Initiating dextromethorphan-bupropion extended release in patients with major depressive disorder: Delphi panel expert consensus recommendations
Anita H. Clayton, Gus Alva, Phillip Bowman, Erin Crown, Bibi Das, Paul Doghramji, Brooke Kempf, Andrew Muzyk, Jeremy Schreiber, John J. Miller
Current Medical Research and Opinion July 15, 2026 DOI: 10.1080/03007995.2026.2700073 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Modified Delphi panel procedure Peer reviewed |
|---|---|
| Sample size | 10 |
| Population | Clinicians with clinical experience treating MDD |
| Intervention | dextromethorphan-bupropion extended release |
| Dose | 45 mg/105 mg |
| Topics | Depression |
| Keywords | Delphi method Extended release Medline Consensus conference Family medicine Checklist |
| Key points | The panel reached consensus on 27 recommendations for initiating dextromethorphan-bupropion extended release for MDD, including its use as a first-line treatment and guidance for switching from other medications. |
Abstract
Objective: To establish consensus recommendations for initiating dextromethorphan-bupropion extended release (45 mg/105 mg) (AUVELITY) for the treatment of major depressive disorder (MDD) in adults.
Methods: = 10) with clinical experience treating MDD participated in a 3-stage modified Delphi panel procedure. An initial literature review was performed to assist in the development of draft recommendation statements. The draft recommendations were discussed and revised in two live meetings, with a series of anonymous votes taken to reach consensus for each proposed statement. Recommendations required a mean score ≥3.0 (75% agreement) to reach consensus.
Results: The panel reached consensus on 27 final recommendations with a mean overall agreement score of 3.8. Key consensus recommendations (abbreviated here) included: (1) dextromethorphan-bupropion is recommended as a first-line treatment for MDD, including with co-occurring symptoms of anxiety; (2) HCPs should individualize treatment decisions that prioritize safety considerations noted in the Prescribing Information; (3) dextromethorphan-bupropion is recommended for patients with inadequate response, residual symptoms, and/or intolerable side effects associated with prior MDD treatment(s); (4) when switching from (or adding to current) medication, the potential for a drug interaction should be considered, consistent with the dextromethorphan-bupropion label; and (5) switching from ketamine or esketamine should be done with caution, and with an awareness of the short-to-intermediate elimination half-lives of these drugs.
Conclusion: These consensus panel recommendations provide real-world guidance for initiating MDD treatment with dextromethorphan-bupropion extended release and address any perceived barriers for scenarios of interest.