Combining serotonin reuptake inhibitors and bupropion in partial responders to antidepressant monotherapy

J Clin Psychiatry. 1997 Apr;58(4):137-45. doi: 10.4088/jcp.v58n0401.

Abstract

Background: Many patients with affective illness show partial or otherwise unsatisfactory responses to standard treatments, encouraging trials of combinations of pharmacologically dissimilar antidepressants.

Method: Records of consecutive outpatients with affective disorders only partially responsive to treatment with a serotonin reuptake inhibitor (SRI) or bupropion, alone, were reviewed for changes in specific symptoms and risks of adverse events when an SRI and bupropion were combined.

Results: Greater symptomatic improvement was found in 19 (70%) of 27 subjects during a mean +/- SD of 11 +/- 14 months of combined daily use of bupropion (243 +/- 99 mg) with an SRI (31 +/- 16 mg fluoxetine-equivalents) than with either agent alone. Adverse effect risks were similar to those associated with each monotherapy, with a > 10% incidence of sexual dysfunction (N = 11, 41%), insomnia (N = 6, 22%), anergy (N = 4, 15%), and tremor (N = 3, 11%) during combined therapy; there were no seizures.

Conclusion: With conservative dosing and close monitoring, combinations of SRIs with bupropion in this uncontrolled clinical series appeared to be safe and often more effective than monotherapy.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • 1-Naphthylamine / analogs & derivatives
  • 1-Naphthylamine / therapeutic use
  • Adult
  • Aged
  • Ambulatory Care
  • Anxiety Disorders / drug therapy*
  • Anxiety Disorders / psychology
  • Bupropion / administration & dosage
  • Bupropion / adverse effects
  • Bupropion / therapeutic use*
  • Depressive Disorder / drug therapy*
  • Depressive Disorder / psychology
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Dysthymic Disorder / drug therapy
  • Dysthymic Disorder / prevention & control
  • Epilepsy / chemically induced
  • Epilepsy / epidemiology
  • Female
  • Fluoxetine / therapeutic use
  • Fluvoxamine / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Panic Disorder / drug therapy
  • Panic Disorder / psychology
  • Serotonin Uptake Inhibitors / administration & dosage
  • Serotonin Uptake Inhibitors / adverse effects
  • Serotonin Uptake Inhibitors / therapeutic use*
  • Sertraline
  • Treatment Outcome

Substances

  • Serotonin Uptake Inhibitors
  • Fluoxetine
  • Bupropion
  • 1-Naphthylamine
  • Fluvoxamine
  • Sertraline