From the Research
There is no significant interaction between Zoloft (sertraline) and Estratest (esterified estrogens/methyltestosterone) that would necessitate switching to Wellbutrin (bupropion). Major drug interaction databases do not list a clinically significant interaction between SSRIs like Zoloft and hormone replacement therapy (HRT) products like Estratest. Patients can generally take both medications together safely without concern for reduced efficacy of either medication. The metabolism of SSRIs occurs primarily through the cytochrome P450 system, while estrogens are metabolized through different pathways, so there is minimal overlap that would cause significant drug interactions.
Some studies have investigated the use of SSRIs in patients with premenstrual syndrome and premenstrual dysphoric disorder, and have found that SSRIs are effective in reducing symptoms 1. However, these studies do not provide evidence of a significant interaction between SSRIs and HRT products like Estratest.
Other studies have compared the efficacy and safety of different antidepressants, including SSRIs and bupropion, and have found that they have similar efficacy but different side effect profiles 2. However, these studies do not provide evidence of a significant interaction between SSRIs and HRT products like Estratest.
Some clinicians may prefer Wellbutrin over SSRIs for other reasons in patients on HRT, such as avoiding potential sexual side effects, but this would be a preference rather than a requirement based on drug interactions. You can continue prescribing SSRIs with HRT for your patients unless there are other patient-specific concerns. If the patient's PCP has specific concerns, direct communication between providers might help clarify the clinical reasoning behind the recommendation.
It's also worth noting that a pilot study found that estrogen therapy did not alter the response rate to antidepressant therapy with sertraline, but may play a role in accelerating the antidepressant response 3. However, this study does not provide evidence of a significant interaction between SSRIs and HRT products like Estratest that would necessitate switching to Wellbutrin.
In summary, based on the available evidence, there is no significant interaction between Zoloft (sertraline) and Estratest (esterified estrogens/methyltestosterone) that would necessitate switching to Wellbutrin (bupropion).