Can Abilify (Aripiprazole), Lexapro (Escitalopram), and Wellbutrin (Bupropion) be taken together?

Combination of Abilify, Lexapro, and Wellbutrin

Yes, Abilify (aripiprazole), Lexapro (escitalopram), and Wellbutrin (bupropion) can be taken together with appropriate monitoring, as this combination targets different neurotransmitter systems and may be beneficial for treatment-resistant depression. 1

Mechanisms and Rationale

• Lexapro (escitalopram): Selective serotonin reuptake inhibitor (SSRI) that primarily affects serotonin levels
• Wellbutrin (bupropion): Norepinephrine-dopamine reuptake inhibitor that affects norepinephrine and dopamine systems
• Abilify (aripiprazole): Atypical antipsychotic that acts as a partial agonist at dopamine and serotonin receptors

This combination provides complementary mechanisms of action:

• The combination of escitalopram and bupropion has shown higher response rates (62%) and remission rates (50%) than SSRI monotherapy alone 2
• Adding aripiprazole to antidepressant therapy (including SSRIs/SNRIs or bupropion) has demonstrated effectiveness for treatment-resistant depression 3

Monitoring Considerations

When using this combination, monitor for:

1. Vital signs: Regular monitoring of blood pressure and heart rate is essential, as bupropion can affect these parameters 1

2. Seizure risk: Bupropion lowers the seizure threshold, requiring caution in patients with seizure history 4

3. Psychiatric symptoms: Watch for:

   • Increased anxiety or agitation
   • Insomnia
   • Emergence of suicidal thoughts, particularly in patients under 24 1

4. Metabolic parameters: Monitor:

   • Weight (combination with aripiprazole may lead to weight gain of 2-3 kg over 52 weeks) 3
   • Fasting glucose and cholesterol levels 3

Contraindications and Precautions

This combination should be avoided in patients with:

• History of seizures
• Recent MAO inhibitor use (within 14 days) 4
• Uncontrolled hypertension
• Severe anxiety disorders
• History of stimulant abuse
• Severe hepatic impairment 1

Dosing Considerations

• Start with lower doses of each medication and titrate gradually
• Consider administering bupropion in the morning to minimize insomnia
• Extended-release formulations may help reduce peak concentration effects 1
• Typical dosing ranges:
  • Escitalopram: 10-20 mg/day
  • Bupropion-SR: 150-400 mg/day 2
  • Aripiprazole: Typically started at lower adjunctive doses

Potential Benefits

1. Enhanced antidepressant response: The combination of bupropion with an SSRI can boost antidepressant response in patients who have had inadequate response to monotherapy 5

2. Reduced sexual side effects: Bupropion can help ameliorate SSRI-associated sexual dysfunction 5

3. Broader symptom coverage: This combination addresses multiple neurotransmitter systems, potentially helping with various depressive symptoms 1

Potential Risks and Side Effects

• Common side effects: Fatigue, somnolence, akathisia 3
• Metabolic effects: Potential for weight gain and changes in glucose/lipid parameters 3
• Drug interactions: Potential for pharmacokinetic interactions, though these specific medications have relatively low interaction potential compared to older antidepressants 6

Alternative Approaches

If this combination is not tolerated or effective:

• Consider SNRIs like duloxetine as an alternative 1
• Mirtazapine could be an option for patients with sleep disturbances 1
• Cognitive-behavioral therapy can be an effective adjunctive treatment 1

Remember that while this combination can be effective, close monitoring is essential, particularly during the initial treatment phase and after any dose adjustments.