAQs: What to pair with Wellbutrin for anxiety

What is a good combination with Wellbutrin?

Wellbutrin can be paired with:

• Selective serotonin reuptake inhibitors (SSRIs). Examples include Lexapro, celexa etc. 
• Serotonin-norepinephrine reuptake inhibitors (SNRIs). Examples include Effexor, pristiq etc. 
• Short acting benzodiazepines. Examples include xanax, Ativan, halcion etc. 

Is Wellbutrin good for anxiety and panic attacks?

Wellbutrin is an atypical antidepressant in nature. It can also be used to reduce the frequency of panic and anxiety attacks. The exact mechanism of action of bupropion is still a topic of research. However, it increases the amount of norepinephrine and dopamine inside your brain and counteracts the symptoms associated with depression.

Can I take Wellbutrin and Zoloft together?

Yes, you can take Wellbutrin and zoloft together only if prescribed by your healthcare provider. However, benefits of this combination can only be achieved at low doses. As both of them are antidepressants, higher doses can cause significant complications. It can increase the risk of serotonin syndrome and can also cause mental confusion and hallucinations. 

Can you take Xanax with Wellbutrin?

Yes, you can take xanax with Wellbutrin, but only if this combination is recommended by your healthcare provider. The concomitant use may increase the risk of drowsiness, low mental alertness, impaired motor functions, confusion, forgetfulness etc, but these side effects depend on the doses you’re at. 

What drugs should not be taken with Wellbutrin?

• Monoaminoxidase inhibitors (MAOIs) 
• Pimozide 
• Non-steroidal anti-inflammatory drugs (NSAIDS) 
• Antipsychotics 
• Controlled substances 
• Alcohol 

Can you drink coffee on Wellbutrin?

You can drink coffee on Wellbutrin, but not too much. Excessive caffeine intake can make your side effects much worse, especially Wellbutrin induced anxiety and agitation. If caffeine is consumed in the evening or at nighttime, this can make Wellbutrin induced insomnia much worse. 

References 

• Sidney Zisook et al. Biol Psychiatry. (2006) – Use of bupropion in combination with serotonin reuptake inhibitors https://pubmed.ncbi.nlm.nih.gov/16165100/
• Chu A, Wadhwa R. (2015) – Selective serotonin reuptake inhibitors https://www.ncbi.nlm.nih.gov/books/NBK554406/#_NBK554406_pubdet_ 
• Stephen M Stahl et al. CNS Spectr. (2005) – SNRIs: their pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants https://pubmed.ncbi.nlm.nih.gov/16142213/#:~:text=Abstract,and%20norepinephrine%20with%20differing%20selectivity.
• M C O’Donovan et al. BMJ. (1993) – short acting benzodiazepines https://pubmed.ncbi.nlm.nih.gov/8098236/ 
• Bupropion (Wellbutrin XL, Wellbutrin SR) https://www.goodrx.com/bupropion/what-is
• Bupropion Hcl – Uses, Side Effects, and More https://www.webmd.com/drugs/2/drug-13507-155/bupropion-hcl-oral/bupropion-oral/details 
• National Library of Medicine – Bupropion https://medlineplus.gov/druginfo/meds/a695033.html