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SNRI+Wellbutrin

Discussion in 'Psychiatry' started by firedoor, Aug 10, 2011.

  1. firedoor

    firedoor let it bleed
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    Just curious if anyone has any knowledge about or experience with this combination? And is it as safe as an SSRI+Wellbutrin?
     
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  3. whopper

    whopper Former jolly good fellow
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    Hmm well Wellbutrin is a DRI and an NRI. So it's not like an SNRI with Wellbutrin will somehow get you an NRI that wasn't happening with an SSRI with Wellbutrin.

    I've never bothered to try an SNRI + Wellbutrin over an SSRI and Wellbutrin.

    There's so many augmentation strategies that I've never bothered to compare the two you mentioned.

    Strangely, I'm getting a few patients on Cymbalta that works well for them, but no SSRI works.
    I've been forced into finding that because several patients come to me already on Cymbalta, sometime down the road the insurance company tells me they won't pay for it unless we try two other meds first, and the two other meds didn't work at all. I'm wondering if there's a specific gene encoding something on the neuron that Cymbalta just works well with where other meds don't work.
     
    #2 whopper, Aug 10, 2011
    Last edited: Aug 11, 2011
  4. firedoor

    firedoor let it bleed
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    I don't have the exact reference at hand, but I recall that many patients respond differentially to serotonergic vs. noradrenergic agents. Maybe that's what's going on?

    I'm also wondering if Cymbalta+Wellbutrin or Effexor/Pristiq+Wellbutrin is too much NRI.
     
  5. firedoor

    firedoor let it bleed
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    Depress Anxiety. 2006;23(3):178-81.
    The combination of duloxetine and bupropion for treatment-resistant major depressive disorder.

    Papakostas GI, Worthington JJ 3rd, Iosifescu DV, Kinrys G, Burns AM, Fisher LB, Homberger CH, Mischoulon D, Fava M.
    Source

    Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, 02114, USA. [email protected]

    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 +/- 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.

    PMID: 16528701 [PubMed - indexed for MEDLINE]
     
  6. whopper

    whopper Former jolly good fellow
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    No one to my knowledge has been able to demonstrate that NRIs by themselves treat depression. Strattera was the only attempt I'm aware of, but it turned out to not have any significant effect on depression.

    NRIs, however, do seem to have some type of use with SNRIs and the only DNRI we got (Wellbutrin).

    NRI can increase BP, reduce anxiety, reduce chronic pain, and have some potential in treating ADHD. NRI should not cause sexual side effects.
     

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