Major Depressive Disorder (MDD) is one of the more common psychiatric illnesses. Treatments can include psychotherapy, oral antidepressant medications, transcranial magnetic stimulation, ECT, and ketamine (IV or nasal spray). Although these treatments can be effective for some patients with MDD, not all patients respond, some are very expensive, and the current oral antidepressants usually take weeks before being effective, if at all.
There is a new oral antidepressant that shows great promise in providing significant relief beginning in about one week. It is a combination of dextromethorphan and bupropion. The name is Auvelity. It has been approved by the FDA and is expected to be available sometime during the fourth quarter of 2022.
Some of you may recognize dextromethorphan as an ingredient in cough medicine. It attaches to certain chemical receptors in the brain (NMDA and sigma-1 receptors). It has been tested on over 1,000 research subjects with MDD in two different studies.
The dextromethorphan is combined with bupropion, a well-established oral antidepressant. In this case, a low dose of the bupropion is used to increase the blood level of dextromethorphan by blocking the enzyme that breaks down dextromethorphan.
As you would expect, there are possible side-effects. The more common ones are dizziness, headache, diarrhea, sleepiness, dry mouth, sexual dysfunction, and excessive sweating. They occur in a minority of patients and can be mild.
The availability of this new oral treatment is a helpful advance in treatment options for MDD.
Peter M. Hartmann, MD
Family Medicine and Psychiatry
