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Re: Wellbutrin/Parnate question for SLS » allisonm

Posted by SLS on October 21, 2000, at 11:58:46

In reply to Wellbutrin/Parnate question for SLS, posted by allisonm on October 21, 2000, at 8:22:07

> Scott,
> Is there something written somewhere about adding Parnate to Wellbutrin or any other MAOI to Wellbutrin that I could get a copy of and show to my doctor?
> Thanks.
> Allison

Sorry, Allison, but I could not find on Medline the references that I had expected to. One of the earliest proponents of using a combination of Wellbutrin and Parnate is a doctor John Feighner. I think he practices in San Diego, California at the Feighner Research Institute. Perhaps he would make himself available for a "quickie" with your doctor.

If I run across anything else, I'll post it. I'm surprised that I couldn't come up with more. I know you'll find people who have used Wellbutrin + MAOI in the Psycho-Babble archives.

- Scott


Bupropion–Tranylcypromine for Refractory Depression

The combination of bupropion and tranylcypromine was used safely and successfully in a patient with chronic, treatment-resistant depression.1

A 27-year-old woman had a history of chronic major depression that had been refractory to trials of an SSRI and various TCAs, plus adjunctive methylphenidate. She had been started on 150 mg/day bupropion, and 2 months later, tranylcypromine was added and titrated to 50 mg/day. Her depressive symptoms slowly resolved.

Five months later, bupropion was tapered and stopped. Within 2 weeks her depressive symptoms recurred, but resolved after bupropion was restarted. A subsequent attempt to withdraw tranylcypromine was associated with a recurrence of mood symptoms.

For the last 2 years, she has remained on a regimen of 150 mg bupropion SR b.i.d. and 60 mg/day tranylcypromine, with no recurrence of depression. During that time she had 1 episode of symptomatic hypertension after eating cheese, which was managed at home with nifedipine. She has nifedipine available for a hypertensive crisis, and uses low-dose lorazepam as needed for mild transient episodes of stress-related dysphoria or insomnia.

According to the criteria of Thase and Rush, this patient’s poor response to multiple antidepressant trials classifies her depression at Stage IV resistance, making her a candidate for ECT.2 However, she preferred to stay employed and to receive outpatient treatment.

Discussion: The combination of bupropion and an MAOI is not generally recommended, because it can increase the risk for hypertensive crisis or may risk bupropion toxicity.3,4 However, cautious coadministration of bupropion and tranylcypromine may be a viable therapeutic option in patients who are unresponsive to trials of antidepressants.

1. Pierre J, Gitlin M: Bupropion-tranylcypromine combination for treatment-refractory depression (letter). Journal of Clinical Psychiatry 2000;61 (June):450–451. From UCLA Neuropsychiatric Institute, Los Angeles, Calif.

2. Thase M, Rush A: When at first you don’t succeed: sequential strategies for antidepressant nonresponders. Journal of Clinical Psychiatry 1997;58 (suppl 13):23–29.
3. Kaplan H, Sadock B, eds. Comprehensive Textbook of Psychiatry. 6th ed. Baltimore, Md: Lippincott, Williams & Wilkins; 1995.

4. Product information. Bupropion (Wellbutrin). Glaxo Wellcome. May 1997.

Drug Trade Names: bupropion—Wellbutrin; lorazepam—Ativan; methylphenidate—Ritalin;
nifedipine—Adalat, Procardia; tranylcypromine—Parnate




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