I often sit with patients who feel like they’ve hit a wall. They’ve been fighting depression, sometimes for years, and the treatments they’ve tried just haven’t lifted the fog. It can be a deeply frustrating and isolating experience. When we’re in that place, we start looking for different approaches. One newer option we might discuss is a combination medication called Dextromethorphan; Bupropion, also known by its brand name, Auvelity. It’s a unique tool in our kit for treating major depressive disorder in adults.
So, let’s talk about what this is and how it works.
Understanding Dextromethorphan; Bupropion
It sounds complicated, but it’s really just two well-known medicines working together in a new way. You might recognize Dextromethorphan from cough syrups. Bupropion is a long-standing antidepressant, what we call an NDRI (norepinephrine-dopamine reuptake inhibitor).
The magic is in the combination. The bupropion component helps boost certain mood-regulating chemicals in your brain, and it also slows down how your body processes the dextromethorphan. This allows the dextromethorphan to work on a different brain pathway related to mood. It’s a bit of a tag-team approach to help rebalance your brain’s chemistry.
Before You Start: A Crucial Conversation
This medication isn’t for everyone, and it’s so important that we have a completely open conversation before starting it. Your safety is always the top priority.
I need to know your full health story. Be sure to tell me if you have a history of any of the following:
- An eating disorder like anorexia or bulimia
- Bipolar disorder, schizophrenia, or a family history of suicide
- Seizures, a head injury, or a brain tumor
- Heart disease, high blood pressure, or a past stroke
- Kidney or liver problems
- Diabetes, especially if you take medication for it
- Glaucoma
- If you drink alcohol regularly or have a history of substance use
- If you are pregnant, planning to be, or are breastfeeding
Being honest about these things helps me make sure Dextromethorphan; Bupropion is a safe choice for you.
How to Take This Medication Correctly
Getting the routine right is key. Here are the simple rules:
- Swallow the tablet whole with a glass of water.
- Do not cut, crush, or chew it. The tablet is designed to release the medicine slowly over time. Crushing it releases it all at once, which can be dangerous.
- You can take it with or without food. If your stomach feels a bit off, try taking it with a small meal.
- If you miss a dose, just skip the missed dose. Don’t double up. Take your next scheduled dose at its normal time.
- Don’t stop taking it suddenly. If we decide to stop this medication, we’ll do it slowly to avoid side effects.
Potential Drug Interactions to Be Aware Of
This is one of the most important parts of our chat. This medication can interact with many others. The list below isn’t exhaustive, but it covers the most critical ones. Always give me a full list of everything you take—prescriptions, over-the-counter meds, herbs, and supplements.
| Medication or Substance | Why It’s a Concern |
|---|---|
| DO NOT TAKE WITH THESE: | |
| MAOIs (like Marplan, Nardil, Parnate) | This is a dangerous combination that can cause a life-threatening reaction called serotonin syndrome or a hypertensive crisis. You must have a 14-day gap between taking these medications. |
| Other medicines containing bupropion (Wellbutrin, Zyban) or dextromethorphan (many cough syrups) | Taking more of the same active ingredients increases your risk of overdose and severe side effects. |
| Linezolid or Methylene Blue (IV) | These also have MAOI properties and carry the same risks. |
| DISCUSS THESE WITH YOUR DOCTOR: | |
| Alcohol | Alcohol can increase your risk of seizures when combined with this medication. It’s best to avoid it. |
| Certain heart or blood pressure meds (metoprolol, flecainide) | This medication can affect how your body processes them, potentially altering their levels and effects. |
| Other antidepressants or antipsychotics | Combining these can increase the risk of side effects, including serotonin syndrome. |
| Digoxin, Tamoxifen, Warfarin | Levels of these drugs may be affected, requiring dose adjustments and monitoring. |
Watching for Side Effects
Every medication has potential side effects. Many are mild and go away on their own. But some are serious and need immediate attention. It’s my job to make sure you know what to look for.
The most important thing to watch for, especially when you first start or change a dose, is any new or worsening thoughts of suicide or depression. This includes sudden shifts in your mood or behavior. If this happens, you need to call us or get help right away.
Here’s a breakdown of what you might experience.
| Side Effect Guide | |
|---|---|
| Call Your Doctor Immediately If You Experience: | |
| Mood or Behavior Changes | Anxiety, agitation, panic attacks, irritability, aggression, or thoughts of self-harm. |
| Allergic Reactions | Skin rash, itching, hives, or swelling of the face, lips, tongue, or throat. |
| Seizures | Any convulsive activity. |
| Severe Skin Reactions | Redness, blistering, or peeling skin, especially with a fever or flu-like symptoms. |
| Eye Pain or Vision Changes | Sudden eye pain, blurry vision, or seeing halos around lights. This could be a sign of glaucoma. |
| More Common Side Effects (Let us know if they persist or are bothersome): | |
| Dizziness or Drowsiness | Be careful with driving or operating machinery until you know how this affects you. |
| Dry Mouth | Sipping water, chewing sugar-free gum, or sucking on hard candy can help. |
| Headache | Usually mild and temporary. |
| Diarrhea | Stay hydrated. Let us know if it’s severe. |
| Excessive Sweating | A known side effect of many antidepressants. |
Take-Home Message
- Dextromethorphan; Bupropion is a combination prescription medicine used to treat major depressive disorder.
- Always swallow the tablets whole. Never crush, cut, or chew them.
- Be completely open with your doctor about your entire health history and all other medications you take, especially MAOIs.
- Avoid alcohol while on this medication, as it can increase your risk of seizures.
- Watch closely for any changes in mood, behavior, or thoughts of self-harm, especially in the first few weeks. Call for help immediately if this occurs.
- We will have regular check-ins to monitor your progress and manage any side effects.
Starting a new medication for depression can feel like a big step, but it’s also a hopeful one. Remember, the goal is to find what works for you. We’re in this together, and I’m here to answer your questions and walk with you on this path. You’re not alone.