Major
Bupropion × Mirtazapine
Other antidepressants (NDRI)×Other antidepressants (NaSSA)
Mechanism
Mirtazapine lowers the seizure threshold less than bupropion, but the effect is additive. Both drugs may also cause insomnia and anxiety in combination.
Symptoms
Seizures (generalised tonic-clonic or focal), agitation, tremor, insomnia. Patients with prior epilepsy or eating disorders are at particular risk.
Management
The combination is possible for augmentation. Keep doses low: bupropion 300 mg, mirtazapine 30 mg/day. Avoid with prior epilepsy.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.