Combining Serotonin Reuptake Inhibitors and Bupropion in Partial Responders to Antidepressant Monotherapy

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.