Can Seroquel Be Given With Wellbutrin?
Yes, Seroquel (quetiapine) and Wellbutrin (bupropion) can be given together safely, and this combination is commonly used in clinical practice, particularly for bipolar depression and treatment-resistant depression. 1
Safety Profile of the Combination
The American Academy of Family Physicians explicitly recommends this combination as appropriate for clinical use. 1 The key safety consideration relates primarily to bupropion's effect on lowering the seizure threshold, not to any dangerous interaction between the two medications. 1
Primary Safety Concerns
Seizure Risk (Bupropion-Specific):
- Bupropion lowers the seizure threshold and should be avoided in patients with seizure disorders or brain metastases. 1
- Maximum dose should not exceed 300 mg per day to minimize seizure risk. 1
- Quetiapine does not significantly increase seizure risk, so this concern is isolated to the bupropion component. 1
Cardiovascular Monitoring:
- Both medications can affect heart rate and blood pressure, requiring vital sign monitoring, particularly in patients with cardiovascular disease or hypertension. 1
Absolute Contraindications
Do not use this combination in patients with:
- Active seizure disorder or conditions lowering seizure threshold 1
- Uncontrolled hypertension 1
- Concurrent MAO inhibitor use 1
- Pregnancy or active attempts to conceive 1
Required Monitoring
Baseline and Ongoing Assessments:
- Baseline and periodic vital signs (blood pressure, heart rate) 1
- Watch for signs of serotonin syndrome 1
- Monitor for neuropsychiatric effects including suicidal ideation 1
- Assess for seizure activity, particularly with dose escalation 1
Recommended Dosing Strategy
Bupropion Initiation:
- Start at 150 mg once daily 1
- Increase to 150 mg twice daily after 3-7 days if tolerated 1
- Maximum dose: 300 mg/day 1
Clinical Context and Evidence
This combination has demonstrated effectiveness in real-world practice. Data from European psychiatric hospitals showed that combinations of antidepressants with atypical antipsychotics like quetiapine are commonly prescribed for bipolar depression. 2 Additionally, bupropion combinations with other agents have shown efficacy in treatment-resistant depression and can boost antidepressant response. 3
Important Caveat on Serotonin Syndrome
While rare, there is one case report of serotonin syndrome with bupropion combined with SSRIs, potentially related to bupropion's inhibition of cytochrome P450 2D6, which can increase blood levels of other medications. 4 However, this risk appears minimal with quetiapine, which is not primarily serotonergic. The monitoring requirement for serotonin syndrome is precautionary. 1