Combining Wellbutrin (Bupropion) with 30mg Lexapro (Escitalopram)
Yes, combining bupropion with 30mg escitalopram is generally safe and well-tolerated, with evidence supporting this combination for treatment-resistant depression and to counteract SSRI-associated side effects. 1, 2
Evidence for Safety and Efficacy
The combination of bupropion and SSRIs like escitalopram has been studied specifically and shows favorable outcomes:
An open-label study of escitalopram combined with bupropion-SR demonstrated a 62% response rate and 50% remission rate, with only 6% of participants discontinuing due to side effects. 1 The mean doses used were escitalopram 18mg/day and bupropion-SR 327mg/day, suggesting that 30mg escitalopram with bupropion is within studied parameters.
A comprehensive review of bupropion combined with SSRIs/SNRIs concluded that this combination is generally well-tolerated, can boost antidepressant response, and can reduce SSRI-associated sexual side effects. 2
A clinical case series of 27 patients showed 70% experienced greater symptomatic improvement with SRI-bupropion combinations compared to monotherapy, with adverse effect risks similar to monotherapy. 3
Dosing Considerations
Your 30mg escitalopram dose is higher than the FDA-approved maximum of 20mg daily, though it falls within the range used in research studies:
The FDA-approved maximum dose for escitalopram is 20mg daily for depression. 4 However, the combination study used doses up to 20mg escitalopram with bupropion-SR up to 400mg/day. 1
When combining these medications, conservative dosing with close monitoring is recommended. 3 Your 30mg escitalopram represents an off-label higher dose that should be carefully monitored.
Safety Profile and Monitoring
The combination has a favorable safety profile with no unique serious interactions between bupropion and SSRIs:
Common side effects include sexual dysfunction (41%), insomnia (22%), low energy (15%), and tremor (11%), similar to monotherapy rates. 3
No seizures were reported in the clinical series, though bupropion does lower seizure threshold and should be avoided in patients with seizure disorders. 4, 3
Bupropion should not be combined with MAO inhibitors (contraindicated within 14 days). 4
Monitor blood pressure and heart rate, as both medications can affect cardiovascular parameters. 4
Clinical Caveats
Important considerations for this combination:
Escitalopram at 30mg exceeds standard dosing and may increase risk of QT prolongation and other dose-dependent side effects. 4 Consider whether this higher dose is necessary or if the combination allows for dose reduction of escitalopram.
Bupropion is contraindicated in patients with eating disorders, seizure history, or those undergoing abrupt discontinuation of alcohol or benzodiazepines. 4
For patients under 24 years old, monitor for suicidal thoughts and behaviors due to bupropion's black box warning. 4
The combination may be particularly useful if you're experiencing SSRI-induced sexual dysfunction or inadequate response to escitalopram alone. 2