COMBINING SEROTONIN REUPTAKE INHIBITORS AND BUPROPION IN PARTIAL RESPONDERS TO ANTIDEPRESSANT MONOTHERAPY

Background: Many patients with affective illness show partial or other wise unsatisfactory responses to standard treatments, encouraging tria ls of combinations of pharmacologically dissimilar antidepressants. Me thod: 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 symp toms and risks of adverse events when an SRI and bupropion were combin ed. 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% incide nce 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 monit oring, combinations of SRIs with bupropion in this uncontrolled clinic al series appeared to be safe and often more effective than monotherap y.