Auvelity: A New Treatment for Depression

Auvelity (Dextromethorphan HBr and Bupropion HCl)

Auvelity is a new prescriptive agent that is the first of its kind. This medication is used in the treatment of Major Depressive Disorder (MDD) in a unique way. This oral medication acts on the N-methyl D-aspartate (NMDA) receptors in the brain, unlike most other treatment options for depression. This medication became FDA approved for the treatment of MDD in adults in August 2022 and is the first oral NMDA receptor antagonist to be used in the treatment of MDD. This medication is a combination pill containing Dextromethorphan which is actually Robitussin and Bupropion (Wellbutrin).

This medication can begin to relieve depressive symptoms in as little as 1 week due to its inotropic mechanism of action, compared to 4-6 weeks with other antidepressant medications. Auvelity works differently than traditional treatments as it affects glutamate, dopamine, and norepinephrine. This medication can be utilized as a first- or second-line treatment for depression.

Current Indication:

FDA approved for the treatment of Major Depressive Disorder (MDD) in adults.

Diagnosing Major Depressive Disorder:

5 or more symptoms present in the same 2 week period and represent a change in functioning; at least one of the symptoms must be depressed mood or loss of interest:

● Depressed mood most of the day, nearly everyday

● Diminished interest or pleasure in all or almost all activities nearly everyday

● Significant weight loss or gain when not dieting

● Insomnia or hypersomnia nearly everyday

● Psychomotor agitation or retardation nearly everyday

● Fatigue or loss of energy nearly everyday

● Feelings of worthlessness or excessive inappropriate guilt nearly everyday

● Diminished ability to think or concentrate nearly every day

● Recurrent thoughts of death, suicidal ideation without a plan, or suicide attempt or plan to commit suicide

Mechanism of Action:

Auvelity is an antidepressant medication affecting multiple neurotransmitters. It contains both Dextromethorphan and Bupropion, giving it a distinctive mechanism of action. Dextromethorphan is an uncompetitive antagonist of the NMDA receptor and a sigma-1 receptor agonist. Bupropion is a CYP2D6 inhibitor that is utilized to increase plasma concentration of Dextromethorphan. NMDA receptor antagonism is through to increase glutamate and other monoamine signaling.

Dosing of Auvelity:

There is currently only one dosing form of this medication.

Extended release tablets: 45 mg/105mg dextromethorphan/bupropion

Starting dose is 1 tablet in the morning for 3 days. After 3 days, increase to the maximum dose of 1 tablet twice daily at least 8 hours apart. This medication can be taken with or without food.

Before initiating treatment, screen for blood pressure abnormalities, history of seizures, history of bipolar disorder or mania, and a full medication history.

Contraindications:

Auvelity is contraindicated in:

● Seizure disorders

● Current of prior diagnosis of anorexia nervosa or bulimia

● Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs

● Do not use with MAOI or within 14 days of stopping treatment with Auvelity

Possible side effects:

Dizziness, headache, diarrhea, decreased appetite, somnolence, dry mouth, sexual dysfunction, and hyperhidrosis

Auvelity is the first treatment of its kind and has been shown to rapidly improve depressive symptoms. This may be a great treatment option for those who are unresponsive or have failed trials of traditional antidepressant treatments.