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.


METHODS
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.


CONCLUSIONS
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.
Bodkin
J A
JA
Consolidated Department of Psychiatry, Harvard Medical School, Boston, Mass, USA.
Lasser
R A
RA
Wines
J D
JD
Gardner
D M
DM
Baldessarini
R J
RJ
D015057:1-Naphthylamine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000523:psychology; D016642:Bupropion / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D019263:Dysthymic Disorder / Q000188:drug therapy / Q000517:prevention & control; D004827:Epilepsy / Q000139:chemically induced / Q000453:epidemiology; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D016666:Fluvoxamine / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000188:drug therapy / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D020280:Sertraline; D016896:Treatment Outcome
D015057:1-Naphthylamine; D016642:Bupropion; D005473:Fluoxetine; D016666:Fluvoxamine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline