Bupropion (Wellbutrin®) versus Duloxetine (Cymbalta®)
Based on "Essential Psychopharmacology"
written by Stephen M. Stahl, MD, PhD
Bupropion advantages over Duloxetine
- Does not cause in sexual problems, hypertension, or urinary retention.
- Safe for patients with increased intraocular pressure.
Duloxetine advantages over Bupropion
- Large body of evidence of duloxetine efficacy in chronic pain syndromes.
- Duloxetine can be useful for patients with concomitant chronic pain issues or anxiety.
- Suitable for patients with eating disorders or with risk of seizures.
Main differences between Bupropion and Duloxetine
|• Wellbutrin®||• Cymbalta®|
|Antidepressant, Norepinephrine-dopamine reuptake inhibitor||Antidepressant, Serotonin-norepinephrine reuptake inhibitor|
|Mechanism of action|
|• Blocks the reabsorption of norepinephrine and dopamine.
• Bupropion has mild stimulant effects.
|• Blocks the reabsorption of serotonin and noradrenaline.
• Duloxetine also inhibits dopamine reuptake to a lesser extent.
|• Major depression|
|• Seasonal affective disorder
• Smoking cessation
|• Generalized anxiety disorder
• Social anxiety disorder
• Chronic musculoskeletal pain
• Diabetic peripheral neuropathic pain
|• Hypersensitivity to bupropion
• Seizure disorder
• Conditions that increase the risk of seizures, e.g. severe head trauma, CNS infection, anorexia nervosa, bulimia nervosa, benzodiazepine withdrawal
• Concomitant use of MAOIs
|• Hypersensitivity to duloxetine
• Uncontrolled narrow-angle glaucoma (risk of increased intraocular pressure)
|Frequent adverse effects|
|Headache, dry mouth, nausea, insomnia 3, agitation, aggravation of psychosis.||Nausea, somnolence, headache, insomnia, dizziness, constipation, and dry mouth 2.|
|Bupropion is particularly useful for patients suffering from sexual dysfunction or excessive sedation caused by other medications.||Duloxetine is may be useful for patients who have concomitant pain symptoms.|
SSRI-resistant major depression
|Results of randomized, single-blind, comparison of duloxetine with bupropion in the treatment of SSRI-resistant depression 1.||Bupropion XL||Duloxetine|
60 to 70%
60 to 70%
30 to 40%
30 to 40%
|Conclusion||Patients who do not respond sufficiently to SSRIs may be treated with antidepressants that have different mechanisms of action|
- Bupropion (Wellbutrin) Facts
- Duloxetine (Cymbalta) Facts
- Duloxetine vs Venlalaxine
- Bupropion vs Escitalopram
- Bupropion vs Methylphenidate
- Bupropion vs Sertraline
- Bupropion vs Venlafaxine
- 1. Rosso G, Rigardetto S, Bogetto F, Maina G. A randomized, single-blind, comparison of duloxetine with bupropion in the treatment of SSRI-resistant major depression. J Affect Disord. 2012 Jan;136(1-2):172-6. PubMed
- 2. Carter NJ, McCormack PL. CNS Drugs. 2009;23(6):523-41. PubMed
- 3. Aubin HJ. Drugs. 2002;62 Suppl 2:45-52. PubMed
Published: March 24, 2014
Last updated: October 24, 2017