Can Bupropion Worsen Anxiety? An In-Depth Look

October 11, 2025 •

3 min read

In clinical studies, antidepressants have been shown to sometimes temporarily increase anxiety, especially in the early stages of treatment. The question, "Can bupropion worsen anxiety?", is important because its unique stimulating mechanism can affect individuals differently than other antidepressants. This guide explores why some people experience heightened anxiety on bupropion, identifying risk factors and management strategies.

Quick Summary

Bupropion's stimulating effect, caused by increased norepinephrine and dopamine, can worsen anxiety in some people, especially those with pre-existing anxiety disorders. Recent studies, however, indicate it may not worsen anxiety more than SSRIs in comparable patient populations.

Key Points

Stimulating Mechanism: Bupropion increases the brain's levels of norepinephrine and dopamine, which can cause stimulating effects and increase anxiety in some individuals.
Not for Everyone: People with pre-existing anxiety or panic disorders, or those sensitive to stimulants, are at a higher risk of experiencing heightened anxiety on bupropion.
Dosage Matters: Higher doses or the immediate-release (IR) formulation are more likely to cause anxiety compared to lower doses or the extended-release (XL) version.
Mixed Clinical Evidence: While older studies showed SSRIs might have an edge for anxious depression, newer research suggests bupropion may not increase anxiety more than SSRIs in comparable patient groups.
Withdrawal Risk: Abruptly stopping bupropion can trigger withdrawal symptoms, including anxiety. A gradual taper is necessary under a doctor's supervision.
Individualized Approach: The decision to use bupropion should be based on a patient's full medical history and specific symptom profile, in close consultation with a healthcare provider.
Complementary Strategies: Non-medication approaches like Cognitive Behavioral Therapy (CBT) and lifestyle changes can help manage anxiety in combination with bupropion.

The Stimulating Mechanism Behind Bupropion

Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) that increases levels of norepinephrine and dopamine in the brain. This can improve mood, motivation, and energy but may also cause a stimulating effect that increases agitation, restlessness, and anxiety in some individuals, particularly at higher doses or with immediate-release formulations. Unlike SSRIs, bupropion has minimal effect on serotonin, a neurotransmitter linked to calming effects.

Why Bupropion Affects Anxiety Differently

Individual responses to bupropion vary. While some people see anxiety improve, others experience worsening symptoms. Several factors can increase the risk of anxiety:

Factors That Increase the Risk of Anxiety

Pre-existing Anxiety or Panic Disorders: Individuals with a history of these conditions may see their symptoms exacerbated by bupropion's stimulating effects.
Dosage and Formulation: Higher doses and immediate-release versions are more likely to cause anxiety.
Sensitivity to Stimulants: People sensitive to stimulants like caffeine may react similarly to bupropion.
Comorbid Conditions: Bupropion is contraindicated in those with seizure disorders or anorexia/bulimia. It can also increase blood pressure.

Clinical Evidence on Bupropion and Anxiety

Research on bupropion and anxiety is evolving. An older meta-analysis suggested SSRIs might be better for anxious depression. However, a more recent 2023 study found no significant difference in anxiety outcomes between comparable patients taking bupropion versus SSRIs. This newer research suggests bupropion may not increase anxiety more than other antidepressants for patients who tolerate it.

Comparison: Bupropion vs. SSRIs for Anxious Patients


Feature	Bupropion (NDRI)	SSRIs (e.g., Zoloft, Prozac)
Mechanism of Action	Inhibits reuptake of norepinephrine and dopamine.	Inhibits reuptake of serotonin.
Primary Target	Motivation, energy, mood.	Mood, fear, compulsive behaviors.
Potential for Stimulation	Can be stimulating or activating for some individuals.	Typically calming; less likely to cause jitters.
Typical First-Line Status for Anxiety	Not typically first-line; used off-label for anxiety, especially with comorbid depression and low energy.	Often a first-line treatment for many anxiety disorders.
Sexual Side Effects	Lower likelihood of causing sexual dysfunction.	Higher likelihood of causing sexual dysfunction.
Other Side Effects (Anxiety-Related)	Insomnia, restlessness, agitation, fast heartbeat.	Initial anxiety, sleep disturbances, nausea.

Managing Bupropion-Induced Anxiety

If anxiety increases on bupropion, consult your healthcare provider. Strategies may include dose adjustment, changing dosage timing, or adding another medication like an SSRI. Combining medication with therapy like CBT and lifestyle changes can also help manage anxiety.

The Risk of Anxiety During Bupropion Withdrawal

Stopping bupropion abruptly can cause withdrawal symptoms, including increased anxiety and irritability. A gradual tapering schedule supervised by a doctor is essential to minimize these effects.

Conclusion: A Personalized Treatment Approach

While bupropion can worsen anxiety in some, it's not a universal experience and is often manageable. Its suitability depends on individual factors and medical history. Open communication with your doctor is crucial to determine if bupropion is the right treatment and to manage any anxiety concerns.

Actionable steps if you experience increased anxiety on bupropion

Monitor your symptoms: Keep a log of anxiety levels and side effects.
Communicate with your doctor: Inform them of any increased anxiety.
Consider dose timing: Discuss taking medication earlier in the day.
Incorporate coping mechanisms: Use stress reduction techniques.
Do not stop abruptly: Always follow a doctor's tapering schedule.

Frequently Asked Questions

Bupropion can cause anxiety in some people due to its stimulating effects. As a norepinephrine-dopamine reuptake inhibitor (NDRI), it increases levels of these activating neurotransmitters, which can lead to heightened agitation, restlessness, and anxiety in susceptible individuals.

Yes, it is possible to experience a temporary increase in anxiety, agitation, or restlessness when first starting bupropion. These symptoms often subside within the first few weeks as your body adjusts to the medication.

Key risk factors include having a pre-existing anxiety disorder or panic disorder, being sensitive to stimulants, and taking higher doses or immediate-release formulations of the medication.

Bupropion works differently by targeting norepinephrine and dopamine, while SSRIs primarily target serotonin. Some older research showed a modest advantage for SSRIs in treating anxious depression, but recent studies suggest bupropion and SSRIs may produce similar reductions in anxiety symptoms over time in comparable patient groups.

You should contact your healthcare provider if bupropion increases your anxiety. They may suggest strategies such as adjusting the dosage, changing the timing of your dose, or switching to an alternative medication.

No, you should not stop taking bupropion abruptly without medical supervision, as this can lead to withdrawal symptoms, including anxiety, irritability, and mood changes. Any changes to your medication regimen should be made in consultation with your doctor, who can guide you through a safe tapering process.

Although not FDA-approved for anxiety disorders, bupropion is sometimes prescribed off-label for anxiety, particularly in cases of co-occurring depression with fatigue or when patients cannot tolerate the sexual side effects of SSRIs.