Can a patient take both Wellbutrin (bupropion) and Lexapro (escitalopram)?

Combining Wellbutrin and Lexapro

Yes, patients can safely take both Wellbutrin (bupropion) and Lexapro (escitalopram) together, and this combination is sometimes used clinically for treatment-resistant depression or to mitigate SSRI-related side effects. This combination therapy approach is supported by clinical evidence and practice guidelines.

Mechanism and Rationale

• Wellbutrin (bupropion) is a dopamine and norepinephrine reuptake inhibitor that works differently from Lexapro (escitalopram), which is a selective serotonin reuptake inhibitor (SSRI) 1
• The combination provides complementary neurotransmitter effects:
  • Lexapro primarily affects serotonin pathways
  • Wellbutrin affects dopamine and norepinephrine pathways
• This dual mechanism can be beneficial for patients with inadequate response to monotherapy 1

Clinical Evidence Supporting Combination Use

• Research shows that combining bupropion with SSRIs like escitalopram can be effective for patients who have had an inadequate response to monotherapy 2
• A pilot study demonstrated that the combination of escitalopram and bupropion-SR achieved 50% remission rates in patients with chronic or recurrent major depressive disorder, which is higher than typical SSRI monotherapy 2
• The American College of Physicians recommends combination therapy with two antidepressant agents for patients who have had an inadequate response to monotherapy 1

Specific Benefits of This Combination

1. Enhanced efficacy for depression:

   • The combination may provide better symptom relief than either medication alone for treatment-resistant depression 3
   • Particularly helpful for patients with partial response to either medication alone

2. Mitigation of side effects:

   • Bupropion can help counteract sexual dysfunction caused by escitalopram 1, 3
   • Bupropion is associated with lower rates of sexual side effects compared to SSRIs 1

3. Broader symptom coverage:

   • May better address both mood and energy/motivation symptoms
   • Can help with both anxiety and depression symptoms

Important Precautions and Monitoring

• Seizure risk: Bupropion lowers the seizure threshold. Maximum dose should not exceed 450 mg/day 1
• Drug interactions: Monitor for potential interactions with other medications
• Contraindications:
  • Bupropion should not be used in patients with seizure disorders 1
  • This combination should not be used with monoamine oxidase inhibitors (MAOIs) 4
• Side effect monitoring:
  • Common side effects include insomnia, dry mouth, headache, nausea, and constipation 1
  • Monitor for changes in blood pressure and heart rate

Dosing Considerations

• Typical dosing ranges:
  • Escitalopram: 10-20 mg daily
  • Bupropion: 150-400 mg daily (often divided doses for immediate release or once daily for extended-release) 2
• Start with lower doses and titrate up based on response and tolerability
• In research settings, mean effective doses were approximately:
  • Escitalopram: 18 mg/day
  • Bupropion-SR: 327 mg/day 2

Conclusion

The combination of Wellbutrin and Lexapro is a clinically supported approach that may provide better outcomes than monotherapy for some patients, particularly those with treatment-resistant depression or those experiencing sexual side effects from SSRI treatment. As with any medication regimen, regular monitoring for efficacy and side effects is essential.