The combination of duloxetine and bupropion for treatment-resistant major depressive disorder

George I. Papakostas, John J. Worthington, Dan V. Iosifescu, Gustavo Kinrys, Alana M. Burns, Lauren B. Fisher, Caitlin H. Homberger, David Mischoulon, Maurizio Fava

Research output: Contribution to journalArticlepeer-review

45 Scopus citations

Abstract

Our objective was to assess the effectiveness and safety of the combination of duloxetine and bupropion for treatment-resistant major depressive disorder (TRD). A retrospective chart review was conducted to identify patients with major depressive disorder (MDD) who had not experienced full remission of symptoms following an adequate trial of either duloxetine (n = 3) or bupropion (n = 7), and who then received the combination of these two antidepressants for TRD. Ten patients [37.2 ± 11.3 years of age, five women, baseline Clinical Global Impressions (CGI) scale score 4.4 ± 1.1], seven of whom had not remitted following treatment with bupropion (330 ± 67 mg, 20.5 ± 12.2 weeks), and three of whom had not remitted following treatment with duloxetine (90 ± 30mg, 18 ± 2 weeks) received at least 4 weeks of combination treatment. The CGI was administered when the combination was first prescribed, and following 8.8 ± 4.0 (range, 4-16) weeks of treatment. There was a significant decrease in CGI-S (Severity) scores (4.4 ± 1.1 to 2.1 ± 0.9, P < .0001) fallowing combination treatment. Three (30%) patients were remitters at follow-up, and six (60%) were responders who did not achieve full symptom remission. The mean maximum adjunctive duloxetine and bupropion doses were 60.0 ± 17.3 mg and 175.0 ± 114.5 mg, respectively. Side effects reported during combination treatment were nausea (n = 2), dry mouth (n = 2), jitteriness/agitation (n = 2), fatigue/drowsiness (n = 2), increased blood pressure (n = 1), increased sweating (n = 1), insomnia (n = 1), pruritus (n = 1), headache (n = 1), sexual dysfunction (n = 1), and weight gain (n = 1). Although preliminary, these results suggest a possible role for the combination of duloxetine and bupropion for TRD.

Original languageEnglish
Pages (from-to)178-181
Number of pages4
JournalDepression and Anxiety
Volume23
Issue number3
DOIs
StatePublished - 2006
Externally publishedYes

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