What's better, Paxil or Wellbutrin?

October 10, 2025 •

4 min read

Antidepressants are prescribed to millions of adults each year, but choosing the right one is critical for successful treatment. When considering what's better, Paxil or Wellbutrin, the answer depends on individual symptoms, health conditions, and potential side effects, as these two medications belong to different drug classes and affect the brain differently.

Quick Summary

Paxil and Wellbutrin are antidepressants but with different mechanisms. Paxil affects serotonin and is also used for anxiety, while Wellbutrin targets norepinephrine and dopamine and has fewer sexual side effects and less weight gain. The choice depends on individual needs.

Key Points

Different Mechanisms: Paxil is an SSRI that increases serotonin, while Wellbutrin is an NDRI that increases norepinephrine and dopamine.
Less Sexual Dysfunction with Wellbutrin: Wellbutrin carries a lower risk of sexual side effects compared to Paxil, which is known for its higher rate of sexual dysfunction.
Weight Gain: Paxil is associated with a higher risk of weight gain, whereas Wellbutrin is often associated with less weight gain or even weight loss.
Anxiety Treatment: Paxil is an FDA-approved first-line treatment for various anxiety disorders, while Wellbutrin is not typically used as a primary treatment for anxiety and can sometimes worsen symptoms.
Seizure Risk: Wellbutrin carries a dose-dependent seizure risk and is contraindicated in patients with a history of seizures or eating disorders.
Discontinuation Syndrome: Both medications require gradual tapering under a doctor's supervision, especially Paxil, to avoid withdrawal-like symptoms.
Consider Combination Therapy: A doctor may prescribe both medications together to enhance effects or mitigate side effects, but this requires careful monitoring due to potential drug interactions.

When faced with a diagnosis of depression or anxiety, a healthcare provider might present several medication options. Among the most common are Paxil (paroxetine) and Wellbutrin (bupropion), two medications that are fundamentally different in how they work. While both can effectively treat major depressive disorder, their distinct mechanisms and side effect profiles mean that one is often more suitable than the other for a given patient. This comprehensive guide details the key differences to help you and your doctor make an informed decision.

Paxil (Paroxetine): An SSRI Explained

Paxil is a selective serotonin reuptake inhibitor (SSRI), a common class of antidepressants that primarily works by increasing the levels of the neurotransmitter serotonin in the brain. Serotonin is a chemical messenger involved in regulating mood, sleep, and appetite. By blocking its reabsorption (reuptake) into neurons, Paxil makes more serotonin available to transmit signals, which can help alleviate the symptoms of depression and anxiety.

Therapeutic Uses of Paxil

Paxil has several FDA-approved uses, making it a versatile option for various conditions beyond just depression. Its approved uses include:

Major Depressive Disorder (MDD)
Generalized Anxiety Disorder (GAD)
Obsessive-Compulsive Disorder (OCD)
Panic Disorder
Post-Traumatic Stress Disorder (PTSD)
Social Anxiety Disorder
Premenstrual Dysphoric Disorder (PMDD)

Wellbutrin (Bupropion): An Atypical Antidepressant

Wellbutrin is not an SSRI but is classified as a norepinephrine-dopamine reuptake inhibitor (NDRI). Instead of focusing on serotonin, Wellbutrin increases the levels of the neurotransmitters norepinephrine and dopamine in the brain by blocking their reuptake. This distinct mechanism of action is why Wellbutrin is often chosen for patients who don't respond well to SSRIs or want to avoid their common side effects.

Therapeutic Uses of Wellbutrin

Wellbutrin has a different range of approved uses, including:

Major Depressive Disorder (MDD)
Seasonal Affective Disorder (SAD)
As an aid for smoking cessation (branded as Zyban)

Wellbutrin may also be used off-label for other conditions, including Attention Deficit Hyperactivity Disorder (ADHD) and certain forms of nerve pain.

Comparing Side Effects: Paxil vs. Wellbutrin

One of the most significant factors in choosing between these medications is their side effect profile, as they differ dramatically.

Common Side Effects of Paxil

Nausea, constipation, or diarrhea
Weakness and fatigue
Drowsiness
Headache
Sexual dysfunction, including decreased libido, delayed ejaculation, and difficulty with orgasm (Paxil has one of the highest rates of sexual side effects among SSRIs)
Weight gain (Paxil is associated with a higher risk of weight gain compared to many other antidepressants)

Common Side Effects of Wellbutrin

Insomnia or trouble sleeping
Dry mouth
Dizziness
Headache
Anxiety and agitation
Weight loss (Wellbutrin is less likely to cause weight gain and may lead to weight loss in some patients)
Lower risk of sexual dysfunction compared to SSRIs like Paxil

Serious Side Effects

Both medications carry warnings for serious side effects. For Paxil, these include an increased risk of bleeding, serotonin syndrome (especially when combined with other serotonergic drugs), and discontinuation syndrome if stopped abruptly. Wellbutrin, meanwhile, has a risk of seizures, which is dose-dependent and higher in patients with a history of seizures or eating disorders. It also carries a black box warning for the increased risk of suicidal thoughts and behavior in children, adolescents, and young adults.

Paxil and Wellbutrin Comparison Table


Feature	Paxil (Paroxetine)	Wellbutrin (Bupropion)
Drug Class	Selective Serotonin Reuptake Inhibitor (SSRI)	Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)
Primary Neurotransmitters	Serotonin	Norepinephrine and Dopamine
Key Side Effects	Nausea, drowsiness, weight gain, and high risk of sexual dysfunction	Insomnia, anxiety, headache, dry mouth, and lower risk of sexual dysfunction
Weight Impact	Higher risk of weight gain	Less likely to cause weight gain; potential for weight loss
Sexual Side Effects	Higher rate of sexual dysfunction	Lower rate of sexual dysfunction
Specific Risks	Discontinuation syndrome, bleeding events, serotonin syndrome	Seizures (dose-dependent), suicidal thoughts, mania
Common Therapeutic Uses	MDD, GAD, OCD, Panic Disorder, PTSD, PMDD	MDD, SAD, smoking cessation
Suitability for Anxiety	Often a first-line treatment for anxiety disorders	Not typically a first-line treatment for anxiety; may sometimes worsen symptoms

The Combination of Paxil and Wellbutrin

In some cases, a healthcare provider might prescribe both Paxil and Wellbutrin together. This is sometimes done to augment the effects of an SSRI or to counteract the sexual side effects commonly associated with Paxil and other SSRIs. However, this combination must be carefully monitored by a doctor, as Paxil can inhibit the metabolism of Wellbutrin, potentially leading to increased Wellbutrin levels and a higher risk of side effects like seizures.

Conclusion: Which Antidepressant is Right for You?

So, what's better, Paxil or Wellbutrin? The answer is not straightforward and depends entirely on the individual. Paxil is a well-established SSRI that is effective for a range of anxiety disorders in addition to depression, but it comes with a higher risk of sexual side effects and weight gain. Wellbutrin is an atypical antidepressant that is a good alternative for those who can't tolerate or don't respond to SSRIs, offering a lower risk of sexual dysfunction and weight gain, but it is not a primary anxiety treatment and carries a seizure risk. The most crucial step is to have an open and honest conversation with your healthcare provider about your symptoms, medical history, and treatment goals. Together, you can determine the most appropriate and safest medication for your specific situation. For more detailed information on specific medications, you can consult authoritative resources such as the National Alliance on Mental Illness (NAMI).

Frequently Asked Questions

Both Paxil and Wellbutrin typically take several weeks to show their full therapeutic effects. While some improvements may be noticed within the first couple of weeks, it can take 4 to 8 weeks or more for the full benefits to be experienced.

No single medication is universally 'better' for depression. Both are effective antidepressants, but the best choice depends on the individual's specific symptoms, tolerance for side effects, and other health factors. Wellbutrin is often chosen when a patient wants to avoid the sexual side effects or weight gain associated with SSRIs like Paxil.

Yes, but this requires careful medical supervision. Combining the two is sometimes done to boost the antidepressant response or to help with sexual side effects from Paxil. However, Paxil can increase Wellbutrin levels in the body, which raises the risk of side effects.

Paxil is generally preferred for anxiety. It is an FDA-approved, first-line treatment for a range of anxiety disorders. Wellbutrin is not typically used to treat anxiety and, due to its stimulating effects, can sometimes worsen anxiety symptoms in some individuals.

Wellbutrin is the better option for avoiding weight gain. Paxil has a higher risk of causing weight gain, while Wellbutrin is less likely to and may even cause weight loss.

The main difference is their mechanism of action. Paxil is an SSRI that increases serotonin levels, while Wellbutrin is an NDRI that increases norepinephrine and dopamine levels.

A doctor might choose Wellbutrin for a patient who has not responded to or experienced severe side effects from an SSRI. It is also a good option for those concerned about weight gain or sexual dysfunction. Additionally, Wellbutrin treats seasonal affective disorder and aids in smoking cessation.