Article

Review: Bupropion and SSRI-induced side effects

University Psychiatric Center KuLeuven, Campus Gasthuisberg, B-3000 Leuven, Belgium.
Journal of Psychopharmacology (Impact Factor: 2.81). 03/2008; 22(7):792-804. DOI: 10.1177/0269881107083798
Source: PubMed

ABSTRACT Selective serotonin reuptake inhibitors (SSRIs) are a first line treatment option for millions of patients, due to the positive balance between efficacy and tolerability. However, some side effects associated with their use, can impair quality of life and compliance with treatment. This paper reviews the prevalence of sexual dysfunction, weight gain and emotional detachment during SSRI treatment, the profile of bupropion for each of these events and the ability of bupropion to reverse them. Double-blind trials, open-label trials and anecdotical reports derived from Medline were included. First, there is robust evidence that SSRIs can induce sexual side effects and that bupropion causes less sexual dysfunction than SSRIs. There is limited, mainly open-label evidence that bupropion can reverse SSRI-induced sexual side effects. Second, there is good evidence that long-term treatment with some SSRIs can result in weight gain and that long-term treatment with bupropion can result in a small weight loss. There is only anecdotical evidence that bupropion can reverse SSRI-induced weight gain. Third, treatment with SSRIs has been associated with ;emotional detachment', although controversy exists about this concept. No data are available on the profile of bupropion for ;emotional detachment' or for the reversal of SSRI-induced ;emotional detachment' by bupropion-addition.

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    • "An early meta-analysis of studies with differing methodologies (including open-label, double-blind, cross-sectional, and retrospective investigations) indicates that " treatmentemergent sexual dysfunction " is no more common with agomelatine, amineptine, bupropion, moclobemide, mirtazapine , or nefazodone than it is with placebo, in contrast to the situation with other antidepressants [17] (Table 1): all other antidepressants were significantly more likely than placebo to be associated with sexual dysfunction, as a unitary category, and nearly all of these were significantly more likely to be associated with dysfunction in each stage of the normal sexual response. A meta-analysis of randomized controlled trials of the efficacy and tolerability of acute treatment of major depressive episodes with " second-generation " antidepressants indicates that bupropion is associated with a significantly lower rate of treatment-emergent sexual dysfunction than is seen with escitalopram, fluoxetine, paroxetine, or sertraline [18]: this is probably due to the nonserotonergic but predominantly noradrenergic-dopaminergic mechanism of action of bupropion [19]. A systematic review of the relative efficacy and tolerability of mirtazapine and comparator antidepressants in the acute treatment of major depression suggests that mirtazapine is significantly less likely than other antidepressants to cause adverse sexual effects [20], which is probably related to its antagonist effects at both the alpha-2 adrenergic receptor and the 5-HT 2C receptor [21]. "
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    • "The present study findings are in line with efficacy trials that have demonstrated the weightgaining properties of antidepressants and antipsychotics (e.g., Allison et al., 1999; Demyttenaere & Jaspers, 2008; Fava et al., 2000; Sussman et al., 2001). Indeed, even after controlling for theoretically relevant variables, the obesity rate among persons taking antidepressants over the past 12 months was over one and a half times the rate observed among persons who did not take this medication; for antipsychotics this ratio was greater than two. "
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    • "These antidepressants have become a first-line treatment option for millions of patients due to their good balance between efficacy and tolerability. However, some adverse effects associated with their use such as, weight gain, sexual dysfunction, RLS, and emotional detachment, can impair the quality of life and compliance with treatment.5,6 Because it appears that these adverse effects are mainly associated with serotonin, many clinicians have moved toward the use of bupropion. "
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