Initiating dextromethorphan-bupropion extended release in patients with major depressive disorder: Delphi panel expert consensus recommendations
Current Medical Research and Opinion July 15, 2026 Anita H. Clayton, Gus Alva, Phillip Bowman et al.
A panel of 10 clinicians with experience treating major depressive disorder (MDD) used a modified Delphi process to develop 27 consensus recommendations for starting the medication dextromethorphan-bupropion extended release (45 mg/105 mg). The recommendations, which achieved a mean overall agreement score of 3.8, include using the drug as a first-line treatment for MDD, including when anxiety symptoms are present; individualizing treatment based on safety information in the Prescribing Information; using it for patients who had inadequate response, residual symptoms, or intolerable side effects from prior treatments; considering drug interactions when switching or adding medications; and switching cautiously from ketamine or esketamine due to their short-to-intermediate elimination half-lives. These recommendations offer practical guidance for initiating this treatment.