Bupropion, a norepinephrine and dopamine reuptake inhibitor, is FDA-approved for depression and smoking cessation but not for anxiety disorders. Its role in patients with comorbid depression and anxiety remains debated. This review examines bupropion's potential anxiolytic and/or anxiogenic effects. Clinical trials suggest bupropion may reduce anxiety symptoms in depressed patients, showing comparable efficacy to SSRIs and SNRIs in mild to moderate anxiety. However, its stimulating properties can also provoke anxiety, particularly at higher doses. While some studies indicate no significant difference in anxiolytic efficacy between bupropion and serotonergic antidepressants, others suggest SSRIs may be preferable for severe depression with anxious distress. Emerging data hint at potential benefits for generalized and social anxiety disorders, though findings remain inconclusive. Given its mixed effects, a cautious approach is recommended. Initiating treatment at lower doses and monitoring for anxiogenic symptoms can help optimize outcomes. Further research is needed to clarify bupropion's potential role in anxiety management and its comparative efficacy against standard treatments.
Oldak et al. (Mon,) studied this question.