Wellbutrin vs Prozac: Which is Better?

The U.S. Food and Drug Administration (FDA) approved Wellbutrin and Prozac to treat major depressive disorder and other mental health conditions. These two drugs work by affecting the levels of certain natural brain chemicals in the central nervous system. However, there are some significant differences between them. Please continue reading to find out which is better: Wellbutrin or Prozac.

What are the differences between Wellbutrin and Prozac?

Wellbutrin vs Prozac: Type of drug

Wellbutrin is the brand name for bupropion hydrochloride (generic name). It belongs to a drug class called aminoketones or norepinephrine-dopamine reuptake inhibitors (NDRIs). Wellbutrin works by increasing levels of norepinephrine, the chemical that helps you stay alert, and dopamine, the “feel good” chemical.

Prozac is the brand name for fluoxetine hydrochloride (generic name). It belongs to a drug class called selective serotonin reuptake inhibitors (SSRIs). Prozac works by increasing serotonin levels which ultimately help to stabilize and regulate your mood.

Wellbutrin vs Prozac: Uses

Wellbutrin (bupropion)

Wellbutrin (bupropion) is FDA-approved to treat depression symptoms and seasonal affective disorder (SAD). Keep in mind that only Wellbutrin XL (extended-release) is approved to treat depression and prevent seasonal affective disorder, while Wellbutrin SR (sustained-release) is only used for depression treatment.  

Additionally, Wellbutrin sustained-release (bupropion SR) is also used to aid smoking cessation (sold under the brand name Zyban). This drug is sometimes used off-label in people with attention deficit hyperactivity disorder (ADHD).

Prozac (fluoxetine)

Prozac (fluoxetine) is prescribed to treat depression, obsessive-compulsive disorder (OCD), bulimia nervosa (an eating disorder), panic disorder, and premenstrual dysphoric disorder (PMDD). 

Prozac (fluoxetine) can be used in combination with an antipsychotic called olanzapine (Zyprexa) to treat depressive episodes caused by bipolar I disorder. 

Besides manic depression, Prozac (fluoxetine) and Zyprexa (olanzapine) can be prescribed together to treat major depression that has not responded to other medications.

Wellbutrin vs Prozac: Age range

Wellbutrin is approved for use in adults. It is not usually prescribed to people under 18 years of age. In other words, there is no FDA-approved use and dosage for children. However, the off-label use of Wellbutrin for ADHD (attention deficit hyperactivity disorder) can be used in children at the provider’s discretion using their clinical judgment. 

Prozac (fluoxetine) is approved to treat many mental health conditions in adults over 18 years. In addition to its use in adults, Prozac can be prescribed to children 7 years and older for obsessive-compulsive disorder (OCD) and children 8 years and older for major depressive disorder (MDD).

Wellbutrin vs Prozac: Dosage forms and doses

Wellbutrin (bupropion) 

Wellbutrin (bupropion) comes as a regular (immediate release) tablet, extended-release tablet (Wellbutrin XL), and sustained release tablet (Wellbutrin SR) to take by mouth. Notably, the brand name Wellbutrin is only available in the extended-release (XL) and sustained-release (SR) versions. The immediate-release (IR) version is available with the generic bupropion. 

The dose of Wellbutrin varies depending on the condition being treated and the formulation being used (XL, SR, or IR), as well as your overall health status, such as kidney and liver function and current medications. Your doctor will help you determine the best medication dose and formulation to treat your health condition safely and effectively. 

For example, the recommended doses for the treatment of major depressive disorder are as follows:

Bupropion immediate-release:

• The usual starting dose of bupropion (immediate-release tablet) is 100 milligram (mg) by mouth twice a day for 3 days. 

• After 3 days, this dose can be increased to 100 mg by mouth 3 times a day with at least 6 hours between the doses. 

• The maximum dose of bupropion (immediate-release) is 450 mg daily given as 150 mg 3 times a day or 100 mg 4 times a day. Maximum single dose is 150 mg. 

Wellbutrin SR (sustained-release):

• The usual starting dose is 150 mg orally once daily in the morning for 3 days

• After 3 days, the dose can be increased to 150 mg by mouth twice daily 

• The maximum dose of Wellbutrin SR is 400 mg daily, given as 200 mg twice daily; all doses should be separated by at least 8 hours. The maximum single dose is 200 mg. 

Wellbutrin XL (extended-release):

• The usual starting dose is 150 mg orally once daily in the morning for 3 days

• After 3 days, the dose can be increased to 300 mg by mouth once daily 

• The maximum dose of Wellbutrin XL is 450 mg daily, given as one single dose.

Keep in mind that Wellbutrin XL and SR (and their generic equivalents) are not interchangeable since the extended-release (XL) formulation is designed to release the medication slowly into the bloodstream for up to 24 hours. In contrast, the sustained-release version releases medicines for up to 12 hours. 

Ask your pharmacist or doctor if you are unsure which version of Wellbutrin you should take. It can be confusing because bupropion XL and SR are sometimes labeled "bupropion extended-release." In which cases you should clarify to see if the prescribed Wellbutrin (bupropion) is 12-hour or 24-hour.

Prozac (fluoxetine) 

Prozac (fluoxetine) comes as a regular (immediate-release/IR) tablet, capsule, and oral solution; it is also available as a delayed-release (DR) capsule to take by mouth. 

The dose of Prozac (fluoxetine) varies depending on the condition being treated and the formulation being used (IR or DR)), as well as your overall health status, such as kidney and liver function and current medications. Your doctor will help you determine the best medication dose and formulation to treat your health condition safely and effectively. 

For example, the recommended doses for the treatment of major depressive disorder are as follows:

Prozac (fluoxetine) immediate-release tablet, capsule, or oral solution:

• The usual starting dose of fluoxetine is 20 mg by mouth daily in the morning. 

• This dose can be increased after several weeks if inadequate response. The medicine can be taken on a once-daily or twice-daily schedule. The typical maintenance dose is 20 to 60 mg by mouth daily

• For the treatment of depression, the maximum dose of Prozac (fluoxetine) immediate-release is 80 mg daily.

Prozac (fluoxetine) delayed-release capsule:

• Take fluoxetine immediate-release 20 mg by mouth once daily for 7 days 

• After 7 days of being on fluoxetine immediate-release 20 mg, start taking fluoxetine delayed-release 90 mg by mouth once weekly.

Wellbutrin vs Prozac: Side effects

Possible side effects of Wellbutrin include confusion, seizures, hallucinations, delusions, paranoia, joint pain, muscle pain, a rapid or pounding heartbeat, and high blood pressure.

Possible side effects of Prozac include anxiety, nervousness, sleep problems, dry mouth, heartburn, nausea, diarrhea, uncontrolled shaking, weakness, excessive yawning, excessive sweating, loss of appetite, weight loss, stuffy nose, sore throat, strange dreams, sexual dysfunction in men and women, headache, memory problems, and difficulty concentrating.

Both Prozac and Wellbutrin can both cause serious adverse effects, including a life-threatening allergic reaction with skin rash, hives, itching, swelling of the head and neck, difficulty breathing, and chest pain. Seek emergency medical care if this happens.

Wellbutrin vs Prozac: Risks and warnings

Taking Wellbutrin is associated with the following risks:

• Increased risk of suicidal thoughts and behaviors, especially in children, adolescents, and young adults.

• Neuropsychiatric adverse events such as mood changes, hallucinations, delusions, paranoia, homicidal ideation, suicidal ideation, aggression, agitation, hostility, anxiety, and panic attacks.

• Increased risk of seizures.

• Elevated blood pressure.

• Activation of manic episodes in people with bipolar disorder.

• Angle-closure glaucoma.

• Interactions with other medications.

• Withdrawal symptoms such as excessive sweating, sleep problems, nausea, vomiting, and loss of appetite if it is stopped suddenly.

Taking Prozac is associated with the following risks:

• Worsening depressive episodes and suicide risk.

• Triggering of a manic episode in people with bipolar disorder.

• Serotonin syndrome (a serious condition that occurs when there is too much serotonin in the body).

• Increased risk of abnormal bleeding.

• Drug interaction with another medication.

• Withdrawal symptoms such as tiredness, headache, and irritability if it is stopped abruptly.

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Is Prozac or Wellbutrin better?

Small double-blind clinical trials comparing Wellbutrin and Prozac have shown that both Wellbutrin (bupropion) and Prozac (fluoxetine) are equally effective antidepressant medications with a similar safety profile. 

Your healthcare provider can help you choose between Wellbutrin (bupropion) & Prozac (fluoxetine). They may even recommend a prescription medication from a different drug class, for example, tricyclic antidepressants. The choice of antidepressants is based on factors such as your medical history, mental health symptoms, side effects, and drug interactions. 

For example, if you have major depression and bulimia nervosa, Prozac may be the better choice because it can treat major depression and your eating disorder. 

Can you take Wellbutrin and Prozac together?

Prozac and Wellbutrin are both prescription medications used to treat depression. They are not typically prescribed together due to a risk of serious adverse effects and drug interactions. 

Your mental healthcare provider may prescribe Wellbutrin and Prozac together off-label. Studies have shown that the combination of bupropion (Wellbutrin) and an SSRI such as fluoxetine (Prozac) is generally well tolerated and can have greater antidepressant effects while reducing the sexual side effects typically caused by SSRIs. But additional research is needed to ensure the safety and efficacy of this combination.

Frequently Asked Questions

Is Prozac & Wellbutrin the same?

Both Wellbutrin & Prozac are used to treat depression, but they are not the same. Wellbutrin is a norepinephrine-dopamine reuptake inhibitor (NDRI). Prozac is a selective serotonin reuptake inhibitor (SSRI). They work differently, cause different side effects, and have different drug interactions.

Is Wellbutrin better for anxiety or depression?

Wellbutrin is not FDA-approved to treat anxiety. Some people report worsening anxiety symptoms after taking Wellbutrin, especially after first starting treatment or dose increases. However, studies have shown no significant differences in anxiety outcomes between SSRIs such as Prozac and Wellbutrin.

Why choose Wellbutrin over other antidepressants?

Some of the reasons to choose Wellbutrin (bupropion) over other medicines for depression include:

• Available in lower-cost generic form.

• Less likely to cause weight gain and sexual dysfunction.

• Good option for people who have not responded to SSRIs like Prozac.

• Bupropion can help with smoking cessation.

Why choose Prozac over other antidepressants?

Some of the reasons to choose Prozac (fluoxetine) over other medicines for depression include:

• Available in lower-cost generic form. 

• Less likely to cause drowsiness than some other antidepressants.

• Fluoxetine can be used to treat several mental health conditions, including major depressive disorder, obsessive-compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder (PMDD).