BUPROPION AND SERTRALINE COMBINATION TREATMENT IN REFRACTORY DEPRESSION

A sizeable minority of depressed patients, estimated at 15-20%, suffer chronic symptoms which often persist despite appropriate treatment. T he search for new, more efficacious pharmacotherapies has included tes ting existing medications for additional therapeutic effects, such as in combination treatment. Four treatment-refractory patients who prese nted to the authors for clinical care are described, in which the comb ination of bupropion and sertraline was effective for a major depressi ve episode. None of the patients experienced adverse effects. Two carr ied the diagnosis of unipolar depression, and two, bipolar disorder. A ll had prior adequate, but ineffective, separate trials of buproprion and a selective serotonin re-uptake inhibitor (SSRI), including sertra line. All had chronic depression with multiple failed medication treat ments, arguing against the alternative explanation that their improvem ent represented a placebo response or spontaneous remission. The effic acious combination of sertraline and bupropion may be due to synergism of its two distinct antidepressant mechanisms involving serotonergic, dopaminergic and noradrenergic systems.