Hi doctor, I am currently taking Venlafaxine and Mirtazapine together. There are discussions around adding Wellbutrin as well, I just wanted to get someone else thoughts on that combination of three drugs. Is it safe? Would it be effective? And is it a known combination of drugs which has been specificied before?
Hello. Combination antidepressant therapy works better if first line monotherapy has not been effective. I note that you are diagnosed with depression, anxiety and PTSD which can sometimes be challenging but gets better with the right treatment regimen. Different combination or augmentation strategies are used for better response. Usually, it will involves combining different types of antidepressants.  Venlafaxine (SNRI type) and Mirtazapine (NaSSA type) is a known combination deemed to be safe and used therapeutically. Adding Wellbutrin (Bupropion) is not used routinely but the rationale is understandable. Bupropion is a NDRI (norepinephrine-dopamine reuptake inhibitor) type atypical antidepressant. Bupropion is also used in smoking cessation. In your case, Is Bupropion used as an additional augmentation drug or to counteract any side effect like sexual dysfunction? Combination of antidepressants can lead to relatively more side-effects including serotonin syndrome. Decision to combine drugs is made by carefully weighing up the benefits and risks involved. If benefits outweigh the possible risks, it is worthwhile trying the combination cautiously. Risk will be more if you have any pre-existing health problems like hypertension, seizures, etc. Complex decision like this are usually made by psychiatrists in specialist/tertiary medical centres. Whenever combination antidepressants are used, the prescribing consultant and treating team will have to follow up closely, monitoring the dose response and look out for any treatment emergent side effects. Usually there will be regular follow up reviews especially during the initial period. Also always inform or remind if you visit any other doctor about being on combination antidepressants if you are prescribed any other medication (like certain antibiotics) to avoid possible drug interactions. Finally, I believe you are also receiving psychotherapy in addition to medication. In many instances, psychotherapy acts as a good augmentation strategy to manage depression and anxiety disorders.