Combining Citalopram or Escitalopram with Bupropion: Side Effects and Considerations

Common Side Effects

The American Academy of Family Physicians and the Annals of Internal Medicine report that gastrointestinal effects, such as nausea, vomiting, diarrhea, and constipation, are common when combining SSRIs with bupropion, with nausea being the most frequent reason for discontinuation 1, 2
Neurological symptoms, including headache, dizziness, tremor, and insomnia, occur regularly when combining SSRIs with bupropion, as reported by the American Academy of Family Physicians and the Annals of Internal Medicine 1, 2
Other common effects, such as dry mouth, fatigue, sweating, and agitation, have been reported when combining SSRIs with bupropion, according to the American Academy of Family Physicians and the Annals of Internal Medicine 1, 2

The Journal of the American Academy of Child and Adolescent Psychiatry recommends monitoring for serotonin syndrome when combining bupropion with SSRIs like citalopram or escitalopram, with key features including mental status changes, neuromuscular hyperactivity, autonomic hyperactivity, and advanced symptoms like fever, seizures, and unconsciousness 3
The Annals of Internal Medicine reports that bupropion carries an increased risk of seizures, particularly at higher doses, and recommends monitoring for dose-dependent seizure risk and avoiding use in patients with seizure disorders or conditions that lower seizure threshold 2
The Journal of the American Academy of Child and Adolescent Psychiatry and the American Academy of Family Physicians recommend monitoring for cardiovascular effects, including QT prolongation, Torsade de Pointes, ventricular tachycardia, and sudden death, when using citalopram, and advise against exceeding 40 mg/day (20 mg/day in adults >60 years) 3, 6

The Journal of the American Academy of Child and Adolescent Psychiatry reports that escitalopram has the least effect on CYP450 enzymes compared to other SSRIs, making it preferable to citalopram when combining with bupropion, with minimal CYP450 interactions and a lower propensity for drug interactions 3

The Journal of the American Academy of Child and Adolescent Psychiatry recommends monitoring for discontinuation syndrome when abruptly ceasing citalopram or escitalopram, with symptoms including dizziness, fatigue, lethargy, myalgias, nausea, vomiting, diarrhea, anxiety, irritability, agitation, sensory disturbances, and paresthesias 3, 7

The Annals of Internal Medicine reports that bupropion can reverse SSRI-associated sexual side effects, providing a clinical advantage when combining with escitalopram 2