What are the 'jitters' and why does Wellbutrin cause them?
The term "jitters" can describe a combination of physical and mental symptoms, including tremors or shaking, nervousness, anxiety, restlessness, and a fast heartbeat. Wellbutrin, the brand name for bupropion, works differently than more common antidepressants like SSRIs (Selective Serotonin Reuptake Inhibitors). Instead of affecting serotonin, Wellbutrin is a norepinephrine-dopamine reuptake inhibitor (NDRI). This means it increases the levels of the neurotransmitters norepinephrine and dopamine in the brain by blocking their reabsorption.
This mechanism has a stimulating effect on the central nervous system, which is beneficial for improving mood, energy, and concentration but can also trigger anxiety-like symptoms and physical shaking. The emergence of these stimulating side effects is particularly common when initiating treatment or increasing the dosage, as the body adjusts to the new levels of neurotransmitters. For most people, these initial jitters and other related symptoms tend to subside within the first few weeks.
Common stimulating side effects of Wellbutrin
Beyond just the jitters, the stimulating effect of bupropion can manifest in several ways. While not everyone experiences them, and they are usually mild, it is important to be aware of the possibilities:
- Tremors and shaking: A fine shaking of the hands or other body parts is a well-documented side effect. This is more common with immediate-release (IR) formulations than sustained-release (SR) or extended-release (XL) versions.
- Restlessness and anxiety: Feelings of agitation, restlessness, and increased anxiety are common, particularly in the beginning stages of treatment.
- Insomnia: Because of its stimulating nature, Wellbutrin can cause trouble sleeping. Taking the dose earlier in the day is a common strategy to mitigate this.
- Increased heart rate and palpitations: Some people may notice their heart beating faster or an irregular heartbeat.
- Increased sweating: Excessive sweating is another frequently reported side effect.
Factors that can increase the risk of jitters
Certain factors can make a person more susceptible to the stimulating side effects of Wellbutrin:
- Dosage: Higher doses are associated with a higher risk of side effects, including tremors and seizures. Dosages are typically started low and increased gradually to minimize this risk.
- Formulation: The immediate-release (IR) version of bupropion is known to cause more pronounced peak concentrations in the bloodstream, which can increase the likelihood of jitters compared to the smoother release of the SR and XL versions.
- Drug interactions: Combining Wellbutrin with other medications that affect the central nervous system, such as stimulants or certain other antidepressants, can increase the risk of jitters and other CNS side effects.
- Lifestyle factors: Consuming caffeine and alcohol can worsen the stimulating effects. Excessive alcohol use, especially abrupt discontinuation while on Wellbutrin, also increases the risk of seizures.
Comparison of Wellbutrin and SSRIs Regarding Jitters
| Feature | Wellbutrin (Bupropion) | SSRIs (e.g., Zoloft, Prozac) |
|---|---|---|
| Mechanism of Action | Norepinephrine-Dopamine Reuptake Inhibitor (NDRI), which has a stimulating effect. | Selective Serotonin Reuptake Inhibitor, which primarily increases serotonin. |
| Tendency to Cause Jitters | Yes, commonly causes jitters, tremors, and restlessness due to its stimulating effects. | Less likely to cause jitters. Some people may experience initial anxiety, but it's not a characteristic side effect in the same way. |
| Energy Levels | Often increases energy and motivation. | Can sometimes cause fatigue or sedation, though stimulating effects are possible. |
| Sexual Side Effects | Associated with a lower incidence of sexual side effects compared to SSRIs. | Higher risk of sexual dysfunction, such as decreased libido and difficulty achieving orgasm. |
| Weight Changes | More commonly associated with weight loss. | May cause weight gain in some individuals. |
How to manage jitters caused by Wellbutrin
If you experience bothersome jitters or other stimulating side effects from Wellbutrin, it is crucial to consult your healthcare provider rather than stopping the medication abruptly. A provider may recommend one or more of the following strategies:
- Adjust the dosage: The dose may need to be lowered, especially if it was increased too quickly.
- Switch formulations: Changing from an immediate-release to a sustained-release or extended-release version can help smooth out peak drug concentrations and reduce side effects.
- Change the timing: Taking the medication earlier in the day can help minimize insomnia and restlessness at night.
- Limit stimulants: Reducing or avoiding caffeine and alcohol can help reduce jitters.
- Incorporate lifestyle adjustments: Regular exercise, maintaining good sleep hygiene, and practicing relaxation techniques like meditation or deep breathing can help soothe the nervous system.
- Discuss alternative medications: If the side effects are persistent and severe, your doctor may suggest alternative antidepressants or adding an additional medication to help manage the anxiety.
Conclusion
Yes, Wellbutrin (bupropion) can cause jitters, tremors, and increased anxiety due to its stimulating effect on norepinephrine and dopamine. These side effects are often temporary and tend to resolve within the first few weeks of starting or adjusting the medication. However, if the symptoms are severe or persistent, it is essential to contact your healthcare provider. Never stop taking the medication abruptly without consulting a doctor, as discontinuation can also cause unpleasant side effects. By working with a medical professional and incorporating lifestyle changes, many people can successfully manage these side effects and continue to benefit from Wellbutrin's therapeutic effects. For more information, the National Alliance on Mental Illness (NAMI) provides comprehensive resources on bupropion and other mental health medications.
