Wellbutrin vs. Lexapro: Which antidepressant is right for you?

Key Takeaways

Healthcare providers must consider several important factors before they can choose the right antidepressant for you. Learning more about how they differ helps you have more informed conversations with your provider, avoid troublesome side effects, and get more effective relief from your symptoms.

What are Wellbutrin and Lexapro?

Lexapro (escitalopram) is an antidepressant that falls in the category of selective serotonin reuptake inhibitors (SSRIs). Other SSRI antidepressants include sertraline (Zoloft), fluoxetine (Prozac), and citalopram (Celexa).

Lexapro is FDA-approved for:

• Treating major depressive disorder (MDD) in patients aged 12 and older
• Treating generalized anxiety disorder (GAD) in patients aged 7 and older

Wellbutrin (bupropion) is also an antidepressant. It is considered an atypical antidepressant. This means it does not fall into any common antidepressant drug families, like SSRIs, selective norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs).

Wellbutrin can be prescribed in two forms: a sustained-release oral tablet (Wellbutrin SR) and an extended-release oral tablet (Wellbutrin XL).

Wellbutrin is FDA-approved for:

• Treating major depressive disorder (MDD) in adults
• Preventing seasonal affective disorder (SAD) in adults (Wellbutrin XL only)

The sustained-release (SR) formulation of bupropion is also sold under the brand name Zyban. This FDA-approved medication is designed to help people quit smoking.

How do Wellbutrin and Lexapro work?

Wellbutrin and Lexapro work differently to relieve depression symptoms.

Wellbutrin increases the amount of norepinephrine and dopamine available to your brain. These two chemicals influence arousal, focus, and motivation.

Lexapro increases the amount of available serotonin in your brain. This chemical plays a role in mood regulation, anxiety-related behavior, stress responses, and sleep.

How long do Wellbutrin and Lexapro take to work?

Many people notice some changes to their symptoms within the first 2 weeks of starting antidepressants like Wellbutrin or Lexapro. However, most providers usually assess whether they are working for you after 6 to 8 weeks.

Several factors can affect your individual timeline and how well the medication works for you:

• Age: Young adults aged between 21 and 35 often respond faster to antidepressants than adolescents or older adults, who may take longer to feel the full benefits of treatment.
• Early change: Some people notice their symptoms improving earlier when taking Lexapro, at around week 2. Studies show these people may be more likely to notice meaningful improvements to their symptoms or report very few symptoms overall (remission) by 8 weeks.
• Baseline depression: Some studies show patients with more severe baseline depression took longer to reach remission. Research also shows patients who had untreated depression for a longer time before starting treatment also had lower remission rates.
• Treatment plan: Antidepressants often work better when paired with psychotherapy. In one study, older adults who were treated for depression with Lexapro and cognitive-behavioral therapy (CBT) had lower depression scores and fewer side effects than those being treated with Lexapro alone.

If you aren’t feeling any better after 6 to 8 weeks, your provider may consider increasing your dose or switching your medication.

What are the differences between Wellbutrin and Lexapro?

Wellbutrin and Lexapro have different side effect profiles and may help with different symptoms.

Sexual side effects

Sexual side effects are much less common with Wellbutrin than with SSRIs like Lexapro. In one clinical trial, 30% of patients taking Lexapro reported orgasm dysfunction at week 8, compared to 15% of those taking Wellbutrin XL.

However, research shows that approximately 9% of people taking a placebo experienced sexual dysfunction, compared to 15% taking Lexapro—meaning the medication itself accounted for only a 6% increase above baseline.

For men, side effects can include erectile dysfunction, delayed ejaculation, or inability to ejaculate. For women, they commonly involve delayed orgasm or inability to reach orgasm.

Talk to your provider if you’re concerned about troublesome sexual side effects of Lexapro or another SSRI antidepressant. Wellbutrin can be an effective alternative antidepressant for many people, with fewer sexual side effects than SSRIs.

Weight effects

Wellbutrin can have appetite-suppressing effects, and is sometimes associated with modest weight loss. The active ingredient, bupropion, is part of the weight loss medication Contrave. Lexapro, however, may lead to modest weight gain over time.

One large study of nearly 200,000 patients compared the risk of a patient gaining at least 5% of their body weight when taking common antidepressants.

Over a 6-month period, compared to patients taking Zoloft (the most commonly prescribed SSRI):

• Patients on Lexapro had a 15% higher risk of this weight gain.
• Patients on Wellbutrin had a 15% lower risk of this weight gain.

Neither medication has FDA approval as a weight loss medication, and weight gain or loss is not guaranteed. Your provider can give you personalized advice if you’re concerned about how either drug might affect your weight.

Effectiveness for anxiety symptoms

Many patients have GAD and MDD together. Lexapro is FDA-approved to treat both, so providers often prescribe it to treat both conditions.

Wellbutrin may still relieve anxiety symptoms in depressed patients, but there is stronger research behind SSRIs like Lexapro for treating anxiety.

Energy and motivation

Wellbutrin and Lexapro can have noticeably different effects on your energy. Wellbutrin can often reduce sleepiness and fatigue. Lexapro tends to have a calming, settling effect that reduces anxiety but can also cause drowsiness and fatigue.

Trouble sleeping is one of the most common side effects of Wellbutrin, so you should avoid taking it too close to bedtime. Get medical help right away if you experience new, sudden insomnia. This can be a serious warning sign of worsening depression, suicidal thoughts and behaviors, or manic episodes.

Serious side effects

Both medications can cause severe side effects.

More rare but serious side effects of Wellbutrin include:

• Increased risk of seizures
• High blood pressure (hypertension)
• Severe hypersensitivity reactions
• Psychosis and other neuropsychiatric reactions

Rare but serious side effects of Lexapro include:

• Low blood sodium levels (hyponatremia)
• Serotonin syndrome
• Discontinuation syndrome, or withdrawal symptoms

Lexapro and Wellbutrin share some serious side effects:

• Manic activation (sudden shifts into abnormally high energy, reckless behavior, or racing thoughts)
• Angle-closure glaucoma (a sudden medical emergency caused by intense buildup of fluid pressure in the eye)

Get medical help immediately if you notice any of these symptoms.

Both Lexapro and Wellbutrin carry an FDA Boxed Warning. They increase the risk of suicidal thinking and behavior in children, adolescents, and young adults up to 24 years of age while starting treatment.

Dosing

Lexapro and generic escitalopram oral tablets are available as 5 mg, 10 mg, and 20 mg strengths, taken once daily. Generic escitalopram is also available as a liquid oral solution, which can be easier to swallow.

Because of its seizure risk, Wellbutrin must be started at lower doses and increased gradually. It is available in different release formats to control peak blood levels. Wellbutrin SR and generic bupropion SR oral tablets are available in 100 mg, 150 mg, and 200 mg strengths. They are typically taken twice a day. Wellbutrin XL and generic bupropion XL are available in 150 mg and 300 mg strengths, taken once daily.

What do Wellbutrin and Lexapro have in common?

Lexapro and Wellbutrin share several important characteristics. Both drugs:

• Are first-line treatments for MDD: Lexapro and Wellbutrin are widely prescribed, effective treatments for major depressive disorder. In clinical trials, patients taking either drug showed similar symptom remission rates at week 8.
• Require medical supervision when stopping: Suddenly stopping either drug carries risks, including the return of depression symptoms. Your provider will recommend how you can safely and gradually reduce your dosage over 2 to 4 weeks.
• Carry extra risks for certain patient groups: For example, both drugs carry higher risks for patients with liver disease. They have mandatory maximum dosage caps. Careful dosing is also required for patients aged 60 years and older. Taking either drug can suddenly trigger a severe psychiatric emergency for patients with bipolar disorder. This is why providers must screen for a personal or family history of the condition before prescribing them.
• Drug interactions: Lexapro and Wellbutrin can also interact with other drugs, which can cause side effects or affect how they work. Neither drug should be taken with alcohol, certain antiseizure medications, or monoamine oxidase inhibitors (MAOIs).

These are not all the drugs that can interact with Lexapro and Wellbutrin. Always share a full list of medications and supplements you are taking with your provider before you start taking either medication.

Which medication is better for depression?

Clinical studies show that Lexapro and Wellbutrin are equally effective medications for treating depression. Neither relieves depression symptoms significantly faster than the other.

Your provider will choose by looking at your symptom profile, medical history, and the possible side effects of each.

• Wellbutrin may be a better fit for treating symptoms like low energy, excessive sleeping (hypersomnia), difficulty concentrating, impulsive behaviors, and lack of drive to do things you used to enjoy.
• Lexapro can be more effective if your depression is linked to constant worry, racing thoughts, overwhelming negative emotions, or high anxiety.
• Wellbutrin may be less suitable if you are concerned about worsening insomnia, anxiety, or tremors. It is not appropriate if you have a history of seizures or eating disorders.
• Lexapro may be less suitable if you are concerned about weight gain or GI side effects. It can also cause significantly more sexual side effects than Wellbutrin.

Frequently asked questions

Can you take Wellbutrin and Lexapro together?

Yes, Wellbutrin and Lexapro can be taken together, if prescribed by your healthcare provider. Depression studies show that patients taking both did not experience more troublesome side effects than patients taking just one antidepressant.

However, large clinical trials show that combining Wellbutrin and Lexapro specifically does not treat depression any faster or more effectively than taking one antidepressant alone.

Is it safe to switch from Lexapro to Wellbutrin?

Yes, switching from Lexapro to Wellbutrin or the other way around is usually safe if recommended and monitored by your healthcare provider. They can manage any possible withdrawal risks. This is usually done by gradually reducing your dose of Lexapro. They will then prescribe you a lower starting dose of Wellbutrin and then gradually increase it.

Does Wellbutrin work better than Lexapro?

According to studies, Wellbutrin and Lexapro are equally effective treatments for depression, but one can be a better fit for your specific symptoms. Wellbutrin may be more suitable if your symptoms include lack of energy, focus, or excessive sleeping. It can also be the better option if you’re concerned about sexual side effects while taking Lexapro. Lexapro may fit better if your depression symptoms are linked to anxiety or constant worry.

A provider can assess your medical history, symptom profile, and preferences to recommend the safest and most appropriate antidepressant for you.

Find the right antidepressant with a Sesame provider

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