Is Zyprexa (Olanzapine) with Wellbutrin (Bupropion) effective for Major Depressive Disorder (MDD)?

From the Guidelines

The combination of Zyprexa (olanzapine) and Wellbutrin (bupropion) is a viable treatment option for major depressive disorder (MDD), particularly in cases where standard antidepressant therapy alone has not been effective, as supported by evidence from studies such as 1 and 1.

Key Considerations

• Olanzapine is an atypical antipsychotic that, when combined with antidepressants, can enhance treatment response in depression.
• Wellbutrin works differently from many other antidepressants by primarily affecting dopamine and norepinephrine rather than serotonin.
• This combination may be especially helpful for patients with depression who have not responded to SSRIs or who experience significant fatigue or lack of motivation.

Dosage and Administration

• Typical dosing might include Wellbutrin at 150-450 mg daily (often divided) and Zyprexa at lower doses of 2.5-10 mg daily.

Potential Side Effects and Monitoring

• The combination carries important considerations including potential side effects like weight gain, metabolic changes, and sedation from olanzapine, while Wellbutrin may cause insomnia, anxiety, or seizures at higher doses.
• Regular monitoring of weight, blood glucose, lipids, and blood pressure is necessary, as indicated by studies such as 1 and 1.

Clinical Supervision

• This combination should only be used under close medical supervision with regular follow-up appointments to assess effectiveness and manage any side effects. Some key points to consider when using this combination include:
• The evidence from studies such as 1 and 1 suggests that augmenting with bupropion may decrease depression severity more than augmentation with other agents.
• However, the quality of evidence is generally low to moderate, and more research is needed to fully understand the effectiveness and safety of this combination.
• As with any treatment for MDD, it is essential to carefully weigh the potential benefits and risks and to closely monitor patients for any adverse effects.

From the Research

Treatment of Major Depressive Disorder (MDD)

• The treatment of MDD often involves the use of antidepressants, either alone or in combination with psychotherapy 2.
• Bupropion, a second-generation antidepressant, has been shown to be effective in the treatment of MDD, with a favorable acceptability and tolerability profile 2.
• Combination therapy of bupropion with other second-generation antidepressants has been shown to improve outcomes in patients failing antidepressant monotherapy 2, 3.

Use of Ziprasidone (Zyprexa) and Bupropion (Wellbutrin) for MDD

• There is limited evidence to suggest the use of ziprasidone (Zyprexa) and bupropion (Wellbutrin) in combination for the treatment of MDD 3.
• However, augmentation with certain second-generation antipsychotics, such as quetiapine or aripiprazole, has been shown to be effective in patients with treatment-resistant depression (TRD) 3.
• Bupropion has been shown to be effective in combination with other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), in patients with MDD 4.

Treatment-Resistant Depression (TRD)

• TRD is a common condition, affecting over a third of patients with MDD, and is characterized by a lack of response to first-line antidepressant treatments 3.
• Treatment options for TRD include switching to a different antidepressant, combining more than one antidepressant, or augmenting an antidepressant with another medication 3, 5.
• A shared decision-making approach is recommended to guide treatment selection and address each patient's individual needs 3.