Is it okay to use bupropion (Wellbutrin) 150 mg in the morning and mirtazapine (Remeron) 15 mg at night?

From the Guidelines

It is generally acceptable to use bupropion 150 mg in the morning and mirtazapine (Remeron) 15 mg at night, but this combination should only be taken under a doctor's supervision. These medications work differently in the brain - bupropion primarily affects dopamine and norepinephrine, while mirtazapine affects serotonin and norepinephrine - and are sometimes prescribed together for depression that hasn't responded adequately to a single medication.

Key Considerations

• Taking bupropion in the morning is appropriate as it can be stimulating and might interfere with sleep if taken later in the day, as suggested by the guidelines for managing depression 1.
• Mirtazapine is typically taken at night because it causes sedation in many people, which can help with sleep, with a recommended initial dosage of 7.5 mg at bedtime and a maximum dosage of 30 mg at bedtime 1.
• However, this combination may increase the risk of seizures in susceptible individuals and could potentially cause serotonin syndrome, though this is uncommon.
• Side effects might include dry mouth, constipation, increased heart rate, and changes in blood pressure.

Monitoring and Adjustment

• Never adjust these medications without consulting your healthcare provider, as proper dosing and monitoring are essential for safety and effectiveness, as recommended by the American College of Physicians 1.
• Clinicians should assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy 1.
• Treatment should be modified if the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy for major depressive disorder 1.

From the Research

Bupropion and Remeron Combination

• The provided studies do not directly address the combination of bupropion 150 mg in the morning and Remeron 15 mg at night 2, 3, 4, 5, 6.
• However, the studies suggest that bupropion can be used in combination with other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), to enhance antidepressant response and reduce side effects 5, 6.
• Bupropion is generally well tolerated, with a favorable acceptability and tolerability profile, and has a minimal effect on sexual function, comparable or lower rates of somnolence than placebo, and is associated with lower rates of weight gain and sedation than some other commonly used antidepressants 3, 4.
• Remeron (mirtazapine) is not mentioned in the provided studies, but it is known to be an antidepressant with a different mechanism of action than bupropion.
• The combination of bupropion and Remeron may be used in clinical practice, but the provided studies do not provide direct evidence for its safety and efficacy.

Dosage and Administration

• The studies suggest that bupropion can be administered in various formulations, including immediate release, sustained release, and extended release, with different dosing schedules 2, 3, 4.
• The recommended dosage of bupropion is typically maintained at 450 mg/day or less in a divided schedule to minimize the risk of seizures 2.
• The dosage of 150 mg in the morning is within the recommended range, but the studies do not provide specific guidance on the combination with Remeron 15 mg at night.

Safety and Efficacy

• The studies suggest that bupropion is an effective and generally well-tolerated antidepressant, with a favorable safety profile 2, 3, 4.
• However, the combination of bupropion and Remeron may have potential interactions or side effects that are not addressed in the provided studies.
• Further research is needed to determine the safety and efficacy of this combination, and patients should be closely monitored by a healthcare professional if this combination is used.