Poor man’s vortioxetine

Utilizing this combination carefully allowed for generating a higher clozapine level at a lesser prescribed dose to minimize the cost of the expensive trade name medicine.1 Clinical data testified to the usefulness of this interaction from an efficacy perspective as well from a tolerability standpoint by diminishing clozapine’s sedative potential.1 We suggest a somewhat parallel situation may be utilized with the interaction between the antidepressant agents vortioxetine and bupropion. To counter this obstacle, we suggest a means of working around this issue with a described drug–drug interaction; bupropion’s cytochrome p450 2D6 significant inhibitory properties that may potentially double the blood levels of vortioxetine.3 Thus we report here, a case of a patient with longstanding OCD who had limited response to 20 mg/day of vortioxetine who reported increased benefit with both an increased daily dose of vortioxetine and subsequently the addition of bupropion to this 20 mg/day dose. A trial of fluvoxamine of 200 mg/day was successful over 4 months in significantly diminishing her symptoms but produced unacceptable side effects: most problematic being weight gain, as well as sweating and sedation.