Dextromethorphan-bupropion combination in depression with dual diagnosis: Insights from a case series.

Three male patients with alcohol or opioid dependence and depression who had not responded to multiple antidepressant trials showed substantial improvement in depressive symptoms and functioning after treatment with dextromethorphan-bupropion. The combination targets glutamatergic and dopaminergic pathways, offering a new option for the challenging dual diagnosis of major depressive disorder and substance use disorder, which is often marked by persistent anhedonia and high relapse rates. The findings suggest clinical promise but require further controlled studies to confirm efficacy and safety.

Study at a glance

Abstract

Major depressive disorder and co-morbid substance use disorder represent a challenging dual diagnosis, characterized by persistent anhedonia, high relapse rates, and poor response to conventional antidepressants. The dextromethorphan-bupropion combination with synergistic glutamatergic and dopaminergic mechanisms provides a new treatment option. We present three male patients with alcohol or opioid dependence and depression who showed substantial improvement in depressive symptoms and functioning with dextromethorphan-bupropion after multiple failed antidepressant trials. These findings highlight the clinical implications of dextromethorphan-bupropion in dual-diagnosis depression and warrant further controlled studies to establish efficacy and safety.