Can I use Wellbutrin (bupropion) and Naltrexone and Prozac (fluoxetine) to treat binge eating disorder and depression?

Using Wellbutrin (Bupropion), Naltrexone, and Prozac (Fluoxetine) for Binge Eating Disorder and Depression

The combination of bupropion-naltrexone is recommended for treating binge eating disorder with comorbid depression, but adding fluoxetine is not recommended due to increased risk of adverse effects without clear additional benefits. 1

Medication Options for Binge Eating Disorder with Depression

Bupropion-Naltrexone Combination

• Bupropion-naltrexone extended-release (ER) is conditionally recommended by the American Gastroenterological Association for weight management and has shown effectiveness for patients with depressed mood 1
• This combination works through dual mechanisms:
  • Bupropion (antidepressant): Increases dopamine levels and activates anorexigenic neurons
  • Naltrexone (opioid antagonist): Enhances bupropion's effects by blocking auto-inhibitory activity 1
• Research shows the combination is effective for both binge eating and depressive symptoms:
  • A randomized controlled trial found significant improvements in binge eating remission with naltrexone-bupropion (31.3%) compared to placebo (17.7%) 2
  • An open-label study demonstrated concurrent improvement in both binge eating and depressive symptoms in patients with major depressive disorder 3

Fluoxetine (Prozac)

• Fluoxetine is FDA-approved for depression, OCD, bulimia nervosa, and panic disorder 4
• While effective for depression, adding fluoxetine to bupropion-naltrexone:
  • Provides no clear additional benefit for binge eating disorder 5
  • Increases risk of drug interactions and side effects
  • May create redundancy in therapeutic mechanisms

Treatment Algorithm

1. First-line option: Bupropion-naltrexone ER

   • Starting dose: 1 tablet (naltrexone 8mg/bupropion 90mg) daily in the morning
   • Titration: Weekly escalation to maintenance dose of 2 tablets twice daily
   • Effectiveness assessment: After 12 weeks, if <5% weight loss is achieved, consider discontinuation 1

2. Monitoring requirements:

   • Vital signs: Regular blood pressure monitoring (avoid in uncontrolled hypertension)
   • Mental health: Watch for neuropsychiatric effects, especially in patients under 24 years
   • Weight and binge eating behaviors: Track frequency of episodes and weight changes

3. Important contraindications:

   • Seizure disorders or history of seizures
   • Use of opioid medications (due to naltrexone component)
   • Uncontrolled hypertension
   • Use of MAOIs (within 14 days)
   • Eating disorders such as anorexia nervosa 6

Special Considerations

Benefits of Bupropion-Naltrexone for This Condition

• Addresses both depression and binge eating through complementary mechanisms
• May assist with weight management, which is often a concern in binge eating disorder
• Could help with smoking cessation if that's a comorbid condition 1

Important Cautions

• Bupropion may lower seizure threshold - avoid in patients with epilepsy or seizure risk factors 1, 7
• Bupropion is not recommended as first-line treatment for anxiety disorders and may exacerbate anxiety symptoms 7
• The combination should be discontinued before procedures requiring opioid pain management 1
• Long-term cardiovascular safety remains unclear, as cardiovascular outcome trials were terminated early 1

Alternative Options

• For patients with significant anxiety alongside depression and binge eating, an SSRI like fluoxetine alone might be more appropriate 7
• For patients with obesity and binge eating without depression, lisdexamfetamine or topiramate may be considered 8

By focusing on the bupropion-naltrexone combination rather than adding fluoxetine, you can effectively target both binge eating disorder and depression while minimizing potential drug interactions and side effects.