Rejection Sensitive Dysphoria and Wellbutrin (Bupropion)

Ahhh, Wellbutrin. It’s been a trusted friend to so many who struggle with emotions and ADHD. And if your main problem is rejection sensitive dysphoria, you may be wondering if it could help you too.

But is Wellbutrin actually a good treatment for rejection sensitive dysphoria? Wellbutrin (bupropion) is not typically prescribed for rejection sensitive dysphoria. There is no evidence that it helps with this symptom, but it is often used to treat disorders where rejection sensitivity is a common symptom, including depression and ADHD.

With this said, it’s also important to know there is no evidence that Wellbutrin doesn’t work for rejection sensitivity either. So there is still a possibility that it may work for this symptom in some people. But it’s probably not the first drug you should try.

What Medications Work for Rejection Sensitive Dysphoria?

To understand what medications work for rejection sensitive dysphoria, it helps to understand exactly what we are talking about.

Rejection sensitive dysphoria is a term that has been popularized by William W. Dodson, a board-certified psychiatrist who has specialized in treating adults with attention deficit hyperactivity disorder (ADHD) since 1994.

Over the years, Dodson noticed a pattern of rejection sensitivity in his patients with ADHD and searched the scientific literature to see if anyone else had noticed this pattern too.

He found that this type of rejection sensitivity was often written about in people labeled as having atypical depression in the 60s and 70s. This label was usually applied to people with major depression with mood reactivity and other symptoms including excessive sleeping, extreme fatigue causing heaviness in arms and legs, excessive eating, and interpersonal rejection sensitivity.

Back then, no one thought adults could have ADHD and the connection between ADHD and emotional dysregulation was unknown. Since then, new evidence has emerged and we know that adults can in fact have ADHD and emotional dysregulation is a common component of the disorder.

Because of this, Dodson believes that most of these patients were likely misdiagnosed with atypical depression when their underlying problem was actually ADHD. In addition, he thinks emotional dysregulation very often manifests as rejection sensitive dysphoria in people with ADHD.

Dodson went on to use monoamine oxidase inhibitors (MAOIs), a common treatments for atypical depression, in many of his ADHD patients and found success. He also began using two alpha agonists called guanfacine and clonidine. These are ADHD medications that can also reduce sympathetic (fight or flight) reactivity) and seem to work in about 60% of his ADHD patients with rejection sensitive dysphoria.

But what if you don’t respond to these medications? Or if your physician doesn’t think you’re a good candidate for them? Should you try Wellbutrin?

Well, that has to be up to you and your physician, but I explored the scientific literature to see what it says on the matter.

Does Science Support the Use of Wellbutrin for Rejection Sensitivity?

Most of what we know about rejection sensitive dysphoria and ADHD is mostly based upon the clinical evidence of a few physicians. There have not been any controlled trials of medications specifically for rejection sensitive dysphoria published.

But like Dodson, we can take some clues from what is written in the literature about atypical depression.

Unfortunately, the research on this is slim as well, and I couldn’t find evidence that Wellbutrin worked well for the rejection sensitivity in patients with atypical depression.

In a study that used Wellbutrin in combination with duloxetine in treatment resistant patients with major depression with atypical features, only five patients (21.7%) receiving duloxetine and a placebo vs. six (26.1%) patients on the Wellbutrin combination achieved response. This shows that Wellbutrin only works a little better than a placebo for atypical depression and there were no reports that it specifically reduced rejection sensitivity.

Several studies, including this one, found that Wellbutrin improved excessive sleeping and fatigue in patients with major depression, which are hallmark features of atypical depression, but again, there were no reported changes in rejection sensitivity.

Wellbutrin can work pretty well for depression as well as fatigue and excessive sleeping. But the scientific literature doesn’t make Wellbutrin look like a promising treatment for rejection sensitive dysphoria. Again, though, the research is so limited, we can’t say definitively that Wellbutrin won’t work either.

And that’s where anecdotal information may be helpful. Are there any reports of individuals seeing a reduction in the rejection sensitivity dysphoria when they use Wellbutrin?

Rejection Sensitive Dysphoria and Wellbutrin: Reports from Individuals

I used Wellbutrin for well nearly ten years and although it helped me function overall by treating my symptoms of depression, particularly my fatigue and excessive sleeping, it didn’t do anything to help improve my rejection sensitive dysphoria. In fact, I think my rejection sensitivity increased over those years.

In addition, I saw a worsening of my anxiety symptoms while taking Wellbutrin, with full blown panic attacks so bad that I ended up at the ER because I legit thought I was dying of a stroke. So unfortunately for me, Wellbutrin was not a solution to rejection sensitive dysphoria at all.

I’ve reached out to a few other people I know with rejection sensitive dysphoria who have used Wellbutrin and like me, none found that it was helpful for rejection sensitive dysphoria either.

To widen my research, I also searched the web for reports in forums and blogs, but came up almost empty, except for this review by someone with the username of 3MShellie on Drugs.com:

“This has been completely life changing. I suffered with Anxiety/Disthymia/ADHD. From near constant panic and self hatred and sadness and not seeing a future to being content, happy, balanced, bright… the ME I remember/want to be. I cried when I felt it kick in because I didn’t remember how to be this calm- with ADHD I’m REALLY emotionally reactive. This took the bad feelings down SEVERAL notches to “there, but normal/manageable.” I keep trying to summon the bad feelings I had before, like poking at a healing bruise, but I CAN’T. I tend to call my anxiety RSD (rejection sensitive dysphoria) caused by a life of being undiagnosed ADHD. I do have decreased appetite but I also take adderall so it’s probably more that. I also want to lose weight so I’m not worried about it.”

That sounds really hopeful. I am so happy for this person and hope they are still experiencing these benefits months and years down the line. But a part of me wonders if this person is experiencing the placebo effect. Without a controlled trial, all anecdotal evidence, including incredibly rosy reviews like this have to be taken with a grain of salt.

But again, just because something doesn’t work for others, doesn’t mean it won’t work for you. Hopefully one day we will have way more scientific evidence on rejection sensitive dysphoria as well as more evidence on what drugs work for it, but until then, your best bet may be a lot of trial and error with a well-trained psychiatrist. And that trial and error may possibly include Wellbutrin, particularly if you suffer from depression or ADHD.

Final Takeaways

So overall, it seems unlikely to me that Wellbutrin (bupropion) will work for rejection sensitive dysphoria and it’s unlikely that a physician would prescribe it for that use anyway as it’s not approved for that problem specifically.

Instead, your doctor may find Wellbutrin a good fit for you if you have a co-occurring condition that Wellbutrin is known to work for such as depression, seasonal affective disorder, or ADHD. These conditions are often seen alongside rejection sensitive dysphoria and can make rejection sensitive dysphoria worse if left untreated. So getting those things under control may be the first step in getting the rejection sensitive dysphoria at a manageable level.