Can you take zoooft and bupropion together?

Combining Zoloft (Sertraline) and Bupropion

No recommendation can be made regarding the use of Zoloft (sertraline) and bupropion in combination due to insufficient evidence on safety and efficacy. 1

Safety Considerations

• The combination of sertraline (an SSRI) and bupropion has potential risks including serotonin syndrome, which can manifest as myoclonic jerks, confusion, agitation, and autonomic dysfunction 2
• Bupropion inhibits cytochrome P450 2D6 (CYP2D6), which may increase blood levels of SSRIs like sertraline, potentially leading to adverse effects 2
• Both medications individually have different side effect profiles:
  • Bupropion commonly causes nervousness, insomnia, dry mouth, and has a risk of seizures at higher doses 3, 4
  • SSRIs like sertraline typically cause nausea, sexual dysfunction, and gastrointestinal effects 3

Potential Benefits

• Some case reports suggest the combination may be beneficial in treatment-resistant depression due to their complementary mechanisms of action 5
• Bupropion primarily affects dopamine and norepinephrine, while sertraline affects serotonin, potentially providing broader neurotransmitter coverage 3, 4
• Bupropion may counteract some SSRI-induced side effects such as sexual dysfunction and fatigue 4

Risk Factors and Contraindications

• The combination is contraindicated with:
  • Monoamine oxidase inhibitors (MAOIs) 6
  • Severe hepatic impairment 6
  • Poorly controlled seizure disorders (bupropion lowers seizure threshold) 6
• Caution is advised in:
  • Elderly patients who may be more susceptible to adverse effects like delirium 7
  • Patients with cardiovascular disease due to potential effects on blood pressure and heart rate 6

Monitoring Recommendations

• If the combination is used, close monitoring is essential for:
  • Early signs of serotonin syndrome (confusion, agitation, muscle twitching, hyperthermia) 2
  • Changes in blood pressure and heart rate 6
  • Neurological symptoms including seizures 4
  • Mental status changes, especially in elderly patients 7

Alternative Approaches

• Consider sequential trials of each medication as monotherapy before attempting combination therapy 6
• Other antidepressant combinations or augmentation strategies may have better established safety profiles 6
• For smoking cessation combined with depression treatment, bupropion alone may be sufficient 4

Dosing Considerations

• If combination therapy is attempted despite limited evidence:
  • Start with lower doses of both medications and titrate gradually 6
  • Typical dosing ranges: bupropion 150-400 mg/day; sertraline 50-200 mg/day 6
  • Prescribe for relatively short durations initially and reassess regularly 1

While some patients may benefit from this combination, the lack of formal studies and guidelines on combined sertraline and bupropion therapy necessitates extreme caution and close monitoring if this approach is considered.