Does Wellbutrin Cause Serotonin Syndrome? (6+ Factors)

By Ivan Kahwa

Page last updated: 05/02/2024 | Next review date: 05/02/2026

Author bio

Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.

Mr Ivan Kahwa’s Highlights:

Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.

Professional Experience:

Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.

With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.

With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.

Education:

2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.

2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.

2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.

Publications:

▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7

▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60

▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.

https://ethnobotanyjournal.org/index.php/era/article/view/4683

▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.

https://doi.org/10.53388/TMRIM202307004

▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.

https://doi.org/10.1186/s43094-021-00296-2

▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.

https://doi.org/10.5799/jmid.951600

Published book Chapter

▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.

https://doi.org/10.1016/B978-0-323-91942-5.00012-4

Submitted manuscripts Under Review:

▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience

▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine

▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology

Submitted book chapters under review

1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.

2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press

You can view my works on the following professional sites:

Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa

Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en

ORCID: https://orcid.org/0000-0002-6440-3437

Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159

Ivan Kahwa

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In this article, we will discuss whether Wellbutrin causes serotonin syndrome as a side effect or not. We will also explore what research suggests on this, the link between serotonin syndrome and Wellbutrin, symptoms and diagnosis of serotonin syndrome, risk factors and precautions associated with it.

Does Wellbutrin cause serotonin syndrome?

Wellbutrin (bupropion) can cause serotonin syndrome if taken in higher doses. However, it is an atypical antidepressant that has nothing to do with serotonin fluctuation, but when the doses are high or given in combination with other medications like SSRIs or SNRIs, it can affect the levels of serotonin. (1)

Wellbutrin works by balancing the levels of certain chemicals in your brain specifically norepinephrine and dopamine. It is commonly prescribed for people who are suffering from seasonal affective disorder and major depressive disorder, with a little help in smoking cessation too. (1)

Serotonin syndrome may be considered a life-threatening condition which is followed by excessive accumulation of serotonin in the brain. It is a neurotransmitter, involved in many important physiological functions along with regulating your emotions. It improves mood and boosts motivation in a depressive or anxious person. (2)

If you’re concerned with the impact of Wellbutrin on serotonin levels or sense any concerning symptoms related to it, it’s best to inform your doctor promptly.

How does Wellbutrin cause serotonin syndrome?

There is no direct connection between Wellbutrin and serotonin syndrome. This antidepressant only works by blocking the reabsorption of specific chemicals in the brain, particularly norepinephrine and dopamine, with minimal or no impact on serotonin levels. (1)

However, Wellbutrin may be given in combination therapy with some other antidepressants like SSRIs or SNRIs to treat various depression and anxiety-related problems. Both of these classes of antidepressants significantly increase the levels of serotonin in the brain by blocking its reabsorption, leading to serotonin syndrome. (4)

It’s important to keep in mind that people’s reactions to medications are different, thus the risk of interactions while taking combination therapy should be kept into consideration.

What does research suggest?

According to a research study, a 15-year-old boy was brought to the hospital with uncontrollable seizures especially in his ankles, high blood pressure, enlarged pupils, confusion and restlessness. He was also hallucinating and his mouth was dry upon examination. (3)

The doctors gave him IV fluids and Lorazepam to help his restlessness. Upon his blood and urine screening, they found the presence of naproxen and bupropion. The levels of bupropion in his blood were way higher than normal. The doctors withdrew bupropion levels from his blood and gave him more fluids. (3)

After 24 hours, the boy woke with normal vitals. This showed that bupropion alone, not combined with other antidepressants has also caused serotonin syndrome, similar cases have been reported 3 times, hence the occurrence is very rare but possible. (3)

What are the symptoms of serotonin syndrome?

Some of the commonly occurring symptoms of serotonin syndrome include: (2)

Agitation or restlessness
Confusion and disrientation
Dilated pupils (pupils may become larger than normal)
Rapid heart rate (tachycardia)
Tremors or muscle twitching
Muscle rigidity (stiffness)
Excessive sweating
Headache
Nausea or vomiting
Shivering or goosebumps
Diarrhea
High blood pressure

If you sense any above-mentioned symptoms while taking Wellbutrin, inform your healthcare provider right away.

What factors contribute to the risk of serotonin syndrome?

Several factors may contribute to the increased risk of developing serotonin syndrome, these include: (4)

Combining serotonin-enhancing medications: If you take a combination of medications that significantly affect serotonin levels like SSRIs (fluvoxamine), SNRIs, tricyclic antidepressants TCAs and monoamine oxidase inhibitors MAOIs, it increases the risk of developing serotonin syndrome.

New medications or dose changes: If you start a new medication that affects serotonin levels or change the dose of your current medication, these changes may lead to a fluctuation in your serotonin levels.

Polypharmacy: If you’re taking multiple medications that may impact serotonin levels simultaneously, this may enhance the risk. Not only prescription medications are included in this but also herbal and over-the-counter medications.

Drug Interactions: Some medications when taken together may interact with each other and increase the levels of serotonin. This is more likely with the drugs that slow down your medication’s metabolism process.

Illicit drug use: Some drugs that people use for recreational purposes like hallucinogens and ecstasy, can increase serotonin and may lead to serotonin syndrome.

Herbal supplements: Even some of the herbal medications that you might be taking like St, John’s wort, can elevate the serotonin levels and may lead to the syndrome. (5)

Medical conditions: Certain health problems like if you have any neurological syndrome or conditions that affect your metabolism, can influence the risk of developing serotonin syndrome.

Individual variability: Some people might be more sensitive to medicine or they carry genes that make serotonin syndrome more likely for them.

Keep in mind that it’s very crucial to tell your doctor about all the medications and herbal supplements you’re taking, so they can evaluate if there is any potential drug interaction between them which might be harmful.

How to diagnose serotonin syndrome?

To figure out if someone is having serotonin syndrome, doctors go for the following diagnostic approaches: (6)

Clinical evaluation: The doctor will assess you to look for any signs and symptoms that occur during serotonin syndrome which are mentioned above in the article.
Medical history: The doctor will ask you about the medications you have been taking in the past, your current medications or any herbal supplements you might be taking. They will review the list to find out if any medication is related to increased serotonin levels.
Elimination of other causes: To rule out that the symptoms are not caused by any other underlying condition, they will run some tests, as some symptoms of serotonin syndrome can mimic other medical conditions.
Observation: Sometimes, especially when the diagnosis is not clear, the doctor will probably keep the patient in observation to monitor the symptoms and see how things develop.
Criteria for diagnosis: Certain rules and criteria help doctors decide if it’s serotonin syndrome or not, like Sternbach criteria that guide the diagnosis.

What to do if you experience Wellbutrin-induced serotonin syndrome?

If you sense that Wellbutrin is causing you strange symptoms and you’re feeling unwell, here’s what you should do: (6)

Stop taking Wellbutrin: If you suspect that Wellbutrin is causing issues stop taking it. However, don’t stop it abruptly and without consulting your doctor as it may lead to withdrawal symptoms.

Seek emergency medical help: Since the symptoms of serotonin syndrome are quite severe and life-threatening, approach the emergency department of your nearest hospital.

Inform healthcare providers: When you go to the hospital, make sure to tell your doctor about all the medications you’ve been taking or using currently. Also, inform them about all the bothersome symptoms you have been experiencing.

Follow medical advice: Ensure to follow the advice and treatment given by your doctor carefully. Do not do anything on your own like stopping the medication or changing its dose.

How to withdraw an overdose of Wellbutrin to avoid serotonin toxicity?

If you have taken an overdose of Wellbutrin or any other medication, seek medical help immediately as time is crucial to avoid toxicity. Your doctor might perform a gastric lavage procedure on you to withdraw the remains of the drug.

Gastric lavage is a very useful medical procedure that involves cleaning out the stomach, either before abdomen surgery or in case of a drug overdose. It’s done using a tube that goes through the nose or mouth into the stomach. A liquid which is usually salt water solution is passed through the stomach and then sucked out along with the stomach contents.

As a pharmacist, In my opinion, Wellbutrin is a safe and well-tolerated medication and has shown promising results in the patients who take it for their depression and anxiety-related problems. However, time-to-time monitoring is essential to keep an eye on your therapeutic outcome and risk profile.

Serotonin syndrome-related cases are not very common with Wellbutrin, but it’s important to keep in mind that people are unique in terms of their brain chemistry and the way their body responds to certain medications. So it’s important to seek guidance from your doctor in this matter and be vigilant about your body changes.