SSRI + wellbutrin vs MAOI

[WiseOne]

this occurred to me - that with a SSRI and wellbutrin combo you get stimulation of all three neurotransmitters (serotonin, norepinephrine, dopamine) much in the same way you would get with an MAOI. however, with the SSRI/wellbutrin combo you would avoid any potential danger of hypertensive crises which is why MAOIs typically aren't prescribed. Has anyone seen, either in research or their clinical experience, this combo working well for atypical depression or other things that MAOIs would typically be used for? A lot of people seem to like this combo as the wellbutrin seems to counteract some of the SSRI side effects while providing some of its own independent benefits.

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[Shikima]

this occurred to me - that with a SSRI and wellbutrin combo you get stimulation of all three neurotransmitters (serotonin, norepinephrine, dopamine) much in the same way you would get with an MAOI. however, with the SSRI/wellbutrin combo you would avoid any potential danger of hypertensive crises which is why MAOIs typically aren't prescribed. Has anyone seen, either in research or their clinical experience, this combo working well for atypical depression or other things that MAOIs would typically be used for? A lot of people seem to like this combo as the wellbutrin seems to counteract some of the SSRI side effects while providing some of its own independent benefits.

I do this often. Even can add in a SNRI and/or Remeron if necessary.
Depends on the case.

Don't expect medication to quell the fire from psychosocial distress.

 

[splik]

You seem to have a very simplistic understanding of psychopharmacology but I will assume you are not a psychiatrists. Firstly, bupropion definitely can and does cause hypertensive crisis (I've seen this happen) it just doesn't have the same "EAT SMELLY CHEESE AND YOU'LL DIE!!!" rap that MAOIs have. Secondly, it is largely because we have more benign drugs like SSRIs and bupropion that MAOIs have largely fallen into disuse. So I would say that using these newer drugs (SRIs, SNRIs, mirtazapine, bupropion) alone or in combination with each other, has become first, second, and third line in the treatment of depression, including atypical depression. Third, MAOIs come into play when the newer drugs (and TCAs etc) aren't effective. Fourth, MAOIs are effective in the treatment of neurotic/anxiety states (which is essentially what "atypical depression" is) whereas no one is going to be using bupropion for the treatment of obsessionality, panic, hypochondriasis, social anxiety disorder and so on. Fifth, it is debatable how much of the efficacy of MAOIs have to do with "stimulation of all three neurotransmitters" [sic]* it is primarily the inhibition of degradation of 5-HT by MAO-A that we're interested in, but who knows.

So yes, the combination of an SRI/SNRI and buproprion is much beloved by psychiatrists, but it certainly has not obviated the need for MAOIs in limited cases, and would not be expected to be effective for the kinds of neurotic states MAOIs are helpful with. Bear in mind, it is highly unusual in this day and age for pts to be on MAOI monotherapy. Since they will have failed multiple agents, we'll either augment with Lithium, or T3, or combine with a psychostimulant and benzodiazepine. The braver might combine an MAOI and TCA!


*there are many more neurotransmitters than these three, and many more neurotransmitters involved in modulating emotion etc than these three

 

[MLT2MT2DO]

I do this often. Even can add in a SNRI and/or Remeron if necessary.
Depends on the case.

Don't expect medication to quell the fire from psychosocial distress.

I know serotonin syndrome is rare but why would prefer SNRI or TCA with Wellbutrin and an SSRI over an MAOI?

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[Shikima]

I know serotonin syndrome is rare but why would prefer SNRI or TCA with Wellbutrin and an SSRI over an MAOI?

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I would do the same. Not combine anything with MAOI. Maybe I wrote my agreement wrongly.