From the Guidelines
Yes, duloxetine and bupropion can be taken together, but this combination should only be used under medical supervision due to potential increased risk of side effects. This approach, known as combination therapy, may be used when a single antidepressant doesn't adequately relieve symptoms. Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that increases both serotonin and norepinephrine levels, while bupropion works primarily on dopamine and norepinephrine. Their different mechanisms of action can complement each other, potentially providing better symptom relief than either medication alone 1.
According to a systematic review and network meta-analysis published in the Annals of Internal Medicine in 2023, various switch and augmentation strategies involving pharmacologic agents or cognitive therapy rendered similar symptom relief for patients with major depressive disorder 1. The review found that switching to bupropion sustained release or augmenting with bupropion SR were among the strategies that showed similar efficacy.
However, it's essential to note that this combination may increase the risk of side effects such as increased blood pressure, anxiety, agitation, or seizures. Your doctor will need to determine appropriate dosages for each medication based on your specific situation and monitor you for potential drug interactions or side effects. It's crucial to inform your healthcare provider about all medications you're taking, including over-the-counter drugs and supplements, to avoid harmful interactions.
Some key points to consider when taking duloxetine and bupropion together include:
- Monitoring for increased blood pressure and heart rate
- Watching for signs of anxiety, agitation, or seizures
- Adjusting dosages as needed to minimize side effects
- Regular follow-up with your healthcare provider to assess treatment response and potential side effects
- Informing your healthcare provider about all medications, including over-the-counter drugs and supplements, to avoid harmful interactions 1.
Ultimately, the decision to take duloxetine and bupropion together should be made in consultation with a healthcare provider, taking into account the individual's specific needs and medical history.
From the Research
Combination of Duloxetine and Wellbutrin
- The combination of duloxetine and bupropion (Wellbutrin) has been studied in several clinical trials for the treatment of major depressive disorder (MDD) and treatment-resistant depression 2, 3, 4.
- A study published in 2014 found that the combination of duloxetine and bupropion was effective in treating patients with treatment-resistant atypical depression, but the response rate was not significantly different from the placebo group 2.
- Another study published in 2006 found that the combination of duloxetine and bupropion was effective in treating patients with treatment-resistant MDD, with a significant decrease in Clinical Global Impressions (CGI) scores 3.
- A randomized, single-blind study published in 2012 compared the efficacy of duloxetine and bupropion in patients with SSRI-resistant MDD and found no significant difference between the two groups in terms of response and remission rates 4.
Safety and Tolerability
- The combination of duloxetine and bupropion has been found to be generally well-tolerated, with common side effects including nausea, dry mouth, jitteriness/agitation, fatigue/drowsiness, and increased blood pressure 3.
- However, the study published in 2014 found that treatment-emergent adverse events leading to withdrawal were more common among patients receiving the combination of duloxetine and bupropion, particularly at lower doses 2.
Mechanism of Action
- Duloxetine is a dual serotonin-norepinephrine reuptake inhibitor, while bupropion is a norepinephrine-dopamine reuptake inhibitor 5.
- The combination of these two medications may provide a synergistic effect in treating depression, particularly in patients who have not responded to other treatments 3, 4.