Use of Bupropion in Combination with Serotonin Reuptake Inhibitors

Department of Psychiatry, University of California, San Diego, La Jolla, USA.
Biological Psychiatry (Impact Factor: 10.26). 03/2006; 59(3):203-10. DOI: 10.1016/j.biopsych.2005.06.027
Source: PubMed


Incomplete symptom remission and sexual side effects are common problems for which bupropion often is added to treatment with selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs) for patients with major depressive disorder (MDD). This article reviews the literature on combining bupropion with SSRIs or SNRIs. We used MEDLINE to select studies that included patients diagnosed with MDD treated with any combination of bupropion and an SSRI or SNRI, either to enhance antidepressant response or to ameliorate antidepressant-associated sexual dysfunction. Bibliographies of located articles were searched for additional studies. Controlled and open-label studies support the effectiveness of bupropion in reversing antidepressant-associated sexual dysfunction, whereas open trials suggest that combination treatment with bupropion and an SSRI or SNRI is effective for the treatment of MDD in patients refractory to the SSRI, SNRI, or bupropion alone. The available data suggest that, although not an approved indication, the combination of bupropion and either an SSRI or an SNRI is generally well tolerated, can boost antidepressant response, and can reduce SSRI or SNRI-associated sexual side effects. Additional randomized controlled studies are needed to answer important questions, such as those regarding optimal dose and duration of treatment.

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    • "Of special importance, bupropion-SR also has well-demonstrated efficacy and tolerability as an augmenting agent (Zisook et al., 2006). Evidence from STAR*D suggested that, as a switching agent, bupropion-SR was at least as effective as other commonly used SS/NRIs and, as an augmenting agent, is possibly more effective than other commonly used augmenting agents (Zisook et al., 2006). Finally, using bupropion-SR as both the switching agent and as one of the augmentation agents allows direct comparison of the effectiveness of switching and augmenting with the same agent in a secondary analysis. "
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    ABSTRACT: Because two-thirds of patients with Major Depressive Disorder do not achieve remission with their first antidepressant, we designed a trial of three "next-step" strategies: switching to another antidepressant (bupropion-SR) or augmenting the current antidepressant with either another antidepressant (bupropion-SR) or with an atypical antipsychotic (aripiprazole). The study will compare 12-week remission rates and, among those who have at least a partial response, relapse rates for up to 6 months of additional treatment. We review seven key efficacy/effectiveness design decisions in this mixed "efficacy-effectiveness" trial. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Full-text · Article · Aug 2015
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    • "The current study was an acute experiment, but in light of the Kennedy Study, chronic dosing and further study in animal models are warranted. Certainly clinical studies support the co-administration of SSRIs and SNRIs with bupropion in patients despite our lack of understanding of the neurochemistry involved (Kennedy et al. 2002; for review see Zisook et al. 2006). The current study would suggest that an unanticipated beneficial additive or synergistic action on multiple neurotransmitter systems may, in part, explain such clinical benefit. "
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    ABSTRACT: Venlafaxine is recognised as an effective treatment for depression and is known to inhibit the reuptake of serotonin (5-HT) and noradrenaline (NA). Another antidepressant, bupropion, acts to inhibit dopamine (DA) and NA reuptake and is commonly co-administered with other antidepressants to improve the efficacy of the antidepressant effect. The present study was designed to investigate the acute effect of combining the 2 drugs on extracellular levels of 5-HT, DA, and NA in rat frontal cortex using brain microdialysis, with the drugs being administered by intraperitoneal injection (i.p). Bupropion (10 mg/kg body mass, i.p.) alone had no effect on extracellular 5-HT levels, whereas venlafaxine (10 mg/kg, i.p.) alone significantly elevated extracellular 5-HT over basal values. As expected, bupropion alone elevated extracellular dopamine above basal values at 40 min post-drug administration, and this effect lasted for a further 2 h. Venlafaxine alone did not statistically elevate extracellular dopamine. The co-administration of venlafaxine with bupropion resulted in a dramatic increase in extracellular dopamine, and this effect was significantly greater than that seen with bupropion alone. In the frontal cortex, NA was elevated by bupropion alone and venlafaxine alone, relative to the control animals. The combination of bupropion and venlafaxine resulted in a marked elevation of NA.
    Preview · Article · Apr 2012 · Canadian Journal of Physiology and Pharmacology
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    • "Bupropion is an antidepressant with properties of norepinephrine- and dopamine-reuptake inhibition instead of serotonergic action. The combination of bupropion and an SSRI or SNRI is widely used as an option that has a triple reuptake inhibitor-like action, and bupropion also seems to reverse certain adverse effects associated with serotonergic agents and to enhance the efficacy of initial antidepressants.41,42 On the other hand, in this study when the initial antidepressants were newer dual-action and other antidepressants including TCAs, other (50%) and newer dual-action antidepressants (44.5%), respectively, were frequently chosen as the concomitant antidepressant. "
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    ABSTRACT: This study aimed to investigate antidepressant prescribing patterns, including initial choice, switching and combining, and concomitant use of non-antidepressant agents, for depressive disorders in naturalistic clinical care settings in Korea. Patients with depressive disorder were recruited from both outpatient and inpatient settings in 18 hospitals from all over Korea. Treatment was performed in naturalistic patterns based on each clinician's decision. Data were collected on the prescription of antidepressants and concomitant agents from baseline to 12-week follow-up. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed initial antidepressant (48.9%), followed by newer dual-action antidepressants (45.8%). When an SSRI was the initial antidepressant, 46.2% of patients whose medication was changed were moved to newer dual-action antidepressants, and 67.4% of combination cases were combined with newer dual-action ones. When a newer dual-action antidepressant was the initial antidepressant, 70.6% of patients whose medication was changed were moved to SSRIs, and other antidepressants including tricyclic antidepressants were most commonly added for combination treatment (50% of combination cases). During the treatment period, 20.6% of antidepressants prescribed were augmented by non-antidepressant agents, and 75.1% were used concomitantly with anxiolytics or hypnotics. The most commonly used concomitant non-antidepressant agent was quetiapine. The selection of antidepressants and the concomitant use of non-antidepressant agents are becoming increasingly diversified, and the results of this study reflect changes in the prescribing pattern in actual Korean practices.
    Full-text · Article · Sep 2011 · Psychiatry investigation
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