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If you’ve been trying to dial in the right dosage for your mental health care, you may have wondered if two medications are better than one for your symptoms. In particular, you might be interested in Wellbutrin and Prozac, also known as bupropion and fluoxetine, respectively. Can you add a second medication to an antidepressant? Can you safely take Wellbutrin and Prozac together?
Combining medications can greatly improve your health, but combining the wrong ones can also create dangerous circumstances. This is a particularly important distinction in the world of mental health medications.
Taking Wellbutrin and Prozac together can be either beneficial or potentially dangerous, depending on certain factors. This is why talking to your healthcare provider about existing medications is always important before taking a new prescription.
That said, there are some reasons a person might want to take both Wellbutrin and Prozac — but there’s not enough research to confidently say the combination is entirely safe. Here’s what to know.
Before we dive into why Wellbutrin and Prozac could pose dangers, it’s vital to understand what each medication does and why using them together can offer some additional benefits.
We’ve broken this down into more manageable chunks of information below.
Wellbutrin (also known as generic bupropion) is an antidepressant. But it doesn’t fit into the typical antidepressant classes like selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants. Instead, it operates as a sort of one-member band for depression treatment.
Wellbutrin treatment works on norepinephrine and dopamine receptors to influence mood instead of serotonin. This means depression that isn’t responsive to serotonin-based treatments can sometimes be better managed by this medication.
It also can help people manage smoking habits (because of that dopamine interaction). And for people who experience sexual dysfunction symptoms as a result of their antidepressants, Wellbutrin can be an alternative that doesn’t reduce libido or, in men, cause erectile dysfunction.
Prozac (and the generic fluoxetine) is also an antidepressant — but one from the more common selective serotonin reuptake inhibitor class. This medication can treat depression symptoms by helping your brain to better manage its supply of serotonin, the neurotransmitter that stabilizes mood.
Why do Prozac and Wellbutrin work well together in treating certain medical conditions?
There aren’t a ton of studies or clinical trials examining the combination of bupropion and fluoxetine. But from what is available, it looks like there could be some notable benefits to combining the two.
For instance, a small 2002 study looked at bupropion alongside several antidepressants, including fluoxetine, for its impact on sexual dysfunction. They found that fluoxetine’s sexual dysfunction side effects were improved by the addition of bupropion to patients’ treatment plans.
Another 2002 animal study looked at the combined use of both medications and found that bupropion and fluoxetine could increase the antidepressant effects of one another. Fluoxetine increased the impact of bupropion’s dopamine and norepinephrine effects.
Of course, combining these two medications can cause adverse effects as well, and some of the drug interactions can be very serious.
One reason you might not be prescribed Wellbutrin for mental health, for instance, is that it’s been found to increase the risk of both seizures and suicidal thoughts in some studies. Now, it's unclear if this medication directly causes seizures or suicidal thoughts.
However, if you're at risk of either of these developing or have experienced them in the past, bupropion can increase your chances of it happening again or worsening.
Fluoxetine, likewise, can increase your risk of seizures and is recommended with caution to people with a history of seizures. In some cases, it can also increase your risk of suicidal ideation.
These severe adverse effects may be rare. But if you do take two medications with the potential to increase your risk, it’s almost like you’re increasing that risk twice over.
Maybe most importantly, we should note that there are circumstances in which both medications simply aren’t necessary. Studies have shown bupropion to be effective in managing treatment-resistant depression, and in at least one study, it’s been shown to be an effective stand-in when fluoxetine fails.
That said, those potential side effects are considered rare. And we weren’t able to find any significant studies showing major adverse reactions to drug interactions between the two medications.
Potential severe side effects noted, how dangerous is this combination, really? We can’t say for sure, but either way, the medications should only be taken together under the supervision of a healthcare professional.
A 2006 review examined various antidepressants of the SSRI variety in combination with bupropion (though they didn’t mention fluoxetine specifically). They found that bupropion was “generally well tolerated” alongside SSRIs and may increase the antidepressant effects of antidepressants while reducing certain side effects.
That study, however, stopped short of a recommendation. The researchers noted that further studies examining long-term effects, optimal dosage and the amount of time it’s safe to combine these medications did not yet exist.
It’s difficult for us to offer concrete recommendations. While the limited study data does suggest that Wellbutrin and Prozac in combination could help with treatment-resistant depression or sexual side effects, those studies can’t speak to your individual needs. Only a healthcare provider can suggest specific medications.
So our advice is this: get medical advice from a healthcare provider. The benefits of taking Wellbutrin and Prozac may outweigh the risks, but that’s a decision that should be made based on your individual circumstances.
Wellbutrin and Prozac may be an option for you. But if you’re thinking about taking two medications because one isn’t solving the problem, it may be time to reevaluate your treatment options.
Depression and treatment-resistant depression are best managed under the guidance of a healthcare professional. If you haven’t spoken to one since your initial prescription, it may be time to discuss other options.
There are plenty of options available, by the way. Your provider may suggest dosage changes, additional medications or new medications altogether. They may also recommend therapy and potentially lifestyle changes to better manage your symptoms of depression.
Those decisions are made on a case-by-case basis, though, and the only person who can decide on your case is the professional you reach out to.
If you’re not sure where to begin, consider us. You can reevaluate your current treatment plan in minutes with our mental health resources. And if you’ve been indecisive on therapy, you can dip your toe in with our online therapy platform. Both resources are convenient, available online and accessible today.
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Kate Hagerty is a board-certified Family Nurse Practitioner with over a decade of healthcare experience. She has worked in critical care, community health, and as a retail health provider.
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