Fluoxetine and Bupropion to Treat Patients With Depression and Alcoholism

Inclusion Criteria: * Patient suffering from a major depressive episode (unipolar only) AND alcohol dependence or abuse; Score of greater than 16 on the HDRS * Age range 18-65 years * History of a past suicide attempt, defined as self destructive behavior with at least some intent to die; patients with suicidal plan or intent will only be enrolled as inpatients if staff agrees it is reasonable. * Able to tolerate cross taper to study medications Exclusion Criteria: * Other major psychiatric disorders such as Bipolar Disorder; schizophrenia or schizoaffective disorder, past or current psychotic symptoms; eating disorder; substance abuse or dependence (other than alcohol, caffeine or nicotine); persons already taking SSRIs or bupropion for other indications such as anxiety disorders. * Primary disorder is an anxiety disorder such as Panic disorder/GAD/OCD/Social anxiety disorder, with secondary depression. * CIWA-AR rating \>10 or history of delirium tremens or seizures. * Blood pressure \>150 systolic or \>90 diastolic * Active or untreated medical problems * Antipsychotic medication required * History of becoming hypomanic or manic on antidepressants * Contraindication to the use of fluoxetine or bupropion, or currently using Zyban * Failure to respond to adequate trials of 3 SSRIs or fluoxetine or bupropion in the last 2 years (failure to respond to therapeutic trial defined as: at least 2/3 maximal PDR dose for at least 6 weeks) * Lack of capacity to consent * Pregnancy,…