Lexapro vs. Wellbutrin: Which more effective?

If you’re considering medication for the treatment of depression or another mental health condition, you may have come across the two brand names Lexapro and Wellbutrin. Both are very commonly prescribed antidepressants, but each works in a different way.

Navigating the maze of antidepressant options can feel overwhelming, which is why we’ve put together a guide comparing these two medications. In this deep dive, we'll compare Lexapro and Wellbutrin, exploring how each actually works, what conditions they are best suited to treat, their side effects, and more. By the end, you’ll be equipped to have an informed conversation with your doctor about these two drugs.  

What conditions do they treat?

Lexapro (escitalopram), is FDA-approved for treating major depressive disorder (MDD) and generalized anxiety disorder (GAD). Additionally, it's often prescribed off-label for conditions like social anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder (PD), premenstrual dysphoric disorder (PMDD), and post-traumatic stress disorder (PTSD).  

Wellbutrin (bupropion) is FDA-approved for MDD, seasonal affective disorder (SAD), and smoking cessation. It's also prescribed off-label for anxiety and attention-deficit/hyperactivity disorder (ADHD), among other conditions.  

Related article: How to get depression medication

How do they work?

Although both Lexapro and Wellbutrin are antidepressants, they are different classes of prescription drugs with distinct mechanisms of action.  

Lexapro is a selective serotonin reuptake inhibitor, or SSRI, a drug class that is commonly used to treat depression and anxiety. Serotonin is a chemical messenger, or neurotransmitter, that helps transfer information between nerve cells, and it’s known to be connected to our mood and emotions. SSRIs work by preventing your nerve cells from absorbing serotonin, thereby increasing the level of serotonin in your brain.  

Though neither depression nor anxiety are caused by low levels of serotonin (it’s much more complicated than that), higher levels of serotonin do seem to help reduce the symptoms of these and related conditions.  

Studies have demonstrated Lexapro’s efficacy, with participants showing reduced depression symptoms and a 90% response rate within four weeks. Lexapro has also been shown to be effective in treating anxiety.

Meanwhile, Wellbutrin is what is known as an atypical antidepressant, meaning that it doesn’t fit into other classes of antidepressants. Similarly to SSRIs, Wellbutrin works by preventing your brain from reabsorbing specific neurotransmitters after they’ve done their job of passing along chemical messages between your neurons. However, unlike an SSRI, Wellbutrin doesn’t impact levels of serotonin; instead, the neurotransmitters that it increases are norepinephrine and dopamine. These are linked to alertness, energy, and pleasure.  

Research indicates that Wellbutrin outperforms placebos in the treatment of depression, with a response rate exceeding 50% after eight weeks. However, the drug’s efficacy for anxiety treatment is less well-established—though some recent research has suggested that it may be just as effective at treating anxiety as SSRIs are.

Dosage differences

If you are prescribed Lexapro, your doctor will probably instruct you to take it once daily. You can take it with or without food. The recommended dose of Lexapro is 10 mg a day and the maximum dose is 20 mg a day. The medicine comes in a pill form—5, 10, and 20 mg tablets—as well as in an oral solution whose concentration is 1 mg per mL.  

Wellbutrin actually comes in a few forms: regular (immediate release), sustained release (SR), or extended release (XL).  

• If you’re taking regular Wellbutrin, you will probably start with taking a 100 mg tablet twice a day, for a total of 200 mg a day, and potentially work up to three 100 mg tablets a day if needed.  
• If you’re taking Wellbutrin SR, you will start with one 150 mg pill a day, increasing if necessary to taking two 150 mg pills a day.  
• If you’re prescribed Wellbutrin XL, you will start at a dosage of 150 mg taken once daily, and work up to two of those doses per day if necessary.  

The maximum daily dose of Wellbutrin is 450 mg.  

As with all prescription drugs, you should always follow your doctor’s dosing instructions, and consult with them before increasing or decreasing your dose—withdrawal symptoms can occur if you stop taking a medication without a tapering plan.  

Related article: Signs your antidepressant dosage too high or too low

Common side effects

Like all medications, Lexapro and Wellbutrin have side effects. These side effects might happen as your body gets used to the medication but should subside eventually. Definitely inform your doctor if you’re experiencing any side effects, especially if they are ongoing. Your doctor can assess if what you’re experiencing is a symptom of a more serious reaction to Lexapro or Wellbutrin.  

The most common side effects of Lexapro are:

• Dry mouth  
• Diarrhea or constipation
• Sleepiness and drowsiness or insomnia
• Headache
• Sweating
• Changes in sex drive

The most common side effects of Wellbutrin are:

• Dry mouth
• Constipation
• Weight loss and decrease in appetite
• Insomnia or trouble sleeping
• Headache
• Sweating
• Ear ringing
• Elevated blood pressure

When you discuss medication options with your doctor, these and other potential side effects should be part of the conversation. You will not necessarily experience any serious side effects, but it’s still important to weigh the common ones as part of your decision about which medication is right for you and your lifestyle to ensure your well-being.

Related article: Wellbutrin vs Buspar

Can you take Lexapro and Wellbutrin together?  

For some people diagnosed with MDD, the combination of Lexapro and Wellbutrin might be a good option, especially if other treatments, like Lexapro by itself, aren’t working or if you have symptoms that could benefit from the different mechanisms of action of these two drugs. Since Lexapro and Wellbutrin are distinct classes of antidepressants that affect distinct neurotransmitters, they could work together to treat depression.  

Sometimes Wellbutrin is even prescribed to counter the side effects of SSRIs like Lexapro—for example, it can help counteract some of the less desirable side effects associated with Lexapro, like the decrease in sex drive or weight gain.

That said, there are some risks associated with the combination of the two. They include:

• Seizures: All classes of antidepressants may lower your threshold for seizures, so combining more than one will exacerbate this effect.
• Serotonin syndrome: Wellbutrin may potentially increase the levels of Lexapro in your bloodstream, which can in turn increase your risk of serotonin syndrome, which is a potentially life-threatening condition where there’s too much serotonin in your body.
• Intensified side effects: Combining these medications may make you more likely to experience each drug’s other potential side effects.  

It's crucial to consult with a healthcare provider before starting or changing any medication regimen. They can assess your specific situation, medical history, and any potential interactions or side effects to ensure the safest and most effective treatment plan for you.

Who is not a good candidate for Lexapro or Wellbutrin?

Before your doctor prescribes you Lexapro or Wellbutrin, they will take into consideration your symptoms, health history, current medications, and existing conditions. This is especially important because there are some characteristics or conditions that might mean that these drugs are not appropriate options for you.  

You should be cautious about taking Lexapro if:

• You have certain allergic reactions or sensitivities: If you’ve had a previous allergic reaction or sensitivity to escitalopram or any other SSRI, you man consider avoid Lexapro.

• You have certain medical conditions: Some medical conditions may warrant caution or avoidance of Lexapro. These include a history of seizures, bipolar disorder (without a mood stabilizer), narrow-angle glaucoma, bleeding disorders, or conditions that affect heart function.

• You are taking certain other medications: Lexapro may interact with other medications, including the antidepressants known as monoamine oxidase inhibitors (MAOIs), some other antidepressants, blood thinners, nonsteroidal anti-inflammatory drugs (NSAIDs), and some herbal supplements.
• You are pregnant or breastfeeding: The safety of Lexapro during pregnancy and breastfeeding is still being studied, but is generally considered safe While it may be used in some cases, it's essential to discuss the potential risks and benefits with a healthcare provider.

• You have suicidal thoughts or behaviors: In some individuals, SSRIs like Lexapro may increase the risk of suicidal thoughts or behaviors, especially in young adults, children, and adolescents. Close monitoring is essential when starting or adjusting the dose of Lexapro, particularly in these populations.

• You want to avoid Lexapro’s side effects: Some individuals may experience intolerable side effects with Lexapro, such as gastrointestinal disturbances, sexual dysfunction, insomnia, or weight changes. If side effects are severe or significantly impact your quality of life, an alternative treatment may be considered.

Related article: Lexapro vs Paxil

Wellbutrin may not be a good option for you if you:

• Have a seizure disorder: Wellbutrin can lower the seizure threshold, meaning it may increase the risk of seizures, particularly in individuals with a history of seizure disorders or conditions that predispose them to seizures. So it’s typically not recommended for people who have a history of seizures or epilepsy.

• Have an eating disorder: Wellbutrin may exacerbate symptoms of eating disorders such as bulimia or anorexia nervosa due to its potential to increase the risk of seizures and its stimulant-like effects on appetite. In some cases, the risk of weight loss associated with Wellbutrin may also be problematic for individuals with eating disorders.

• Have been bipolar disorder: Wellbutrin can induce manic or hypomanic episodes in individuals with bipolar disorder.  

• Have an alcohol or substance-use disorder: Wellbutrin may increase the risk of seizures, particularly in individuals with alcohol or substance-use disorders.  

• Have certain other medical conditions: People with certain medical conditions, such as severe liver disease, severe kidney disease, or uncontrolled hypertension (high blood pressure), may be at increased risk of adverse effects with Wellbutrin.

• Are taking certain other medications: Wellbutrin can interact with other medications, including monoamine oxidase inhibitors (MAOIs), other antidepressants, antipsychotics, certain antiretrovirals, and drugs that lower the seizure threshold.

• Are pregnant or breastfeeding: As with Lexapro, the safety of Wellbutrin during pregnancy and breastfeeding is still being studied. So while it may be used in some cases, be sure to discuss the potential risks and benefits with your healthcare provider.

Is Lexapro or Wellbutrin right for me?

When you’re struggling with symptoms of a mental-health condition, it’s tempting to want a one-size-fits-all, easy solution, the best medicine for whatever your diagnosis is. But we all know that life is more complicated than that: There is no best medication in general, just a best medication for you.  

That said, both Wellbutrin and Lexapro have been proven to be effective treatments, and depending on your symptoms and goals, it’s likely that one of them will work for you and your well-being.  

Lexapro is FDA-approved to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD), and there is robust evidence backing up its efficacy in treating these conditions. It only needs to be taken once a day.  

Meanwhile, Wellbutrin is only FDA-approved for the treatment of MDD and seasonal affective disorder (SAD), and for smoking cessation. Research has shown that it can be effective in treating these conditions. It's also sometimes prescribed off-label for anxiety and attention- deficit/hyperactivity disorder (ADHD), but there is less data demonstrating its efficacy in treating these conditions.  

Sometimes, it may be appropriate to take both Lexapro and Wellbutrin together, especially if just one on its own isn’t working.

If you’re trying to decide which of these two medications is right for you, your very first step should be to work with a psychiatrist, who can help you figure out what medication or treatment options is most suited for your specific symptoms in your specific life. Doing so is way easier than it sounds: Click here to take Talkiatry’s quick assessment, and then you will be matched with one of our psychiatrists.  

FAQs

Here’s how else Wellubtrin and Lexapro compare.

Does Lexapro or Wellbutrin cause weight gain?

Weight gain may be a potential side effect of many antidepressant medications, including Lexapro (escitalopram). Meanwhile, Wellbutrin is generally considered to be weight-neutral or associated with weight loss rather than weight gain. However, the likelihood and extent of these weight-related effects will vary person to person.

Does Wellbutrin work better than Lexapro?

There is no definitive answer to whether Wellbutrin works better than Lexapro or vice versa. Both medications can be effective treatments for depression and anxiety, but the choice between them depends on individual factors and preferences. It's essential to work closely with your healthcare provider to determine the most appropriate treatment approach for your unique situation  

What are other antidepressant medications?

Other antidepressant medications include other selective serotonin reuptake inhibitors (SSRIs) like Lexapro, such as Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine); serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta (duloxetine) and Effexor (venlafaxine); tricyclic antidepressants (TCAs) such as Elavil (amitriptyline) and Tofranil (imipramine); and monoamine oxidase inhibitors (MAOIs) such as Nardil (phenelzine) and Parnate (tranylcypromine). These medications work by altering the levels of neurotransmitters in the brain, which can alleviate symptoms of depression and anxiety.

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.