Wellbutrin vs. Paxil

See how Wellbutrin and Paxil compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Wellbutrin works on norepinephrine and dopamine and is only FDA-approved for depression, while Paxil is an SSRI approved for depression plus several anxiety disorders.

  • Wellbutrin tends to cause less sexual dysfunction and weight gain than Paxil, but it carries a seizure risk that Paxil does not have.

  • Both drugs carry a boxed warning for increased suicidal thoughts in children, adolescents, and young adults, and neither should be combined with MAOIs.

Wellbutrin vs. Paxil Drug Summary

Wellbutrin

Wellbutrin (bupropion) is an aminoketone antidepressant that works on norepinephrine and dopamine instead of serotonin. It's FDA-approved for major depressive disorder and is taken as an oral tablet, usually starting at a lower dose for the first few days before increasing.

Paxil

Paxil (paroxetine) is a selective serotonin reuptake inhibitor (SSRI) approved for depression and several anxiety disorders, including OCD, panic disorder, and PTSD. It's taken once daily as an oral tablet, typically starting at 20 mg and increasing gradually if needed.

Wellbutrin vs. Paxil Side Effects

Wellbutrin

Most common
headache/migraine (up to 26%)
nausea/vomiting (up to 18%)
dry mouth (up to 17%)
insomnia (up to 11%)

Paxil

Most common
nausea (up to 26%)
somnolence (up to 23%)
dry mouth (up to 18%)
asthenia (up to 15%)

Wellbutrin vs. Paxil Dosage

Wellbutrin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 200 mg/day (100 mg BID) Days 1-3
Maximum dose 450 mg/day (150 mg TID) If needed
Dose changes 2 increases Every 3 days

Paxil

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 20 mg once daily At the start
Maximum dose 50 mg once daily If needed
Dose changes 3 increases As tolerated

Wellbutrin vs. Paxil Indications

Wellbutrin

Wellbutrin is FDA-approved only for major depressive disorder. Doctors sometimes prescribe it off-label for adult or pediatric ADHD, as an add-on for bipolar depression, to counter sexual side effects from other antidepressants, or for weight management.

  • Major depressive disorder (FDA-approved)

  • ADHD in adults and children (off-label)

  • Bipolar depression, as an add-on (off-label)

  • Antidepressant-induced sexual dysfunction (off-label)

  • Obesity or weight management (off-label)

Paxil

Paxil is FDA-approved for major depressive disorder and a range of anxiety-related conditions. It is not approved for use in children or adolescents.

  • Major depressive disorder

  • Obsessive-compulsive disorder

  • Panic disorder

  • Social anxiety disorder

  • Generalized anxiety disorder or PTSD

Wellbutrin vs. Paxil Pros and Cons

Wellbutrin

Wellbutrin works differently than most antidepressants, targeting norepinephrine and dopamine rather than serotonin. This makes it less likely to cause sexual side effects or weight gain, though it carries a seizure risk that limits its use in some patients.

Pros

  • Lower rates of sexual dysfunction than SSRIs

  • Less likely to cause weight gain than SSRIs

  • Non-sedating, may improve energy and focus

  • Same active ingredient sold separately as Zyban for smoking cessation

Cons

  • Seizure risk; contraindicated with seizure disorders or bulimia/anorexia history

  • Not approved for anxiety disorders, which often occur alongside depression

  • Immediate-release form requires multiple daily doses

  • Roughly $500 to $900 per month without insurance, before savings programs

Paxil

Paxil is a serotonin-focused SSRI with FDA approval across a wider range of anxiety and mood disorders than Wellbutrin. That broader approval comes with tradeoffs, including a higher chance of sexual side effects, weight gain, and a harder tapering process.

Pros

  • FDA-approved for six conditions, including several anxiety disorders

  • Once-daily dosing with a single tablet

  • Long track record of use since 1992

  • Roughly $300 to $310 per month without insurance, before savings programs

Cons

  • Higher rates of sexual dysfunction and weight gain typical of SSRIs

  • Strong CYP2D6 inhibitor, causing many drug interactions

  • Short half-life linked to more noticeable discontinuation symptoms

  • Not approved for use in children or adolescents

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