Venlafaxine and bupropion combination therapy in a case of treatment-resistant depression

OBJECTIVE: To report the therapeutic efficacy of venlafaxine and bupropion in a patient with treatment-refractory major depression. CASE SUMMARY: A 21-year-old white woman with chronic and recurrent major de pression presented with lack of response to several antidepressants, On exa mination, the patient exhibited neurovegetative signs of depression, guilt feelings, and suicidal ideation. The patient was administered venlafaxine 7 5 mp three times daily. The dose was titrated to 150 mg three times daily o ver the next month. Later bupropion was instituted up to 100 mg three times daily over a four-month period. The patient responded favorably to combina tion therapy and has remained free of depression for approximately 23 month s. DISCUSSION: Venlafaxine and bupropion are antidepressant agents with unique pharmacologic profiles, each effective in the treatment of depression. Rec ent data indicate that combinations of selective serotonin-reuptake inhibit ors and bupropion can convert partial response to full response in patients with treatment-resistant depression. We considered whether a combination o f venlafaxine and bupropion would reduce the depressive symptoms of a patie nt who was unresponsive to various classes of psychotropic agents, Gradual administration of venlafaxine and bupropion acted synergistically to signif icantly reduce depressive symptoms (p < 0.002) and significantly increase s ocial function (p < 0.002) over a period of eight months. CONCLUSIONS: To our knowledge this is the first report of successful combin ation therapy with venlafaxine and bupropion in treatment of chronic recurr ent and refractory major depression.