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Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder
Published on: April 26, 2024
Initiating dextromethorphan-bupropion extended release in patients with major depressive disorder: Delphi panel
Anita H Clayton1, Gus Alva2, Phillip Bowman3
1Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
Current Medical Research and Opinion
|July 15, 2026
Summary
Consensus recommendations support dextromethorphan-bupropion extended release as a first-line treatment for major depressive disorder (MDD). Guidance addresses individualized care, safety, and switching from other medications for effective MDD management.
Area of Science:
- Psychiatry and Clinical Neuroscience
- Pharmacology and Therapeutics
- Mental Health Treatment
Background:
- Major Depressive Disorder (MDD) affects millions globally, necessitating effective treatment strategies.
- Current treatment paradigms for MDD often involve multiple medication options with varying efficacy and side effect profiles.
- Optimizing the initiation of novel pharmacotherapies like dextromethorphan-bupropion is crucial for improving patient outcomes.
Purpose of the Study:
- To establish consensus-based recommendations for initiating dextromethorphan-bupropion extended release (45 mg/105 mg) in adult patients with MDD.
- To provide practical guidance for healthcare providers (HCPs) on the real-world application of this treatment.
- To address potential barriers and specific clinical scenarios related to initiating dextromethorphan-bupropion therapy.
Main Methods:
- A 3-stage modified Delphi panel procedure involving 10 US-based HCPs experienced in treating MDD.
- Development of draft recommendations based on an initial literature review.
- Two live meetings with anonymous voting to achieve consensus, requiring a mean score of ≥3.0 (75% agreement).
Main Results:
- Consensus was reached on 27 final recommendations with a mean agreement score of 3.8.
- Dextromethorphan-bupropion is recommended as a first-line MDD treatment, including for patients with co-occurring anxiety symptoms.
- Recommendations cover individualizing treatment based on safety, use in patients with inadequate response to prior treatments, and considerations for drug interactions and switching from ketamine/esketamine.
Conclusions:
- The consensus recommendations offer practical, real-world guidance for initiating dextromethorphan-bupropion extended release in MDD.
- These guidelines aim to facilitate the adoption of this treatment option and overcome perceived initiation barriers.
- The recommendations support informed clinical decision-making for optimizing MDD management with dextromethorphan-bupropion.
Keywords:
AUVELITYAXS-05Delphi techniqueMajor depressive disorderNMDA-receptordextromethorphan-bupropionMore Related Videos
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