Wellbutrin vs. Lexapro: What to Know

Antidepressant medications are commonly used to treat depression and other mental health conditions, such as anxiety disorder or major depressive disorder (MDD).

Used for the treatment of depression and anxiety, two popular antidepressant options include the orally administered, brand-name Wellbutrin (bupropion) and Lexapro (escitalopram).

Although both have similar uses, Wellbutrin and Lexapro have key differences, such as discrepancies in how they work on a pharmacological level and who can safely take each drug.

Keep reading to learn more about Wellbutrin vs. Lexapro and their similarities and differences, including information on their respective uses, potential side effects, storage requirements, and more.

What Is Wellbutrin? How Does It Work?

Wellbutrin, containing the active ingredient bupropion, is an antidepressant medication. Bupropion belongs to a class of antidepressants known as norepinephrine-dopamine reuptake inhibitors (NDRIs).

Norepinephrine and dopamine are brain chemicals that regulate and boost mood, among many other functions.

It’s thought that bupropion works by blocking the receptors that absorb dopamine and norepinephrine, making more of these brain chemicals available.

Bupropion, branded as Wellbutrin, is approved to treat MDD, commonly known as depression, in adults (people 18 and older). It is also available in longer-acting formulations, as follows:

• Wellbutrin SR (sustained-release) works for about 12 hours, and Wellbutrin XL (extended-release) works for about 24 hours).
• Wellbutrin XL is also Food and Drug Administration (FDA)–approved for the prevention of seasonal affective disorder (SAD), a type of depression related to changes in seasons in adults.

Wellbutrin has off-label uses (those not approved by the FDA) as well, such as for:

• Attention deficit hyperactivity disorder (ADHD)
• Antidepressant-induced sexual dysfunction
• Depression in adolescents or children
• Depressive episodes related to bipolar disorder
• Weight loss
  

What Is Lexapro? How Does It Work?

Lexapro, containing the active ingredient escitalopram, is an antidepressant medication. Lexapro is FDA-approved for treating MDD in adults and children 12 and older.

Lexapro is also approved for treating generalized anxiety disorder, or GAD (chronic, excessive worrying that you can't control), in adults and children 7 and older.

Lexapro can also be used off-label for SAD, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and to reduce symptoms of menopause.

Lexapro and Wellbutrin are both antidepressants, but they work in different ways. Lexapro belongs to a drug class known as selective serotonin reuptake inhibitors (SSRIs).

Serotonin is a chemical messenger in your body that regulates mood, sleep, and memory, among other functions.

Lexapro is thought to work by blocking your brain from reabsorbing serotonin after its release. This increases the availability of serotonin for your body to use.

Wellbutrin vs. Lexapro: How to Take Them

Wellbutrin (bupropion) and Lexapro (escitalopram) come as orally administered tablets. However, escitalopram also comes as an oral solution (liquid).

The table below summarizes the dosage forms, strengths, and typical dosing guidelines for Wellbutrin vs. Lexapro. Note, however, that it does not include all possible doses of Wellbutrin and Lexapro.

Your healthcare provider may instruct you to take your medication differently or for an off-label use not listed above.

Note that the same medicine in name-brand Lexapro, Wellbutrin SR, and Wellbutrin XL is also sold in generic versions.

Wellbutrin immediate-release is no longer made, but the generic version is still available.

If you wish to stop either drug, a tapering schedule is required. Your provider will instruct you on reducing your dose over time before stopping it. This helps to relieve uncomfortable withdrawal symptoms.

Here are a few tips to keep in mind when comparing how to take Wellbutrin vs. Lexapro:

• Best time of day: Take Lexapro in the morning or evening. Wellbutrin XL should be taken in the morning. Wellbutrin SR and immediate-release bupropion are typically taken twice daily, in the morning, afternoon, or evening. However, evening doses should not be taken too close to bedtime since they can cause insomnia. It is often suggested that the second dose of Wellbutrin SR be taken at least eight hours after the first one.
• Food: Either drug may be taken with or without food.
• Alcohol: Alcohol use is not recommended with either drug.
• Do not crush: You should not crush, chew, or split any form of bupropion. Lexapro 10 mg and 20 mg tablets can be crushed or broken. Escitalopram also comes in an oral solution that may be a better option for children or people with trouble swallowing pills.

Which Is More Effective?

In separate clinical trials, Wellbutrin and Lexapro were more effective than a placebo (a treatment containing no medication) for treating depression. Remember, though, it may take two weeks for either drug to start working.

There are not many studies directly comparing Wellbutrin to Lexapro. One head-to-head study, however, compared the effectiveness of Wellbutrin XL vs. Lexapro for treating depression in nearly 800 people.

The results demonstrated that both medications were similarly effective in improving depressive symptoms. However, individuals treated with Wellbutrin experienced less sexual side effects.

Side Effects and Safety

As with other antidepressants, Wellbutrin and Lexapro carry a boxed warning. A boxed warning appears prominently on a drug’s labeling to alert patients of a severe risk or side effect.

Wellbutrin and Lexapro may cause similar side effects, though some are unique.

Common Side Effects

 The following side effects are common for both Wellbutrin and Lexapro:

• Nausea
• Dry mouth
• Sweating
• Diarrhea
• Constipation
• Tiredness
• Decreased appetite

In addition, Wellbutrin can cause:

• Vomiting
• Muscle Weakness
• Fatigue
• Dizziness
• Agitation
• Headache
• Weight loss

Lexapro can cause:

• Indigestion
• Heartburn
• Insomnia
• Sexual side effects, such as erectile dysfunction (ED), ejaculation problems, or anorgasmia (trouble reaching orgasm)

Severe Side Effects

Rarer, more serious side effects of both medications include allergic reactions. Both drugs also carry a risk of suicidal thoughts and behaviors.

Lexapro may rarely cause serotonin syndrome, a condition caused by too much serotonin in the body. Symptoms can range from mild to life-threatening and include sweating, fever, tachycardia (rapid heartbeat), hallucinations, confusion, or rigid muscles.

Talk to your healthcare provider if you are experiencing an undesirable side effect, and seek medical attention immediately if it seems severe or if you have a medical emergency.

Potential Interactions

Bupropion and escitalopram do not interact with each other, though they work similarly and produce similar side effects.

It is possible for a healthcare provider to prescribe Wellbutrin and Lexapro together, but it isn’t a common practice.

Both antidepressants can interact with other medicines. Tell your pharmacist and healthcare provider about everything you take, including medications, supplements, and over-the-counter (OTC) drugs.

Some drugs that may interact with bupropion are:

• Anti-platelet drugs, such as Plavix (clopidogrel)
• Certain antiviral drugs, such as Norvir (ritonavir) or Kaletra (lopinavir)
• Some seizure medications, such as Tegretol (carbamazepine), Sezaby (phenobarbital), or Dilantin (phenytoin)
• Monoamine oxidase inhibitors (MAOIs), such as Marplan (isocarboxazid)

Drugs that can interact with Lexapro include:

• Other SSRIs, such as Prozac (fluoxetine) or Zoloft (sertraline)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as Effexor XR (venlafaxine) or Cymbalta (duloxetine)
• MAOIs, including Nardil (phenelzine)
• Blood thinners, such as Jantoven (warfarin)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin (ibuprofen), Celebrex (celecoxib), or Naprosyn (naproxen)

This is not a complete list; other medications can interact with Wellbutrin or Lexapro.

Tell your healthcare provider about all medicines you currently take to help avoid unsafe drug combinations.

When to Avoid Wellbutrin or Lexapro

As antidepressants, Wellbutrin and Lexapro carry a boxed warning that alerts users to the possibility of severe risks or side effects.

All antidepressants have a boxed warning due to an increased risk of suicidal thoughts and behaviors in children and adults under the age of 24. In general, untreated depression can also increase these risks.

An FDA meta-analysis of 372 studies showed a significant risk of suicidal thinking and behavior among children and adolescents under age 18 taking antidepressants compared to peers taking a placebo.

This risk is highest when treatment is first started or after the dosage is increased. Your healthcare provider (or your child’s) will monitor for signs of suicidal thoughts or behaviors.

Tell your healthcare provider immediately if you notice any concerning changes in behavior. Remember that Wellbutrin is not FDA-approved for use in people younger than 18.

Wellbutrin and Lexapro carry other risks. For example, either drug may increase seizure risk, especially in people prone to seizures.

In addition, Wellbutrin is not recommended for use in people who’ve had an eating disorder.

While both medications have risks, determining which is safer than the other will depend on your individual medical history and conditions. A healthcare provider can review all the risks before starting you on Lexapro or Wellbutrin. They’ll help you weigh the possible risks vs. benefits. 

Summary

Wellbutrin (bupropion) and Lexapro (escitalopram) are antidepressant medications. Both are commonly prescribed to treat depression. Bupropion prevents SAD, while escitalopram is often used to treat GAD.

Another way they differ is that Wellbutrin is not approved for use in children or adolescents, while Lexapro is.

While both medications are typically safe if taken properly, several serious side effects are rare but possible. Talk to a healthcare provider to see if one of these medications might be right for you.