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Papakostas, G.I. et al.

Papakostas, Worthington, Iosifescu, Kinrys, Burns, Fisher, Homberger, Mischoulon, Fava,

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

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+/-30 mg, 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) following 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. Depression and Anxiety 23:178-181, 2006. (c) 2006 Wiley-Liss, Inc.[1]

References

The combination of duloxetine and bupropion for treatment-resistant major depressive disorder. Papakostas, G.I., Worthington, J.J., Iosifescu, D.V., Kinrys, G., Burns, A.M., Fisher, L.B., Homberger, C.H., Mischoulon, D., Fava, M. Depression and anxiety. (2006) [Pubmed]

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