BILL asked
I've been on Celexa for the past year and the side effects (mainly weight gain) have really been a problem. I recently switched to Wellbutrin, but I still have Celexa in my system and I feel great. So my question is whether or not taking these two medications in conjunction with each other will be a problem?
Answer
While not specifically a recommended therapy in most guidelines for the treatment of depression and associated disorders, the combination of Celexa (citalopram) and Wellbutrin (buproprion) has been used successfully in many different situations. There is a minor interaction between the two that you and your doctor need to be aware of, but taking both together may be appropriate for certain individuals.
Both Celexa and Wellbutrin are antidepressant medications but are in different classes and work via different mechanisms.
Celexa is a SSRI (Selective Serotonin Reuptake Inhibitor) and works by increasing and enhancing the effect of serotonin in the brain. SSRI drugs are often used as first line therapy for depressive disorders due to their efficacy and relative safety. They unfortunately are associated with certain side effects such as weight gain and sexual dysfunction, which are often challenging to deal with for many patients.
Wellbutrin is unrelated to other antidepressant medications and the exact mechanism of action is unclear. It thought to work by increasing the amount of the dopamine in the brain, but the antidepressant effects of the drug are known to occur at doses below what is needed to have a significant effect on dopaminergic systems. It does not appear that Wellbutrin has any effect on serotonin.
The few studies that have evaluated use of Wellbutrin and Celexa are generally positive. One review showed that the combination of the Wellbutrin and SSRI drugs are well tolerated, can improve the overall antidepressant response and, perhaps most importantly, can reduce or negate the side effects of SSRI drugs (e.g. weight gain and sexual side effects).
Another study, that specifically looked at the combination of Wellbutrin and Celexa, had similar results. The combination was more effective than either drug alone and there was not an increased incidence of side effects.
It should be noted that using Celexa and Wellbutrin together is not a FDA approved indication, but initially studies are promising and warrants further research.
In regard to the interaction mentioned, there is a minor one that needs to be considered if you and your doctor are looking to combine the two drugs. Wellbutrin may increase the concentrations of Celexa in the body and a minor dose adjustment to Celexa may be necessary. One study showed the concentration of Celexa increased by 30% when taken with Wellbutrin, so care must be taken when using both together.
Be sure to talk to your about about this possible therapy option so you can have the appropriate prescribed doses of each.
