Combination treatment was well tolerated with no greater side effect burden than monotherapy. Limitations of this study include the nonrandomized design, open-label treatment, and small sample size. Abstract Objective: There are limited data comparing medication strategies in patients with treatment-resistant depression.
In a meta-analysis of 10 randomized controlled trials of depression with anxiety, outcomes for anxiety were not significantly different between bupoprion and the SSRIs, including several large trials where it was compared head-to-head with an SSRI. The same authors of that paper reanalyzed the data looking specifically at patients with very high levels of anxiety. Those studies were done in patients with anxious depression, but what about patients with a separate anxiety disorder.
Here bupropion may not fare as well, unless that anxiety disorder is the generalized type GAD. In GAD, bupropion performed just as well as escitalopram Lexapro in a small head-to-head controlled trial. This one is partly true. Bupropion along with desvenlafaxine does carry a higher risk of causing initiation insomnia than the other antidepressants, but the difference is very small.
Most second-generation antidepressants can cause insomnia, and the rates are similar. Depression impairs sleep architecture in several ways. Bupropion reverses[7] those changes, while the SSRIs tend to make them worse. On the other hand, bupropion does stand out among the antidepressants as having a positive effect on energy.
Dr Aiken does not accept honoraria from pharmaceutical companies but receives royalties from W. Pharmacopsychiatry, ;51 4 Second-generation anti-depressants and risk of new-onset seizures in the elderly. Clin Toxicol Phila , ;56 12 Why isn't bupropion the most frequently prescribed antidepressant? J Clin Psychiatry ;66 5 SSRI drugs are often used as first line therapy for depressive disorders due to their efficacy and relative safety.
They unfortunately are associated with certain side effects such as weight gain and sexual dysfunction, which are often challenging to deal with for many patients. Wellbutrin is unrelated to other antidepressant medications and the exact mechanism of action is unclear. It thought to work by increasing the amount of the dopamine in the brain, but the antidepressant effects of the drug are known to occur at doses below what is needed to have a significant effect on dopaminergic systems. It does not appear that Wellbutrin has any effect on serotonin.
The few studies that have evaluated use of Wellbutrin and Celexa are generally positive. One review showed that the combination of the Wellbutrin and SSRI drugs are well tolerated, can improve the overall antidepressant response and, perhaps most importantly, can reduce or negate the side effects of SSRI drugs e. Another study , that specifically looked at the combination of Wellbutrin and Celexa, had similar results. The combination was more effective than either drug alone and there was not an increased incidence of side effects.
It should be noted that using Celexa and Wellbutrin together is not a FDA approved indication, but initially studies are promising and warrants further research. In regard to the interaction mentioned, there is a minor one that needs to be considered if you and your doctor are looking to combine the two drugs.
Wellbutrin may increase the concentrations of Celexa in the body and a minor dose adjustment to Celexa may be necessary. Be sure to talk to your about about this possible therapy option so you can have the appropriate prescribed doses of each.
He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs.
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