Alternatives to Auvelity XR If You Can't Fill Your Prescription

If you've been prescribed Auvelity XR for depression but can't find it at your pharmacy, you may be wondering what your options are. While we always recommend trying Medfinder first to locate Auvelity XR in stock near you, it's also helpful to know about alternative medications you can discuss with your doctor.

Important: Never switch or stop your antidepressant medication without talking to your healthcare provider first. The information below is for educational purposes to help guide a conversation with your doctor.

What Is Auvelity XR?

Auvelity XR is a prescription antidepressant that combines dextromethorphan and bupropion in an extended-release tablet. It's approved by the FDA to treat major depressive disorder (MDD) in adults.

What makes Auvelity XR unique is its mechanism of action. While most antidepressants work primarily on serotonin or norepinephrine, Auvelity XR targets the NMDA receptor and glutamate system — a completely different pathway in the brain. This makes it a particularly interesting option for patients who haven't responded well to traditional antidepressants.

How Does Auvelity XR Work?

Auvelity XR works through two complementary mechanisms:

• Dextromethorphan blocks NMDA receptors and activates sigma-1 receptors in the brain. This helps regulate glutamate, a neurotransmitter involved in mood, learning, and neural plasticity. By modulating glutamate signaling, dextromethorphan may help "reset" mood pathways that aren't functioning properly in depression.
• Bupropion is an antidepressant on its own (you may know it as Wellbutrin). In Auvelity XR, it serves a dual purpose: it provides its own antidepressant effects through norepinephrine and dopamine reuptake inhibition, and it also inhibits the enzyme CYP2D6, which slows down the breakdown of dextromethorphan. This keeps dextromethorphan active in your body longer.

For a deeper dive, read our guide on how Auvelity XR works.

Alternative Medications to Auvelity XR

If you and your doctor decide to explore alternatives while Auvelity XR is unavailable, here are some medications that may be considered:

1. Bupropion (Wellbutrin XL, Wellbutrin SR)

Bupropion is one of the two active ingredients in Auvelity XR and is available as an affordable generic. It works by blocking the reuptake of norepinephrine and dopamine.

• Pros: Widely available, inexpensive (as low as $10-$30/month for generic), lower risk of sexual side effects and weight gain compared to SSRIs
• Cons: Does not include the NMDA receptor component (dextromethorphan), so the mechanism is less novel. May not be sufficient for patients who specifically need glutamate modulation.
• Best for: Patients who want a component of Auvelity XR's mechanism at a much lower cost

2. Esketamine (Spravato)

Esketamine is a nasal spray that, like dextromethorphan, targets the glutamate system through NMDA receptor antagonism. It's FDA-approved for treatment-resistant depression and major depressive disorder with suicidal ideation.

• Pros: Targets a similar pathway (NMDA/glutamate), fast-acting (can improve symptoms within hours to days), strong clinical evidence for treatment-resistant depression
• Cons: Must be administered in a certified healthcare setting under observation (REMS program), expensive ($600-$900 per treatment session), requires visits every 1-4 weeks
• Best for: Patients with treatment-resistant depression who need rapid relief and can access a Spravato treatment center

3. Vortioxetine (Trintellix)

Vortioxetine is a multimodal antidepressant that works on multiple serotonin receptors. While its mechanism is different from Auvelity XR, it's another newer antidepressant option for MDD.

• Pros: May improve cognitive symptoms of depression (memory, focus), fewer sexual side effects than traditional SSRIs
• Cons: Brand-name only (expensive, $400-$600/month without savings), nausea is a common side effect, works primarily through serotonin rather than glutamate
• Best for: Patients with depression accompanied by cognitive difficulties

4. SSRIs or SNRIs (Sertraline, Duloxetine, and Others)

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the most commonly prescribed antidepressants. While they work through different mechanisms than Auvelity XR, they remain effective first-line treatments for many patients.

• Pros: Decades of clinical evidence, widely available generics, very affordable ($4-$20/month), well-understood side effect profiles
• Cons: Different mechanism of action from Auvelity XR, may cause sexual side effects or weight gain, typically take 4-6 weeks for full effect
• Best for: Patients who haven't tried first-line antidepressants or need an affordable, accessible option

Always consult with your healthcare provider before making any changes to your medication. Your doctor can help determine which alternative is the best fit based on your medical history, current medications, and treatment goals.

Final Thoughts

If you can't find Auvelity XR at your pharmacy, you have options. Before switching to an alternative, we recommend trying Medfinder to locate Auvelity XR in stock — it's free and may save you from needing to change medications at all.

If you and your doctor do decide to explore alternatives, the medications above represent the most relevant options. Each has its own strengths and trade-offs, and the right choice depends on your individual situation.

Learn more about Auvelity XR:

• How to Find Auvelity XR in Stock Near You
• What Is Auvelity XR? Uses, Dosage, and What You Need to Know
• Auvelity XR Side Effects