From the Guidelines
The combination of Wellbutrin (bupropion), Lexapro (escitalopram), and Buspar (buspirone) can be considered for patients with major depressive disorder who have not responded to single-medication approaches, with evidence suggesting that augmenting with bupropion may decrease depression severity more than augmentation with buspirone 1. When considering this combination, it's crucial to understand the mechanisms of action for each medication: Wellbutrin primarily affects dopamine and norepinephrine, Lexapro works on serotonin as a selective serotonin reuptake inhibitor (SSRI), and Buspar targets serotonin receptors to help with anxiety.
- Typical dosing might include Wellbutrin XL 150-300mg once daily,
- Lexapro 10-20mg once daily,
- and Buspar 5-15mg twice daily, though dosages must be individualized based on patient response and tolerance. This combination may be particularly helpful for patients who experience depression with anxiety and who haven't achieved full symptom relief with a single medication.
- Side effects can include headache, nausea, insomnia, dry mouth, and sexual dysfunction. It's essential to start these medications gradually under medical supervision to minimize side effects and monitor for any adverse reactions or drug interactions, with moderate-quality evidence showing no difference in overall discontinuation rates between SGAs (like fluoxetine, fluvoxamine, or paroxetine) and cognitive behavioral therapy (CBT) at 8 to 14 weeks of follow-up 1. Regular follow-up appointments are crucial to assess effectiveness and adjust dosages as needed, considering the low-quality evidence showing no difference in response, remission, or depression severity for augmentation of citalopram treatment with another SGA (bupropion or buspirone) versus augmentation with cognitive therapy 1.
From the Research
Wellbutrin, Lexapro, and Buspar Combination
- The combination of Wellbutrin (bupropion) and Lexapro (escitalopram), an SSRI, has been studied in various contexts 2, 3, 4.
- A case study reported serotonin syndrome induced by a combination of bupropion and SSRIs, highlighting the potential risks of this combination 2.
- Another study found that combining escitalopram and bupropion as initial treatment did not result in quicker remission or a higher remission rate than monotherapy with either drug 3.
- A pooled analysis of 10 studies found that SSRIs were more effective than bupropion in treating major depressive disorder with high levels of anxiety (anxious depression) 4.
Buspar (Buspirone) Combination
- There is limited information available on the specific combination of Wellbutrin, Lexapro, and Buspar.
- However, buspirone is often used in combination with SSRIs, such as Lexapro, to enhance anxiolytic effects.
- The safety and efficacy of combining bupropion with buspirone and an SSRI like Lexapro would need to be carefully evaluated, considering the potential risks of serotonin syndrome 2.
Clinical Considerations
- When prescribing bupropion, particularly in combination with other medications like SSRIs and buspirone, it is essential to monitor patients closely for potential adverse effects, including serotonin syndrome 2, 4.
- The use of bupropion in children, young adults, and adults has been increasing, with depression and ADHD being common indications 5.
- Further research is needed to inform prescribing decisions, particularly in populations with unknown efficacy or safety profiles 5.