Lexapro vs. Wellbutrin: Differences between Side Effects and Uses

  • Medical Reviewer: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Lexapro and Wellbutrin comparison of differences

What is Lexapro? What is Wellbutrin? How do they work?

Lexapro (escitalopram) is an oral drug that is used for treating depression and generalized anxiety disorder. Lexapro belongs to a class of antidepressant drugs called serotonin reuptke inhibitors (SSRIs). Lexapro prevents the reuptake of serotonin (a neurotransmitter) which results in more serotonin in the brain to attach to nerve receptors.

Drugs in the SSRI class also are used for treating obsessive compulsive disorders and panic disorders, although Lexapro is not approved for these purposes. Other SSRI antidepressants include fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft).

Wellbutrin (bupropion) is an antidepressant that also affects neurotransmitters. Wellbutrin works by inhibiting the reuptake of the neurotransmitters dopamine, serotonin, and norepinephrine, which results in more dopamine, serotonin, and norepinephrine to transmit messages to other nerves. Wellbutrin is unlike other antidepressants in that its major effect is on dopamine, an effect that is not shared by selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) uses

What are the uses for Lexapro vs. Wellbutrin?

Lexapro uses

Wellbutrin uses

What are the side effects of Lexapro vs. Wellbutrin?

Lexapro side effects

WARNING

Some patients experience withdrawal reactions upon stopping SSRI therapy. Symptoms may include

In order to avoid these symptoms, the dose of SSRI can be slowly reduced instead of abruptly stopped.

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Lexapro or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults beyond 24 years of age. There was a reduction in risk of suicidality with antidepressants compared with placebo in adults 65 years of age and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients who are started on therapy with antidepressants should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.

Common side effects of Lexapro

Common side effects associated with Lexapro include

Other side effects include influenza-like symptoms and pain in neck or shoulders.

Although changes in sexual desire, sexual performance, and sexual satisfaction often occur as a result of depression itself, they also may be a consequence of the drugs used to treat depression. In particular, about one in 11 men given Lexapro report difficulties ejaculating.

Possible serious side effects of Lexapro include:

Wellbutrin side effects

WARNING

Four of every 1000 persons who receive bupropion in doses less than 450 mg/day experience seizures. When doses exceed 450 mg/day, the risk increases ten-fold. Other risk factors for seizures include past injury to the head and medications that can lower the threshold for seizures. (See drug interactions.)

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of bupropion or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.

The most common side effects associated with bupropion include:

In some people, the agitation or insomnia is most marked shortly after starting therapy.

Less common side effects include:

More serious side effects include:

What are the dosage instructions for Lexapro vs. Wellbutrin?

Lexapro drug interactions

  • The usual starting dose of Lexapro for treating depression in adults or adolescents is 10 mg once daily in the morning or evening. The dose may be increased to 20 mg once daily after 1 week.
  • Benefit may not be seen until treatment has been given for up to 4 weeks. A daily dose of 20 mg may not be more effective than 10 mg daily for treatment of depression.
  • The dose for treating generalized anxiety disorder is 10 mg once daily.
  • Lexapro can be taken with or without food.

Wellbutrin dosage instructions

  • Bupropion immediate release tablets are usually is given in one, two or three daily doses. For immediate-release tablets, no single dose should exceed 150 mg and each dose should be separated by 6 hours.
  • For depression, the recommended dose of immediate-release tablets is 100 mg 3 times daily (300 mg/day) maximum dose is 450 mg daily. The initial dose is 100 mg twice daily. The dose may be increased to 100 mg 3 times daily after three days and 150 mg 3 times daily after several weeks if the response is not adequate. .
  • The initial dose of sustained-release tablets is 150 mg daily; target dose is 150 mg twice daily; maximum dose is 200 mg twice daily.
  • The initial dose of extended-release tablets is 150 mg daily; target dose is 300 mg daily; maximum dose is 450 mg daily. Alternatively initiate at 174 mg daily and increase to 348 mg daily after 4 days and up to a maximum dose of 522 mg daily after 4 weeks. Extended release tablets are administered once daily.
  • When used for smoking cessation, bupropion (Zyban) usually is started as 150 mg once daily for three days, and then the dose is increased to 150 mg twice daily for 7 to 12 weeks if the patient tolerates the starting dose.
  • Smoking is discontinued two weeks after starting bupropion therapy.
  • The dose for seasonal affective disorder is 150 mg once daily. Wellbutrin SR is given as two daily doses. Wellbutrin XL is given as one dose daily, up to 300 mg daily using extended release tablets. Alternatively treatment may be started with 174 mg daily and increased to a target dose of 348 mg day. Start treatment in the autumn prior to onset of seasonal depressive symptoms, and continue through the winter season.

What are the drug interactions of Lexapro vs. Wellbutrin?

Lexapro drug interactions

  • All SSRIs, including Lexapro, should not be combined with drugs in the monoamine oxidase (MAO) inhibitor class of antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl) and procarbazine (Matulane) or other drugs that inhibit monoamine oxidase such as linezolid (Zyvox) and intravenous methylene blue. Such combinations may lead to confusion, high blood pressure, high fevers, tremor or muscle rigidity, and increased activity. At least 14 days should elapse after discontinuing Lexapro before starting an MAO inhibitor. Conversely, at least 14 days should elapse after discontinuing an MAO inhibitor before starting Lexapro.
  • Similar reactions occur when SSRIs are combined with other drugs that increase serotonin in the brain, for example tryptophan, St. John's wort, meperidine (Demerol), lithium (Lithobid, Eskalith), triptans (for example, sumatriptan [Imitrex, Alsuma]), and tramadol (Ultram)
  • Use of selective serotonin inhibitors may increase the risk of gastrointestinal bleeding in patients taking warfarin (Jantoven, Coumadin), aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and other drugs that cause bleeding.

Wellbutrin drug interactions

  • Bupropion should be used cautiously in patients receiving drugs that reduce the threshold for seizures. Such drugs include prochlorperazine (Compazine), chlorpromazine (Thorazine), and other antipsychotic medications of the phenothiazine class. Additionally, persons who are withdrawing from benzodiazepines [for example, diazepam (Valium), alprazolam (Xanax)] are at increased risk for seizures.
  • Carbamazepine (Tegretol) may reduce the effect of bupropion by reducing the blood concentration of bupropion. Monamine oxidase inhibitors should not be combined with bupropion because of the risk of severe reactions. At least 14 days should elapse between discontinuation of an MAOI and initiation of bupropion. Bupropion may affect the action of warfarin (Coumadin).
  • Ritonavir (Norvir) may increase the breakdown and elimination of bupropion. In some studies ritonavir reduced the concentration of bupropion in the body by 22% to 66%.

Are Lexapro and Wellbutrin safe to take if I am pregnant or breastfeeding?

Lexapro safety

  • The safety of Lexapro during pregnancy and breastfeeding has not been established. Therefore, Lexapro should not be used during pregnancy unless, in the opinion of the physician, the expected benefits to a patient outweigh unknown hazards to the fetus.
  • Lexapro is excreted in human milk. Lexapro should not be given to nursing mothers unless, in the opinion of the physician, the expected benefits to the patient outweigh the possible hazards to the child.

Wellbutrin safety

  • There are no adequate studies of bupropion in pregnant women. In one study, there was no difference between bupropion and other antidepressants in the occurrence of birth defects. Bupropion should only be used in pregnancy if the benefit outweighs the potential risk.
  • Bupropion is secreted in breast milk.

Summary

Lexapro (escitalopram) and Wellbutrin (bupropion) are drugs used to major depression and general anxiety disorder (GAD). Lexapro belongs to the selective serotonin reuptake inhibitor (SSRI) antidepressant drug class, and Wellbutrin belongs to the aminoketone drug class. Lexapro and Wellbutrin do not have the same mechanism of action, but they have similar side effects, for example, nausea, headache, dry mouth, insomnia, agitation, shaking, and restlessness.

Lexapro also may cause side effects like diarrhea, blurred vision, drowsiness, sexual difficulties, weight changes, indigestion and blurred vision. Wellbutrin also may cause side effects like constipation.

Off-label (non-FDA approved) uses for Wellbutrin include attention deficit hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD), social phobia, and neuropathic pain (nerve pain), and smoking cessation. Dosage for Lexapro and Wellbutrin depend upon the condition being treated. Lexapro and Wellbutrin have important drug interactions, and is not recommended during pregnancy or while breastfeeding.

In addition to Wellbutrin, other brand names for bupropion include Wellbutrin SR, Wellbutrin XL, Zyban, Aplenzin, Fortivo XL, and Zyban

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Medically Reviewed on 11/2/2017
References
REFERENCE: FDA Prescribing Information.
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