From the Research
For patients with major depressive disorder who are not fully responding to Lexapro 20mg or Buspar 7.5mg, the most effective addition is bupropion (Wellbutrin) at doses of 150-300mg daily, as it has been shown to be effective in addressing symptoms like low energy and motivation that may persist 1. When considering adding medications to Lexapro or Buspar, it's essential to target specific remaining symptoms, such as anxiety, sleep problems, or lack of energy.
- Bupropion works differently than Lexapro by affecting dopamine and norepinephrine rather than serotonin, making it a good option for patients with persistent symptoms.
- Other options include adding mirtazapine 15-30mg at bedtime, which can help with sleep and anxiety while boosting antidepressant effects, or low-dose aripiprazole (Abilify) 2-5mg daily, which has shown effectiveness as an add-on treatment 2.
- Buspirone (Buspar) itself can be increased to 15-30mg daily in divided doses if you're not already at that level.
- A recent study found that matching patients to the most effective antidepressants based on their medical history can improve remission rates, and a decision aid is available to help clinicians make informed decisions 3. It's crucial to start at low doses and increase gradually while monitoring for side effects and improvement, and these medication changes should only be made under medical supervision, as drug interactions can occur, particularly when combining multiple medications affecting serotonin.