From the Research
The combination of mirtazapine and Wellbutrin (bupropion) should be used with caution in treating depression in Parkinson's disease patients due to the potential risk of extrapyramidal symptoms, as evidenced by a large pharmacoepidemiological study 1. When considering this combination, it is essential to weigh the potential benefits against the risks. Mirtazapine may help with sleep disturbances, anxiety, and appetite issues common in Parkinson's disease, while Wellbutrin's dopaminergic and noradrenergic effects might counteract fatigue and cognitive slowing without worsening motor symptoms. However, this approach requires careful monitoring as Wellbutrin can potentially increase the risk of seizures and may worsen tremors in some patients. Additionally, mirtazapine's sedative effects could exacerbate daytime sleepiness. Some key points to consider when using this combination include:
- Starting with low doses of both medications, such as 7.5-15mg of mirtazapine at bedtime and 150mg of Wellbutrin once daily, and gradually increasing as needed and under close medical supervision.
- Regularly assessing both psychiatric symptoms and Parkinson's motor symptoms to promptly identify any adverse effects.
- Patients should be instructed to report any worsening of tremors, balance issues, confusion, or significant mood changes immediately to their healthcare provider. It is also important to note that other studies have suggested that certain antidepressants, including bupropion, may be associated with a lower risk of extrapyramidal symptoms compared to others 2, but the most recent and highest quality study 1 should be prioritized when making treatment decisions.