Early Antidepressant Response to Bupropion-Dextromethorphan Compared with Escitalopram in Major Depressive Disorder: A Prospective Comparative Study

Background: This study compared the efficacy and tolerability of bupropion–dextromethorphan with escitalopram in patients with first-episode Major Depressive Disorder.

Methods: This prospective, randomized, open-label comparative study included 173 adult patients with first-episode major depressive disorder. Patients were randomized to receive either escitalopram (n = 90) or bupropiondextromethorphan (n = 83) for six weeks. Depressive symptoms were assessed using the Montgomery–Asberg Depression Rating Scale (MADRS) and Hamilton Depression Rating Scale (HAM-D) at baseline and Weeks 2, 4, and 6. Sexual function was assessed using the Arizona Sexual Experience Scale (ASEX), and body weight was recorded at baseline and Week 6.

Results: Baseline MADRS and HAM-D scores were comparable between the two groups. The bupropiondextromethorphan group had significantly lower MADRS scores than the escitalopram group at Week 2 (21.89 ± 2.93 vs. 23.13 ± 3.29; P = 0.009), Week 4 (14.00 ± 3.31 vs. 16.71 ± 3.42; P < 0.001), and Week 6 (9.81 ± 3.31 vs. 13.42 ± 3.60; P < 0.001). HAM-D scores were also significantly lower in the bupropion–dextromethorphan group at Week 4 (10.99 ± 3.03 vs. 12.19 ± 3.12; P = 0.011) and Week 6 (7.61 ± 3.22 vs. 9.20 ± 3.17; P = 0.001). At Week 6, ASEX scores were lower in the bupropion–dextromethorphan group than in the escitalopram group (16.01 ± 1.94 vs. 20.63 ± 2.04; P < 0.001). Mean body weight was also lower in the bupropion–dextromethorphan group at Week 6 (64.49 ± 6.77 kg vs. 66.52 ± 6.02 kg; P = 0.039).

Limitations: This was a single-centre, open-label study with a six-week follow-up period.

Conclusion: Bupropion-dextromethorphan was associated with greater reduction in depressive symptoms than escitalopram and showed a more favourable sexual-function and body-weight profile during six weeks of treatment.