Disclaimer: Human Health is not recommending any specific medical treatment for any particular symptom, nor providing any other medical advice. Always seek the advice of your doctor regarding any medical concern.

What is bupropion?

Bupropion is a medication that was designed to treat depression, and is now also approved to treat seasonal affective disorder (seasonal depression) and to help with quitting smoking. Other conditions that bupropion may commonly be used to treat include ADHD, sexual dysfunction, and obesity.

Bupropion is sold under the brand names Wellbutrin, Zyban, Clorprax, Aplenzin, and Forfivo. Some combined medications contain bupropion as well as other ingredients, such as Contrave and Auvelity. It’s usually taken by mouth, as a tablet.

Bupropion isn’t officially approved by the FDA to be prescribed to treat anxiety disorders and their symptoms. However, because there is some evidence for bupropion as an effective medication for anxiety symptoms, clinicians may choose to prescribe it for their patients if they believe it will help them.

This post will explain a bit about how bupropion works and why some healthcare professionals may use it to treat anxiety symptoms.

What kind of drug is Bupropion?

Bupropion is primarily classified as an antidepressant. It is a type of drug known as a norepinephrine and dopamine reuptake inhibitor (NDRI). Bupropion is also a nicotinic receptor antagonist, which means it blocks the function of certain proteins in the brain called nicotinic receptors.

What are norepinephrine and dopamine?

Norepinephrine (also known as noradrenaline) and dopamine are chemical messengers in our body that are involved in the stress response, as well as regulating mood, behavior, alertness, and arousal. Physiological symptoms of the stress response and increased states of alertness and arousal include a faster heart rate, tremors, sweating, and palpitations.

Usually, after they are released in the brain, norepinephrine and dopamine are recycled, which means they can only exert their effects for a limited period of time. Reuptake inhibitors like bupropion block norepinephrine and dopamine from being recycled, which means that they can exert their effects on the brain for longer than usual after they have been released.

What are nicotinic receptors?

Nicotinic receptors in the body are important for processes that produce movement. In the brain in particular, nicotinic receptors interact with nicotine inhaled from cigarette smoke. Nicotine activates nicotinic receptors, which has the effect of producing dopamine. The release of dopamine signals to the brain that the intake of nicotine has created a pleasurable experience.

This is how smoking becomes addictive, because our brain starts to expect this release of dopamine that incites pleasure, and as a result we start to crave smoking.

Activation of nicotinic receptors can have effects such as increasing heart rate and blood pressure. When agents like bupropion block nicotinic receptors, it limits the binding of nicotine to nicotinic receptors, which may interrupt the pleasure-reward cycle of smoking and aid in curbing addiction.

How does an antidepressant like bupropion work to reduce anxiety symptoms?

It’s unclear how bupropion acts to reduce anxiety symptoms. There are limited studies on the effectiveness of bupropion in reducing anxiety in patients with anxiety disorders. A 2008 randomized controlled trial compared the action of bupropion in patients with generalized anxiety disorder to another medication called escitalopram, which has established efficacy for treating anxiety. The study found comparable results for each treatment in reducing anxiety symptoms.

Click here to read a summary about escitalopram.

In particular, there has been more substantial research on the action of bupropion in patients with depressive disorders who also have symptoms of anxiety. A 2008 meta-analysis of 10 clinical trials found evidence for comparable action of bupropion in relation to anxiety symptoms in comparison to some other antidepressants commonly used to treat anxiety, such as sertraline.

The activities of norepinephrine, dopamine, and nicotinic receptors are known to impact the stress response, mood, hyperarousal, and increased heart rate and blood pressure. Since bupropion has some effect on these chemicals and receptors, it is possible that the mechanism by which bupropion affects anxiety symptoms has something to do with the action of bupropion on these agents.

However, further research is required to confirm the exact mechanism by which bupropion reduces anxiety symptoms.

‍

We hope this information helps you better understand what bupropion is and how it might work to treat anxiety symptoms. Please reach out to your doctor if you want to know more.

If you think someone you know could benefit from reading this post, please share it with them. We’d love for our resources to reach those who need them.

Resources

1. Huecker MR, Smiley A, Saadabadi A. Bupropion. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470212/
2. Garakani A, Murrough JW, Freire RC, Thom RP, Larkin K, Buono FD, Iosifescu DV. Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Front Psychiatry. 2020 Dec 23;11:595584. doi: 10.3389/fpsyt.2020.595584. PMID: 33424664; PMCID: PMC7786299.
3. Benowitz NL. Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annu Rev Pharmacol Toxicol. 2009;49:57-71.doi: 10.1146/annurev.pharmtox.48.113006.094742. PMID: 18834313; PMCID: PMC2946180.
4. DrugBank Online: Bupropion. https://go.drugbank.com/drugs/DB01156
5. Bystritsky A, Kerwin L, Feusner JD, Vapnik T. A pilot controlled trial of bupropion XL versus escitalopram in generalized anxiety disorder. Psychopharmacol Bull. 2008;41(1):46-51.PMID: 18362870.
6. Papakostas GI, Trivedi MH, Alpert JE, Seifert CA, Krishen A, Goodale EP, Tucker VL. Efficacy of bupropion and the selective serotonin reuptake inhibitors in the treatment of anxiety symptoms in major depressive disorder: a meta-analysis of individual patient data from 10 double-blind, randomized clinical trials. J Psychiatr Res. 2008 Jan;42(2):134-40.doi: 10.1016/j.jpsychires.2007.05.012. Epub 2007 Jul 12. PMID: 17631898.

‍