[HN Gopher] Dextromethorphan-Bupropion in Major Depressive Disor...
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Dextromethorphan-Bupropion in Major Depressive Disorder: Controlled
Trial
 
Author : bookofjoe
Score  : 21 points
Date   : 2022-09-28 22:07 UTC (53 minutes ago)
 
web link (pubmed.ncbi.nlm.nih.gov)
w3m dump (pubmed.ncbi.nlm.nih.gov)
 
| mpalczewski wrote:
| TLDR: Have some cough syrup with your Bupropion (anti-depressant)
| for increased efficacy.
 
  | genewitch wrote:
  | Guaifenesin, another ingredient in most cough syrups, is also
  | used in muscle relaxants.
  | 
  | Who knew that "more tussin" would be the answer?
 
    | schwartzworld wrote:
    | Guaifenesin also makes you puke if you have too much.
 
  | xen2xen1 wrote:
  | Just had a problem finding regular Nyquil last night, now I get
  | why they changed it so much.
 
  | sallystarace wrote:
  | Dextromethorphan tolerance builds so rapidly. I have found the
  | withdrawal to be hell after taking it legitimately for a cold
  | longer than I realized. I have tried SSRIs and found that they
  | also have a synergetic effect with Bupropion (good medicine).
  | SSRIs also make me drowsy, but at least they can be sustainably
  | taken daily for months.
 
| PaulHoule wrote:
| See https://www.erowid.org/chemicals/dxm/faq/
 
  | PragmaticPulp wrote:
  | Not the same. The Bupropion significantly changes the
  | metabolism of Dextromethorphan when administered as a combo.
  | 
  | It's nothing like taking high doses of DXM alone for
  | recreational purposes.
 
| bergenty wrote:
| DXM is a fantastic dissociative. There's a reason so many rappers
| with really bad childhoods use it so much.
 
  | skyyler wrote:
  | Is this a potshot directed at someone in particular? I wasn't
  | aware that DXM was popular with rappers.
 
    | Mandatum wrote:
    | Google "lean". They made it popular in the 90s.
 
| PragmaticPulp wrote:
| The combination is known as AXS-05 in studies and will be
| marketed as Auvelity.
| 
| Interesting combo. Buproprion is an antidepressant by itself, but
| it also inhibits the enzymes that break Dextromethorphan down in
| the body. Taking the two drugs together is not equivalent to
| taking the same dose of Dextromethorphan alone because Bupropion
| induces a very different exposure to DXM and its metabolites.
| Ignore anyone who tries to compare this to recreational DXM
| consumption because they're quite different.
| 
| Dextromethorphan gets a lot of attention for being an NMDA
| antagonist, but fewer people know that it has quite strong
| affinity for the serotonin transporter (the primary affinity of
| SSRIs). It also has potentially significant affinity for the
| sigma-1 receptor, the norepinephrine transporter, and several
| other receptors that have been noted to be potentially useful for
| depression modulation.
| 
| In other words, this feels a little bit like a shotgun approach
| to poking a wide array of receptors that may or may not be
| helpful in modulating depressive disorders. I'd take some of the
| narratives about this being an "NMDA drug like ketamine" with a
| huuuge grain of salt.
| 
| People have been trying this combination for several years in DIY
| fashion (not recommended, but info is out there) since the
| original study came out. I've seen some reports of good results,
| other reports of weird side effects that interfered with daily
| activities. I wouldn't rush to characterize this as a miracle
| drug or a first-line treatment, but it does seem to help certain
| patients who haven't seen much benefit from previous drugs.
| 
| Also worth noting that other studies haven't been as
| overwhelmingly positive as this one. Axsome Therapeutics (company
| researching the drug) stumbled a few years ago when their own
| trial failed to show statistical significance for Bupropion+DXM
| over Bupropion alone. Later studies seem to have been more
| positive though.
 
  | forbiddenvoid wrote:
  | Thank you for explaining the interaction that makes this work.
  | I was very confused for a bit trying to understand how mixing a
  | cough suppressant with an anti-depressant would change the
  | chemistry to the extent highlighted in the study.
 
| braingenious wrote:
| I'm always happy to see this.
| 
| I know a therapist that's interested in ketamine/psilocybin
| therapy and when she asked me about these types of drugs, I
| immediately told her that DXM is hands down obviously going to
| have clinical use.
 
| nnlsoccer wrote:
| Unable to access the full paper at the moment, but curious if
| they addressed the fact that Bupropion can take 6-8wks before
| symptoms such as depressed mood or anhedonia are affected. Were
| these bupropion naive patients? From the abstract, this was only
| a 6wk study - which means that the bupropion may not yet have
| been working at maximal efficacy for those in the bupropion group
| during the study period and therefore of course the AXS would
| show a benefit when compared to only bupropion
 
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(page generated 2022-09-28 23:00 UTC)