Insomnia can be a side effect

Dear Dr. Roach: My doctor started me on Wellbutrin 150 mg XL for depression, but I have had terrible insomnia. She said it would get better in two to four weeks, but I am having severe anxiety due to not sleeping.

Do you have any suggestions? — N.M.N.

Bupropion (Wellbutrin) is an antidepression medicine in another kind of class from medicines like Prozac or Celexa, which are SSRIs and have a very different side-effect profile.

Bupropion seldom causes the sexual side effects often noted with SSRIs, and more often causes weight loss than weight gain.

However, bupropion must be used with extreme caution or not at all in people with a seizure disorder. Other side effects include dry mouth, nausea or dizziness, and your doctor is right that most often these will go away within the two to four weeks she mentioned.

Insomnia can be a real problem.

The dose of 150 mg is better tolerated than 300 mg, and the XL formulation also tends to reduce side effects. However, in some people, enough of the medicine is left in the system to make it hard to sleep. In that case, one approach is to use a smaller dose of the shorter-acting formulation while the person is getting used to the medication.

Behavioral treatments to help sleep — getting regular exercise (but not right before bed), avoiding bright lights and computer or television screens before bed, and avoiding caffeine after noon — may certainly help and are worth trying.

Finally, people who have some anxiety with depression may not do well with bupropion, because it does tend to be stimulating.

People with depression and fatigue, and excess sleeping are excellent candidates for bupropion.