Dextromethorphan/Bupropion: A Novel Oral NMDA (N-methyl-d-aspartate) Receptor Antagonist with Multimodal Activity
Open accessAbstract
Although currently available antidepressants increase monoamine levels soon after the start of treatment, therapeutic benefits are often delayed by several weeks and the majority of patients with major depressive disorder fail to achieve an adequate response to first- or second-line therapies targeting monoamines. The recent approval of the NMDA (N-methyl-d-aspartate) antagonist esketamine given intranasally for treatment-resistant depression has reinforced the need for agents with rapid onset with alternate mechanisms of action. Dextromethorphan/bupropion, an investigational medicine currently in development, is one such candidate.
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Dextromethorphan-bupropion has demonstrated efficacy after only one week of treatment.
“while dextromethorphan-bupropion has demonstrated efficacy after only one week of treatment [19]”
From Dextromethorphan-bupropion (Auvelity) for the Treatment of Major Depressive Disorder (2023) · cites this paper as [19]
The section on major depressive disorder and treatment-resistant depression reports improved depression scores and higher remission rates with dextromethorphan/bupropion by week 2 compared with bupropion alone. It supports relatively rapid efficacy, but does not establish efficacy after only one week. Page information was not available in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredDXM-bupropion operates through a broader multimodal profile: weak NMDA antagonism is complemented by sigma 1 receptor activation and dopamine transporter inhibition.
“Weak NMDA antagonism is complemented by sigma 1 receptor activation and dopamine transporter inhibition, shaping excitability, stress resilience, and neurotrophic tone alongside glutamatergic mechanisms [57,58,59].”
From Synaptic Plasticity—Intrinsic Excitability and Antidepressant Discovery (2026) · cites this paper as [59]
The Summary and Conclusions (Figure 3; page not provided) identifies dextromethorphan as an NMDA antagonist and sigma-1 agonist, and bupropion as a dopamine transporter inhibitor, supporting the multimodal profile. The paper does not characterize the NMDA antagonism as weak. Its discussion of neural plasticity does not establish the citing sentence’s further claim about stress resilience and neurotrophic tone for these combined mechanisms. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAuvelity is hypothesized to work via NMDAR antagonism of dextromethorphan, which is prolonged by bupropion, a norepinephrine-dopamine reuptake inhibitor.
“Auvelity is hypothesized to work via the NMDAR antagonism of dextromethorphan, which is prolonged by bupropion, a norepinephrine-dopamine reuptake inhibitor [187]”
From Ketamine in neuropsychiatric disorders: an update (2024) · cites this paper as [187]
Bupropion increases the bioavailability of dextromethorphan by CYP2D6 inhibition.
“Bupropion, a dopamine and norepinephrine reuptake inhibitor, competitively inhibits CYP2D6, which extends dextromethorphan’s half-life to 22 hours [16,17,19].”
From Dextromethorphan-bupropion (Auvelity) for the Treatment of Major Depressive Disorder (2023) · cites this paper as [19]
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- Authors
- Stahl, S. M.
- Affiliations
- University of Cambridge (GB)
- Corresponding author
- Stahl, Stephen M.
- ORCID
- Stahl, Stephen M.
- Venue
- CNS Spectrums
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019-09-30
- Volume
- 24
- Issue
- 5
- Pages
- 461-466
- ISSN
- 1092-8529 (ISSN-L)
- 2165-6509
- OpenAlex
- W2979131874
- Cited by
- 73
- References
- 22
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 18 · 2023: 17 · 2022: 9 · 2021: 7 · 2020: 2 · 2019: 1
- FWCI
- 0.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- CNS Spectrums (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
- Keywords
- NMDA receptor antagonists, major depressive disorder, treatment-resistant depression, rapid-acting antidepressants, esketamine, monoamine hypothesis
- MeSH terms
- Administration, Oral, Animals, Dextromethorphan, Dopamine, Humans, Norepinephrine, Receptors, N-Methyl-D-Aspartate, Bupropion, Antidepressive Agents, Second-Generation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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