Combining Wellbutrin (Bupropion) and Cymbalta (Duloxetine)
Yes, Wellbutrin (bupropion) and Cymbalta (duloxetine) can be safely combined for treatment of depression, particularly in cases of treatment-resistant depression or to address specific symptom profiles. 1, 2
Efficacy and Clinical Applications
- The combination of bupropion and duloxetine may be particularly beneficial for patients with treatment-resistant depression who have not achieved full remission with either medication alone 2
- This combination can be effective for addressing different neurotransmitter systems simultaneously - duloxetine acts as a serotonin-norepinephrine reuptake inhibitor (SNRI) while bupropion primarily affects dopamine and norepinephrine 3
- Adding bupropion to an SNRI like duloxetine may help boost antidepressant response in patients with incomplete symptom remission 4
- The combination may be especially helpful for patients with atypical depression features, though higher numbers of atypical features may predict poorer response 5
Dosing Considerations
- When combining these medications, typical dosing ranges are:
- Bupropion: 150-400 mg/day
- Duloxetine: 30-120 mg/day 1
- It's generally recommended to start with lower doses of both medications and titrate gradually when using them in combination 1
- In one study examining this combination, the mean maximum adjunctive doses were 60 mg for duloxetine and 175 mg for bupropion 2
Safety and Side Effects
- Common side effects of this combination may include:
- Nausea, dry mouth, jitteriness/agitation, fatigue/drowsiness
- Less commonly: increased blood pressure, increased sweating, insomnia, headache, sexual dysfunction 2
- The combination is generally well-tolerated with no greater side effect burden than monotherapy 6
- Caution is advised when using bupropion in patients with seizure disorders as it lowers seizure threshold 1
- The combination may potentially increase blood pressure and heart rate, requiring monitoring 1
- This combination is contraindicated in patients with:
- Poorly controlled seizure disorders
- Eating disorders
- Severe hepatic impairment 1
Monitoring Recommendations
- Blood pressure and heart rate should be monitored regularly due to the potential for increases with this combination 1
- Watch for signs of hepatotoxicity, primarily associated with duloxetine 1
- Monitor for potential drug interactions, though both medications have relatively favorable drug-drug interaction profiles compared to some other antidepressants 3
- Be alert for rare but serious adverse effects such as seizures (with bupropion) or serotonin syndrome (with duloxetine) 3
Alternative Approaches
- Before combining these medications, consider sequential trials of each medication as monotherapy 1
- Other antidepressant combinations with potentially fewer interaction concerns might be considered for some patients 1
- Augmentation with non-antidepressant medications (such as atypical antipsychotics or mood stabilizers) is another option for treatment-resistant depression 1