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2. Antidepressant Combinations
Prof. Philip Cowen
Professor of Psychopharmacology
Department of Psychiatry
University of Oxford, UK

3. Antidepressant combination
Widely used but scant evidence base

4. Antidepressant combination
Widely used but scant evidence base
Mirtazapine + SSRI or SNRI
Different MOA: broader neurotransmitter spectrum
Carpenter LL, Yasmin S, Price LH. A double-blind, placebo-controlled study of antidepressant augmentation with mirtazapine. Biological psychiatry Jan 15;51(2):183-8.

5. Antidepressant combination
Widely used but scant evidence base
Mirtazapine + SSRI or SNRI
Different MOA: broader neurotransmitter spectrum
Bupropion + SSRI or SNRI (common in the US)
NA and DA enhancement

6. Antidepressant combination
Widely used but scant evidence base
Mirtazapine + SSRI or SNRI
Different MOA: broader neurotransmitter spectrum
Bupropion + SSRI or SNRI (common in the US)
NA and DA enhancement
Low evidence base
STAR*D : adding bupropion was better than adding buspirone on some secondary outcome measures
Trivedi MH, Fava M, Wisniewski SR, et al (2006) Medication augmentation after the failure of SSRIs for depression. New England Journal of Medicine, 354: 1243–52.

7. Antidepressant Combinations
Start at a low dose
Decrease in risk of drug interactions
Mirtazapine 15 mg/day
Bupropion 150 mg/day

8. Antidepressant Combinations
Start at a low dose
Decrease in risk of drug interactions
Mirtazapine 15 mg/day
Bupropion 150 mg/day
If low dose is well tolerated and effective
Increase towards a normal dose
Watch out for side effects and drug interactions

9. Key Points
Based on pharmacological reasoning, clinicians often use two specific antidepressant combinations:
Mirtazapine + SSRI or SNRI
Bupropion + SSRI or SNRI

10. Key Points
Based on pharmacological reasoning, clinicians often use two specific antidepressant combinations:
Mirtazapine + SSRI or SNRI
Bupropion + SSRI or SNRI
Limited evidence

11. Key Points
Based on pharmacological reasoning, clinicians often use two specific antidepressant combinations:
Mirtazapine + SSRI or SNRI
Bupropion + SSRI or SNRI
Limited evidence
Start at low doses

12. Next Presentation: Second-Generation Antipsychotic Augmentation