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This treatment strategy involves the augmentation of a primary antidepressant (typically a selective serotonin reuptake inhibitor [SSRI], serotonin-norepinephrine reuptake inhibitor [SNRI], or mirtazapine) with bupropion sustained-release (SR). Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) that acts by inhibiting the neuronal reuptake of norepinephrine and dopamine. This combination is used to improve outcomes in patients with major depressive disorder (MDD) who have not achieved an adequate response to initial monotherapy. The strategy was a key arm in the VAST-D (VA Augmentation and Switching Treatments for Improving Depression Outcomes) trial, sponsored by the VA Office of Research and Development, which compared augmentation strategies to switching monotherapies in veterans.
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