Wellbutrin vs. Remeron

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

Key Takeaways

  • Wellbutrin is a non-sedating antidepressant that raises norepinephrine and dopamine activity, while Remeron is a sedating tetracyclic antidepressant that works through serotonin and norepinephrine pathways.

  • Wellbutrin is generally weight-neutral and rarely causes sexual side effects, while Remeron commonly causes drowsiness, increased appetite, and weight gain.

  • Both carry a boxed warning for increased suicidal thinking in children, teens, and young adults, so either drug requires close monitoring when treatment starts.

Wellbutrin vs. Remeron Drug Summary

Wellbutrin

Wellbutrin (bupropion) is an aminoketone antidepressant that works by inhibiting the reuptake of norepinephrine and dopamine, a different mechanism than most antidepressants that target serotonin. It is FDA-approved for major depressive disorder and is taken as an immediate-release tablet, usually two or three times a day. Its non-sedating profile is often why doctors choose it for patients bothered by fatigue or sexual side effects on other antidepressants.

Remeron

Remeron (mirtazapine) is a tetracyclic antidepressant that boosts norepinephrine and serotonin signaling through a mechanism distinct from SSRIs. It is FDA-approved for major depressive disorder and is taken as a single tablet, usually at bedtime. Its sedating and appetite-stimulating effects make it a common choice for depression that comes with insomnia or poor appetite.

Wellbutrin vs. Remeron Side Effects

Wellbutrin

Most common
Dry mouth (up to 5%)
Constipation (up to 5%)
Dizziness (up to 5%)
Headache/migraine (up to 5%)

Remeron

Most common
Dry mouth (up to 25%)
Constipation (up to 13%)
Dizziness (up to 7%)
Somnolence (up to 54%)

Wellbutrin vs. Remeron 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

Remeron

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 15 mg once daily At the start
Maximum dose 45 mg once daily If needed
Dose changes 2 increases As tolerated

Wellbutrin vs. Remeron Indications

Wellbutrin

Wellbutrin is FDA-approved to treat major depressive disorder in adults. Doctors also prescribe it off-label for ADHD, as an add-on for bipolar depression, to offset sexual side effects from other antidepressants, and sometimes for weight management.

  • FDA-approved for major depressive disorder

  • Off-label: ADHD in adults and children

  • Off-label: adjunct for bipolar depression

  • Off-label: antidepressant-induced sexual dysfunction

  • Off-label: weight management

Remeron

Remeron is FDA-approved to treat major depressive disorder in adults. Doctors also prescribe it off-label for insomnia, anxiety, appetite stimulation in older or cancer patients, and nausea during pregnancy.

  • FDA-approved for major depressive disorder

  • Off-label: insomnia

  • Off-label: anxiety disorders

  • Off-label: appetite stimulation

  • Off-label: nausea in pregnancy

Wellbutrin vs. Remeron Pros and Cons

Wellbutrin

Wellbutrin stands out among antidepressants for its low rates of sexual dysfunction and weight gain, plus an energizing rather than sedating effect. It carries a dose-related seizure risk, so it isn't used in people with seizure disorders or a history of eating disorders.

Pros

  • Low risk of sexual side effects

  • Weight-neutral or can support weight loss

  • Non-sedating, can improve energy and focus

  • Also used off-label for ADHD symptoms

Cons

  • Carries a dose-related seizure risk

  • Contraindicated with seizure or eating disorder history

  • Can cause insomnia or anxiety in some patients

  • Typically costs $500 to $900 per month without insurance

Remeron

Remeron works well for depression accompanied by insomnia or appetite loss, since sedation and appetite increase are built into its side-effect profile. Sedation tends to be stronger at lower doses, and it requires monitoring for rare but serious blood cell effects.

Pros

  • Helps with sleep due to sedating effect

  • Can stimulate appetite in underweight patients

  • Available as a dissolvable tablet (SolTab)

  • Generic mirtazapine often costs $10 to $40 per month

Cons

  • Causes drowsiness that can affect daytime function

  • Often leads to increased appetite and weight gain

  • Rare risk of severe neutropenia requires monitoring

  • Postmarketing reports of QT prolongation and arrhythmia

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