Can you take Wellbutrin in the morning and Zoloft at night? (3 benefits) 

In this article, we will discuss whether it’s safe to take Wellbutrin (bupropion) in the morning and Zoloft (sertraline) at night. We will also discuss the potential benefits and risks of this treatment approach and what the research has to say about it.

Can you take Wellbutrin in the morning and Zoloft at night?

You can take Wellbutrin in the morning and Zoloft at night if prescribed by your healthcare provider. Both Wellbutrin and Zoloft are prescription antidepressants belonging to two different classes and having different mechanisms of action. 

It is a known fact that antidepressant monotherapy may not work for everyone. Some people may have treatment-resistant depression or overlapping symptoms for which one antidepressant may not work adequately. 

In such cases, doctors prefer a suitable combination of antidepressants for enhanced therapeutic effects. However, the thing with antidepressants is that they all might not go well with one another. 

Such combinations are carefully determined to prevent disturbing adverse events, out of which serotonin syndrome is a major concern. To avoid this, doctors prefer antidepressants that work differently and act on different neurotransmitters. 

This is where the combination of Wellbutrin and Zoloft can be a good one. Zoloft is an SSRI that primarily works on the serotonergic system of your brain (1,2). Wellbutrin, on the other hand, primarily works on the dopaminergic and noradrenergic systems of your brain (3). 

This can reduce the chances of adverse reactions while managing different excitatory chemicals at the same time. However, dose adjustment is crucial for any antidepressant combination.

What does research suggest?

There is limited research on the combined use of Wellbutrin and Zoloft. One research study indicated that the combination of bupropion and sertraline can be beneficial for people who do not respond well to antidepressant monotherapy (4). 

These meds when taken together can help manage stubborn depression symptoms and can enhance the overall quality of life. This is because these meds can together work on all three, serotonergic, dopaminergic and noradrenergic systems of your brain (4). 

Another research study indicated that, although it is not approved by the FDA, a combination of bupropion and an SSRI can help manage major depressive disorder (MDD) safely and effectively (5). 

However, it is important to note that people are different and can respond differently to such antidepressant combinations. What works for one may not always work for another. So, it’s important to rely on your doctor’s expertise to ensure a safe and effective therapeutic response. 

Potential benefits of taking Wellbutrin in the morning and Zoloft at night

Taking Wellbutrin in the morning and Zoloft at night can offer potential benefits for managing depression more effectively, including: 

Management of MDD 

Taking Wellbutrin and Zoloft on the same day can manage the symptoms of MDD, a condition which does not generally respond well to antidepressant monotherapy. (5)

Stabilised mood throughout the day

Wellbutrin, known for its energising effects, can provide a boost in the morning, helping to combat symptoms of fatigue and low energy. Zoloft, with its serotonergic influence, may contribute to a more stable and positive mood throughout the night.

Improved treatment response

Combining medications with distinct mechanisms of action increases the chances of a positive response to treatment. This dual approach can address a broader range of depressive symptoms, leading to an overall improvement in mood and well-being.

Potential risks of taking Wellbutrin in the morning and Zoloft at night

While combining Wellbutrin in the morning and Zoloft at night can have potential benefits, it’s crucial to be aware of the potential risks associated with this medication regimen. Some may include:

Additive side effects

Taking Wellbutrin in the morning, known for its energising effects, and Zoloft at night may contribute to additive side effects, such as insomnia
(1,3). The stimulating properties of Wellbutrin could interfere with sleep, especially if taken later in the day.

The risk of serotonin syndrome

Combining two antidepressants that influence serotonin levels, like Wellbutrin and Zoloft, increases the risk of serotonin syndrome. This condition can occur when there’s an excess of serotonin, leading to symptoms such as agitation, confusion, rapid heart rate, and even potentially life-threatening complications (6). 

Increased risk of seizures

Wellbutrin is associated with an increased risk of seizures, especially at higher doses (3). Combining it with Zoloft, which also has a lower seizure risk, could potentially increase this risk. Individuals with a history of seizures or other risk factors should discuss this concern with their healthcare provider.

How to ensure the safe and effective use of Wellbutrin and Zoloft?

The following points are important to ensure the safe and effective use of Wellbutrin and Zoloft on the same day:

• Strictly follow the prescribed doses and timings for each medication. Consistency is crucial in maintaining a stable therapeutic level of the drugs in your system.

• Know the potential side effects of both Wellbutrin and Zoloft. Keep a close eye on any unusual symptoms and report them to your healthcare provider immediately.

• Be aware of the signs and symptoms of serotonin syndrome, such as agitation, confusion, rapid heart rate, and muscle stiffness. If you experience any of these, seek medical attention promptly.

• If you have a history of seizures or other risk factors, discuss this with your healthcare provider. Regular monitoring can help mitigate the risk, and adjustments to the dosage or timing may be considered.

• Alcohol and certain substances can interact adversely with antidepressant medications. It’s advisable to avoid or limit the consumption of these substances during the course of treatment.

• Maintain a healthy lifestyle with regular exercise, a balanced diet, and adequate sleep. This improves your overall physical and mental well-being.

As a pharmacist, I have come across many such patients who take a combination of antidepressants and such a combined treatment approach can be a great option for many people. However, the choice of antidepressants should be carefully made. 

You must follow your doctor’s directions and stick to the recommended doses. Do not take a higher dose or take these medications more often than recommended. Remember, proper use of meds is the best way to ensure a safe and effective therapeutic response. 

References 

1. Singh HK, Saadabadi A. Sertraline. 2023 Feb 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31613469. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547689 

2. The Food and Drug Administration (FDA). HIGHLIGHTS OF PRESCRIBING INFORMATION. ZOLOFT (sertraline hydrochloride) tablets, for oral use. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019839s74s86s87_20990s35s44s45lbl.pdf

3. Huecker MR, Smiley A, Saadabadi A. Bupropion. 2023 Apr 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29262173. https://www.ncbi.nlm.nih.gov/books/NBK470212

4. Marshall RD, Johannet CM, Collins PY, Smith H, Kahn DA, Douglas CJ. Bupropion and sertraline combination treatment in refractory depression. J Psychopharmacol. 1995 Jan;9(3):284-6. doi: 10.1177/026988119500900313. PMID: 22297770. https://pubmed.ncbi.nlm.nih.gov/22297770/ 

5. Zisook S, Rush AJ, Haight BR, Clines DC, Rockett CB. Use of bupropion in combination with serotonin reuptake inhibitors. Biol Psychiatry. 2006 Feb 1;59(3):203-10. doi: 10.1016/j.biopsych.2005.06.027. Epub 2005 Sep 13. PMID: 16165100. https://pubmed.ncbi.nlm.nih.gov/16165100/

6. Simon LV, Keenaghan M. Serotonin Syndrome. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29493999. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482377