Bupropion × duloxetine

Additive seizure threshold reduction plus elevated synaptic norepinephrine (bupropion is a norepinephrine-dopamine reuptake inhibitor; duloxetine is an SNRI). Tachycardia and hypertension may emerge.

Tachycardia, hypertension, tremor, agitation. Seizures may occur, especially with prior epilepsy or eating disorders.

The combination is possible for antidepressant augmentation with careful blood pressure and pulse monitoring. Cap bupropion at 300 mg and duloxetine at 60 mg/day. Avoid with prior epilepsy or eating disorders.