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Author: Admin | 2025-04-28
Publication: American Journal of PsychiatryTo the Editor: We describe an apparent antidepressant response to a combination of venlafaxine and bupropion, despite previous unsuccessful trials of each agent alone.Ms. A, a 42-year-old white woman, presented with dysthymia and major depression that had been successfully treated with fluoxetine, 15 mg/day, for 5 years. Fluoxetine induced sexual dysfunction, which led to attempts to substitute other antidepressants as follows: sertraline, 75 mg/day for 4 weeks; paroxetine, 30 mg/day for 6 weeks; bupropion, 75 mg/day for 4 weeks; and venlafaxine, 75 mg/day for 8 weeks. There were no therapeutic responses to these trials, and adverse drug reactions prompted a return to fluoxetine. For instance, bupropion caused agitation, and venlafaxine induced headaches, sedation, and sexual dysfunction. Ms. A then elected a trial without medication. Three months later, a moderate to severe major depression began and developed over 4 months. Nefazodone, up to 500 mg/day, was taken over 10 weeks but was discontinued because of lack of response. Next, bupropion was retried and increased over 7 weeks up to 225 mg/day. After 3 weeks at this dose, no improvement was seen, and severe urinary urgency developed as an adverse drug reaction. Therefore, bupropion was tapered to 187.5 mg/day and venlafaxine, 12.5 mg/day, was added. Seven days after this addition and 5 months after the onset of the major depression, symptoms improved. Full remission was achieved after 2 weeks of the combination, with final daily doses of bupropion being 187.5 mg and venlafaxine being 37.5 mg. The depression
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