Candidate Patients for Dextromethorphan-bupropion


Dr Andrew Cutler and Dr Greg Mattingly talk about patient profiles they consider for treatment with dextromethorphan-bupropion.


This agent is approved in adults only (18+ years) currently. The clinicians have used it successfully across genders, ages, and occupations. However, there are some relative cautions and warnings to consider:

- Active eating disorders (anorexia, bulimia): Bupropion can lower seizure threshold, so caution is warranted in active seizure disorders as well.

- Recent psychotic episodes: The glutamatergic mechanism could theoretically worsen psychosis.

- Pregnancy/fetal development: There are specific warnings about potential fetal harm, though not an absolute contraindication.

Outside of those considerations, the clinicians emphasize it can be used broadly, not just in treatment resistant depression. It is approved for MDD after only 1-2 prior failures. Based on positive patient experiences, their group now offers it as a second line treatment after initial antidepressant non-response.

They note that with efficacy rates exceeding current options and generally good tolerability, cost/coverage is the only barrier to using it as a potential first line agent in many patients. They see it as beneficial across the depression spectrum but especially helpful for residual symptoms like anhedonia and concentration difficulties not addressed by traditional antidepressants.

They see the agent as an important new tool with a wide range of appropriate candidates, moving up their treatment algorithms based on superior efficacy/tolerability, but exercise caution in the labeled populations like active psychosis or eating disorders.

This summary was AI-generated and edited for clarity and readability.

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