Can Wellbutrin cause mental issues? Understanding the psychiatric risks

October 7, 2025 •

3 min read

The US Food and Drug Administration (FDA) has issued a black box warning for Wellbutrin (bupropion), alerting prescribers and patients to the risk of serious psychiatric side effects, including worsened depression and suicidality. While often effective, can Wellbutrin cause mental issues, and what specific risks should patients and caregivers be aware of?

Quick Summary

Wellbutrin can cause various psychiatric side effects, from anxiety and agitation to more severe reactions like mania and psychosis. Patient history and dosage influence risk, requiring careful monitoring.

Key Points

Black Box Warning: Wellbutrin carries a black box warning from the FDA concerning increased suicidal thoughts and behaviors, especially in children, adolescents, and young adults.
Anxiety and Agitation: Wellbutrin can cause or exacerbate anxiety, restlessness, and agitation due to its activating properties, particularly at the start of treatment or with dose increases.
Mania Risk: There is a risk of triggering manic or hypomanic episodes, particularly in individuals with bipolar disorder or a family history of the condition.
Potential for Psychosis: Rare cases of psychotic symptoms, including delusions, hallucinations, and paranoia, have been reported, especially at higher doses or in predisposed individuals.
Risk Factors: Substance abuse, concurrent medication use, and pre-existing psychiatric conditions can increase the likelihood of experiencing mental health issues while on Wellbutrin.
Management: Side effects are often manageable through dose adjustments, complementary medication, or lifestyle changes, always under the guidance of a healthcare professional.
Patient Monitoring: Close monitoring of behavior and mood changes by both patients and caregivers is vital throughout treatment.

Understanding the Mechanism: How Bupropion Affects Brain Chemistry

Wellbutrin, the brand name for bupropion, works differently than many other common antidepressants like SSRIs and SNRIs. It is classified as a norepinephrine-dopamine reuptake inhibitor (NDRI), meaning it increases the levels of norepinephrine and dopamine in the brain. This action helps treat major depressive disorder (MDD), seasonal affective disorder (SAD), and aids in smoking cessation. However, due to its stimulant-like properties, it can also have significant psychological effects.

Common Mental Health Side Effects

Psychiatric side effects can be noticeable for some patients, particularly when starting treatment or after a dosage change. Monitoring and reporting these to a healthcare provider are important.

Anxiety and Agitation: Wellbutrin's activating nature can lead to or increase feelings of anxiety, nervousness, or restlessness, especially in those with pre-existing anxiety.
Insomnia: Difficulty sleeping is a common side effect. Taking the medication earlier in the day may help.
Mood Swings and Irritability: Some individuals may experience mood instability, increased irritability, or hostility, which warrants monitoring as it could precede more serious mood episodes.
Confusion and Concentration Issues: Reports of feeling confused, difficulty concentrating, or memory problems have occurred.

Serious Psychiatric Side Effects and FDA Warnings

Wellbutrin carries a black box warning from the FDA concerning serious, though less common, psychiatric events. For more details, consult the {Link: Drugs.com https://www.drugs.com/pro/wellbutrin-xl.html} or {Link: SingleCare https://www.singlecare.com/blog/wellbutrin-side-effects/}.

Black Box Warning: Suicidal Thoughts and Behaviors

Mania and Psychosis

Mania/Hypomania: Wellbutrin can potentially trigger manic or hypomanic episodes, especially in individuals with undiagnosed bipolar disorder. Symptoms include increased energy, reckless behavior, racing thoughts, and excessive irritability.
Psychosis: Rarely, patients may experience psychotic symptoms such as delusions, hallucinations, and paranoia. Higher doses, substance abuse, or pre-existing psychotic symptoms can increase this risk.

Factors Increasing the Risk of Mental Issues with Wellbutrin

Several factors can influence the likelihood of experiencing psychiatric side effects from Wellbutrin:

Pre-existing Conditions: A history of bipolar disorder, psychosis, or severe anxiety increases the risk of adverse psychiatric reactions.
Dosage: Higher doses of Wellbutrin are associated with an increased risk of severe effects like seizures and psychosis.
Substance Use: Combining Wellbutrin with alcohol, illicit drugs, or other stimulants can heighten the risk of serious mental and neurological side effects, including seizures and hallucinations.
Abrupt Discontinuation: Suddenly stopping Wellbutrin can result in withdrawal symptoms such as increased anxiety, agitation, headaches, and dizziness.

Wellbutrin vs. Other Antidepressants: Mental Side Effects


Feature	Wellbutrin (Bupropion)	SSRIs (e.g., Sertraline) & SNRIs (e.g., Venlafaxine)
Mechanism	Norepinephrine and dopamine reuptake inhibitor (NDRI).	Serotonin-focused; SNRIs also target norepinephrine.
Energy/Activation	More activating, which can lead to anxiety, agitation, and restlessness.	Can cause initial anxiety, but generally not as stimulating. More prone to fatigue/drowsiness.
Mania Risk	Potential to trigger manic episodes in susceptible individuals, especially those with undiagnosed bipolar disorder.	Can also trigger mania, but the risk profile and presentation may differ.
Sexual Side Effects	Less likely to cause sexual side effects compared to SSRIs/SNRIs.	Commonly associated with decreased libido and sexual dysfunction.
Weight Changes	More commonly associated with weight loss.	More commonly associated with weight gain.
Psychosis	In rare cases, can cause psychotic symptoms (hallucinations, paranoia).	Can also trigger psychotic symptoms, but rare in either class without risk factors.

How to Manage Mental Health Side Effects

Managing mental health side effects from Wellbutrin requires close collaboration with a healthcare provider.

Monitor and Communicate: Keep track of your symptoms, mood, and behaviors and report any unusual or worsening mental health symptoms to your doctor immediately.

Dosage Adjustment: Your doctor may suggest adjusting your dosage or the timing of your dose to reduce stimulating effects like insomnia or anxiety.

Complementary Medication: Sometimes, another medication may be prescribed to help manage Wellbutrin's side effects, such as for acute anxiety or insomnia.

Lifestyle Changes: Reducing caffeine, maintaining a consistent sleep schedule, and avoiding alcohol and illicit drugs can help minimize side effects.

Conclusion

While Wellbutrin is effective for many, it does carry psychiatric risks, ranging from common anxiety and agitation to rare but serious mania and psychosis. The FDA's black box warning about suicidal thoughts in young adults and the dose-dependent risk of seizures emphasize the need for careful patient selection and monitoring. Being informed about these risks, communicating openly with a healthcare provider, and following management strategies are key to safe treatment.

Alternative to Meds: Recover from long-term effects of Wellbutrin

Frequently Asked Questions

Yes, Wellbutrin can cause or increase anxiety and agitation in some people due to its stimulating effects on norepinephrine and dopamine. This is especially true when starting the medication or increasing the dose.

Psychosis, including delusions and hallucinations, is a rare but serious side effect of Wellbutrin. This risk is higher in individuals with certain risk factors, such as a history of psychosis, or when taking high doses.

Yes, changes in mood, including mood swings, irritability, and hostility, are reported psychological side effects of Wellbutrin. For some, this can be a sign of a more serious mood episode, like mania.

Wellbutrin carries a black box warning about the increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults.

If you experience severe mental side effects like hallucinations, psychosis, severe agitation, or suicidal thoughts, you should contact your healthcare provider immediately. They may recommend dose reduction or discontinuation of the medication.

Yes, antidepressant treatment, including Wellbutrin, can trigger a manic or hypomanic episode in individuals with bipolar disorder. Patients should be screened for bipolar disorder before starting treatment.

For most people, psychiatric side effects, particularly common ones like anxiety and insomnia, are temporary and may resolve as the body adjusts to the medication. However, some serious side effects may require discontinuing the drug.