From the Research
For a patient with seasonal affective disorder (SAD) who is already taking Wellbutrin (bupropion), a good medication option to add would be an SSRI antidepressant such as sertraline (Zoloft), escitalopram (Lexapro), or fluoxetine (Prozac).
Rationale
The combination of Wellbutrin with an SSRI often works well because they have complementary mechanisms of action - Wellbutrin primarily affects dopamine and norepinephrine, while SSRIs target serotonin 1.
Key Considerations
- Typical starting doses would be sertraline 50mg daily, escitalopram 10mg daily, or fluoxetine 20mg daily, with potential increases based on response and tolerability.
- Light therapy (10,000 lux for 20-30 minutes each morning) would also be an excellent non-pharmacological addition to this regimen specifically for SAD.
- Patients should be monitored for potential side effects of the combination, including increased anxiety, insomnia, or elevated blood pressure, particularly during the initial weeks of treatment.
Evidence Base
The most recent and highest quality study, a 2021 Cochrane review, found that fluoxetine was numerically superior to placebo in achieving clinical response, although the confidence interval included both a potential benefit and no benefit of fluoxetine 1.
Clinical Implications
Given the limited evidence for the effectiveness of second-generation antidepressants for SAD, the choice of medication should be based on individual patient factors, such as comorbidities and potential side effects 1.
Monitoring and Follow-up
Regular monitoring of the patient's response to treatment and potential side effects is crucial to ensure optimal management of SAD.