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
Paxil
Wellbutrin vs. Paxil Dosage
Wellbutrin
Paxil
| 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 |
| 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
| 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
| 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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