Psychoses associated with bupropion treatment.
ABSTRACT The authors describe the development of acute psychoses in four patients treated with bupropion, a unicyclic aminoketone antidepressant. In two of the cases the psychoses seemed to be affected by dose. The mechanism responsible for the psychotic reactions is unclear, although it may involve perturbation of dopaminergic systems. On the basis of their experience, the authors offer recommendations regarding the clinical use of bupropion.
SourceAvailable from: Wei-Chung Mao[Show abstract] [Hide abstract]
ABSTRACT: Bupropion is a newer antidepressant with the main pharmacological effects of dopamine and norepinephrine reuptake inhibition. The usage of bupropion is relatively safe with minor side effects. In some rare instances, psychosis and delirium may emerge because of its potentiating effects on dopaminergic neurotransmission. Here we presented a case of bupropion SR (300mg/day) related to delirium with concurrent quetiapine (400mg/day) usage. Although there are fewer side effect profiles of bupropion SR, our case revealed acute delirium after administration of a therapeutic dosage of bupropion. Poor cytochrome P450 2D6 (CYP2D6) and cytochrome P450 2B6 (CYP2B6) metabolism and underlying bipolarity may contribute to this adverse effect. Clinicians should be cautioned when prescribing bupropion SR to vulnerable populations.
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ABSTRACT: Psychotic depression, although considered in DSM-IV to he a subtype of major depression, has many features of a separate disorder, including its own distinct phenomenology, epidemiology, family history, course of illness, biology and treatment. When evaluating patients with both depressive and psychotic symptoms, it is important to always consider psychotic depression as a possible diagnosis, as well as other diagnoses which may resemble it, such as bipolar disorder, schizoaffective disorder, schizophrenia with superimposed depression, delusional disorder and obsessive-compulsive disorder with poor insight and com-orbid depression. Although patients with psychotic depression and those with depression without psychotic symptoms appear to respond equally well to electroconvulsive therapy (ECT), numerous studies have shown a significant lack of response to tricyclic antidepressants (TCAs) in the former group of patients compared with the latter. However, patients with psychotic depression appear to respond significantly better to combinations of antidepressants and antipsychotics. There is disagreement as to whether ECT is superior to combined TCA-antipsychotic treatment. Most researchers agree, however, that both are effective first-line treatments for psychotic depression. Amoxapine, selective serotonin (5-hydroxytrypt-amine; 5-HT) reuptake inhibitor (SSRI) monotherapy, and combination treatment with an SSRI and an antipsychotic, are promising as possible additional first-line treatments. Atypical antipsychotics and the addition of lithium or other mood stabilisers to an antidepressant-antipsychotic regimen are potential treatments for patients with refractory psychotic depression. Psychotic depression is a recurrent disorder with a high rate of relapse after successful initial treatment with medications or ECT. The rate of relapse appears to be especially high when no maintenance therapy is used or when the antipsychotic drug of an antidepressant-antipsychotic combination is tapered off prematurely. Maintenance ECT is a promising tool for preventing relapse after initial ECT treatment. Additional studies of psychotic depression are needed to better determine the effectiveness of new treatments as well as to help resolve how to most effectively prevent relapse after acute treatment of this disorder.CNS Drugs 12/1997; 8(6). DOI:10.2165/00023210-199708060-00004 · 4.38 Impact Factor
Article: Antidepressants[Show abstract] [Hide abstract]
ABSTRACT: Supplementing but not supplanting the original series of tricyclic and monoamine oxidase (MAO) inhibitor compounds, a new generation of antidepressant medications has been developed and marketed throughout the past decade. Constituting a more diverse group of drugs than the standard agents, the newer drugs in general have more selective acute biochemical actions (reuptake blockade of a single neurotransmitter, inhibition of 1 subtype of MAO), enabling more precise targeting of symptoms and avoiding common antidepressant-associated side effects, especially anticholinergic and cardiovascular effects. Moreover, a number of recent additions to this group, such as bupropion and ademetionine (S-adenosyl-methionine), incorporate novel mechanisms of action, challenging previous concepts of how antidepressants work, and offering opportunities for research into the pathophysiology of mood disorders. Caution in prescribing the newer antidepressants must be applied, however, as recent experience, e.g. with nomifensine, suggests that unforeseen toxicities may not appear until a medication has been in use for several years.Drugs 05/1989; 37(5). DOI:10.2165/00003495-198937050-00006 · 4.13 Impact Factor