Bupropion SR Maintenance > Placebo: 8 week open trial 300mg/d. 429 responders DB PC for 44 weeks at same dose. By week 12 of DB, significant difference. By end p<.003. Continuation phase treatment with bupropion SR effectively decreases the risk for relapse of depression. Weihs KL, Houser TL, Batey SR, Ascher JA, Bolden-Watson C, Donahue RM, Metz A. Biol Psychiatry 2002 May 1;51(9):753-61

Bupropion SR = Sertraline: 692 patients in identical DB PC studies of MDD. No difference in benefit for anxiety or depression with both beneficial. U Tx SW, Do bupropion SR and sertraline differ in their effects on anxiety in depressed patients? Trivedi MH, Rush AJ, Carmody TJ, Donahue RM, Bolden-Watson C, Houser TL, Metz A. J Clin Psychiatry 2001 Oct;62(10):776-81

Bupropion SR > Sertraline: 364 MDD pt DB 8 weeks. Only Bupropion better than placebo and more sexual side-effects with sertraline. Bupropion more agitation and nervousness. Both well tolerated. Sexual dysfunction associated with the treatment of depression: a placebo-controlled comparison of bupropion sustained release and sertraline treatment. Coleman CC, Cunningham LA, Foster VJ, Batey SR, Donahue RM, Houser TL, Ascher JA. Ann Clin Psychiatry 1999 Dec;11(4):205-15; Mississippi Neuropsych Clinic

Bupropion = Fluoxetine: 456 pt MDD DB PC 8 weeks. No difference in effectiveness. Fewer sex side-effects with bupropion. Mississippi Neuropsyc Clinic. A placebo-controlled comparison of the effects on sexual functioning of bupropion sustained release and fluoxetine. Coleman CC, King BR, Bolden-Watson C, Book MJ, Segraves RT, Richard N, Ascher J, Batey S, Jamerson B, Metz A. Clin Ther 2001 Jul;23(7):1040-58

Bupropion = Fluoxetine: 6 week DB 124 pt MDD. No difference helping depression: HAM-D decreased 59% each. No difference in the frequency of side-effects or dropout rate: 26% vs 29%. Double-blind comparison of bupropion and fluoxetine in depressed outpatients. Feighner JP, Gardner EA, Johnston JA, Batey SR, Khayrallah MA, Ascher JA, Lineberry CG. J Clin Psychiatry 1991 Aug;52(8):329-35

Bupropion = SSRIs: Analysis of six DB studies comparing them for MDD. Bupropion and SSRIs have similar effectiveness; however, bupropion was associated with less nausea, diarrhea, somnolence, and sexual dysfunction. Bupropion versus selective serotonin-reuptake inhibitors for treatment of depression. Nieuwstraten CE, Dolovich LR. Ann Pharmacother 2001 Dec;35(12):1608-13

Bupropion = Paroxetine in Elderly: DB 100 60-88yos MDD paroxetine 10-40/d or bupropion 100-300/d. No difference. Author claims fewer side-effects with bupropion but give incomplete and possibly misleading data. Bupropion sustained release versus paroxetine for the treatment of depression in the elderly. Weihs KL, Settle EC Jr, Batey SR, Houser TL, Donahue RM, Ascher JA. J Clin Psychiatry 2000 Mar;61(3):196-202

Bupropion = > Trazodone in DB: 111 MDD completed DB 6 week. Bupropion 225-450, trazodone 150-450/d. 58% vs 46% improvement favoring bupropion not significant. 2.5# wt. loss vs 1.2# wt. gain. Comparison of bupropion and trazodone for the treatment of major depression. Duke: Weisler RH, Johnston JA, Lineberry CG, Samara B, Branconnier RJ, Billow AA. J Clin Psychopharmacol 1994 Jun;14(3):170-9

Bupropion or Fluoxetine No Faster Than Traditional Anti-Depressants: review 24 double-blind placebo-controlled studies comparing fluoxetine or bupropion against previously available antidepressants, to assess where there is evidence for a difference in the speed of onset of antidepressant action. Critical comparison of the studies showed no difference in speed of onset of action between these newer agents and conventional antidepressants. MUSC. Speed of onset of action of the newer antidepressants--fluoxetine and bupropion. George MS, Lydiard RB, Int Clin Psychopharmacol 1991 Winter;6(4):209-17

Bupropion Add-on for SSRI Sex Dysfunction: 47 pt with Bupr as adjunct PRN or fixed dose. Got 75-150 mg 1-2 hr bef sex and if not work, gradually incr to 75 mg TID over 2 weeks. 66% successful, 38% with PRN. 15% d/c Bupr due anx or tremor. Adam Ashton, SUNY Buffalo, J Clin Psychiatry 59:112-5.

Bupropion Substitution for SSRI Sex Dysfuntion: 11 pt had SSRI phased out while bupropion was started. There was no increase in depression overall and 55% made the switch successfully. Substitution of an SSRI with bupropion sustained release following SSRI-induced sexual dysfunction. U Va, Clayton AH, McGarvey EL, Abouesh AI, Pinkerton RC. J Clin Psychiatry 2001 Mar;62(3):185-90

Bupropion Helps Some Hyposexual Desire Disorder Females: 51 pt DB PC 4 week with PC nonresponders 8 weeks bupropion. 29% response rate. Bupropion sustained release (SR) for the treatment of hypoactive sexual desire disorder (HSDD) in nondepressed women. Segraves RT, Croft H, Kavoussi R, Ascher JA, Batey SR, Foster VJ, Bolden-Watson C, Metz A.

Bupropion Helps Orgasmic Dysfunction: 20 females 10 males. DB PC 150 vs 300mg/d. The 150 group did as well. 70% improved libido or orgasmic functioning. Helped both men and women. Effect of bupropion-SR on orgasmic dysfunction in nondepressed subjects: a pilot study. Modell JG, May RS, Katholi CR. J Sex Marital Ther 2000 Jul-Sep;26(3):231-40

No Difference Topiramate=Bupropion: Single blind 36 bipolar depressed on mood stabilizers. 11# wt loss with topiramate in 8 weeks vs. 3# with bupropion. 6 d/c due to side effects vs. 4. 175 vs. 250 mg average. 56% vs. 59% response rate. Topiramate versus bupropion SR when added to mood stabilizer therapy for the depressive phase of bipolar disorder: a preliminary single-blind study. McIntyre RS, Mancini DA, McCann S, Srinivasan J, Sagman D, Kennedy SH. Bipolar Disord 2002 Jun;4(3):207-13

Bupropion Polypharmacy: Added to SSRI + Lithium as Second Adjunct: 6 cases of MDD/Dysthymia appearing responsive to SSRI + lithium without being in total remission from from depression had bupropion or desipramine added without stopping either of the other medications. 2 of the 6 achieved total remission and 3 others had "near-complete remission." Only measure of improvement CGI and GAF. U Calgary. Treatment of resistant depression by adding noradrenergic agents to lithium augmentation of SSRIs. Ramasubbu R. Ann Pharmacother 2002 Apr;36(4):634-40

Dry Mouth, Insomnia Related to Blood Level: incidences of dry mouth and insomnia were directly related to bupropion plasma concentrations while the incidence of anxiety was inversely proportional to bupropion plasma concentrations. To maximise efficacy (with an acceptable safety profile), the optimal daily dose for the majority of patients is 300mg. Pharmacokinetic optimisation of sustained-release bupropion for smoking cessation. Johnston AJ, Ascher J, Leadbetter R, Schmith VD, Patel DK, Durcan M, Bentley B. Drugs 2002;62 Suppl 2:11-24

Modest Wt. Loss in Long-Term DB: 44 wk DB PC 426 pt who had responded in open trial 8 weeks of bupropion for MDD. At the end of double-blind treatment, mean change-from-baseline weights were as follows: BMI < 22, -0.1 kg; BMI 22 to 26, -0.6 kg; BMI > or = 27, -1.4 kg; and BMI > or = 30, -2.4 kg. Effect on body weight of bupropion sustained-release in patients with major depression treated for 52 weeks. Croft H, Houser TL, Jamerson BD, Leadbetter R, Bolden-Watson C, Donahue R, Metz A. Clin Ther 2002 Apr;24(4):662-72

Trigeminal Nerve Dysfunction Case: Pain left side face twitching. ophthalmic and maxillary brances. Stopped within 8 days of d/c, but recurred on resumption and had to stop, not just lower dosage. 1-2% patients get paresthesia or hypesthesia. Int Clin Psychoph 00;15:115

Overdose Frequent Seizures: Intentional overdoses resulted in seizures 15% of the time. Cardiac side-effects were rare. Bupropion exposures: clinical manifestations and medical outcome. Belson MG, Kelley TR. J Emerg Med 2002 Oct;23(3):223-30

Carbamazepine, But not Valproate, Induces Metabolism of Bupropion: Small study of a single 150mg dose bupropion found marked effect. Carbamazepine but not valproate induces bupropion metabolism. Ketter TA, Jenkins JB, Schroeder DH, Pazzaglia PJ, Marangell LB, George MS, Callahan AM, Hinton ML, Chao J, Post RM. J Clin Psychopharmacol 1995 Oct;15(5):327-33

Bupropion + Bromocriptine Benefit for Cocaine Addiction Questioned: 8-week, open-label study tested the combination of bupropion (< or =300 mg) and bromocriptine (< or =7.5 mg) daily in 34 cocaine-dependent (DSM-IIIR) outpatients also receiving weekly individual counseling. The first 18 subjects spent one week at maximum dose; the next 16 spent three weeks. Both groups showed significant reductions in self-reported cocaine use, with no significant change in proportion of urine toxicology tests positive for cocaine. There were no significant differences in outcome between groups. These results suggest that the combination of bupropion and bromocriptine is safe in cocaine addicts, but provide ambiguous evidence of its efficacy. Open-label pilot study of bupropion plus bromocriptine for treatment of cocaine dependence. NIDA. Montoya ID, Preston KL, Rothman R, Gorelick DA. Am J Drug Alcohol Abuse 2002;28(1):189-96

Bupropion No Help Marijuana Withdrawal: 10 pt DB PC. Bupropion SR worsens mood during marijuana withdrawal in humans. Haney M, Ward AS, Comer SD, Hart CL, Foltin RW, Fischman MW. Psychopharmacology (Berl) 2001 May;155(2):171-9

Bupropion = Desipramine in Bipolar Depression with Less Mania: Very small 19 DB 6 weeks with 1 year maintenance for bipolar MDD. Both helped depression but 5 of 10 desipramine pt and only 1 of 9 bupropion hypomanic/manic. A double-blind trial of bupropion versus desipramine for bipolar depression. Sachs GS, Lafer B, Stoll AL, Banov M, Thibault AB, Tohen M, Rosenbaum JF.

400mg/d Best for Wt Loss: counseled on energy-restricted diets, meal replacements, and exercise. During a 24-week extension, placebo subjects were randomized to bupropion SR 300 or 400 mg/d in a double-blinded manner. RESULTS: Of 327 subjects enrolled, 227 completed 24 weeks; 192 completed 48 weeks. Percentage losses of initial body weight for subjects completing 24 weeks were 5.0%, 7.2%, and 10.1% for placebo, bupropion SR 300, and 400 mg/d, respectively. Bupropion SR enhances weight loss: a 48-week double-blind, placebo- controlled trial. Anderson JW, Greenway FL, Fujioka K, Gadde KM, McKenney J, O'Neil PM. Obes Res 2002 Jul;10(7):633-41

Trazodone Helps Sleep in Fluoxetine or Bupropion Pts in DB: 17 pt DB PC crossover. Trazodone for antidepressant-associated insomnia. Nierenberg AA, Adler LA, Peselow E, Zornberg G, Rosenthal M. Am J Psychiatry 1994 Jul;151(7):1069-72

Bupropion May Help Atopic Dermatitis and Psoriasis: Open trial 150 x 3 weeks to 300 x 3 weeks helps 6 of 10 atopic and 8 of 10 psoriasis patients with 50% improvement in area covered with relapse on d/c of med. Treatment of atopic dermatitis and psoriasis vulgaris with bupropion-SR: a pilot study. Modell JG, Boyce S, Taylor E, Katholi C. Psychosom Med 2002 Sep-Oct;64(5):835-40

Bupropion Increased Fall Risk in Elderly: In 104 Major Depression patients on paroxetine for 21 weeks, those with an orthostatic drop in systolic BP, more memory impairment, and who received supplementary bupropion had more falls. Of 13 on bupropion, 28% or five patients fell. Age, depression, nortriptyline, and lithium were not associated with falling. Joo J, et al: Risk factors for falls during treatment of late-life depression. J Clin Psychiatry 2002;63:936-41. Univ Pittsburgh and NIMH.

Bupropion Can Exacerbate Psoriasis: Three patients with known psoriasis in whom use of bupropion (Zyban), prescribed to assist with cessation of smoking, led to severe pustular or erythrodermic exacerbation of psoriasis within 3-5 weeks. All patients were systemically unwell and required hospitalization to control the disease flare. Generalized pustular and erythrodermic psoriasis associated with bupropion treatment. Cox NH, Gordon PM, Dodd H. Br J Dermatol 2002 Jun;146(6):1061-3

Few Sex Side-Effects Bupropion: Bupropion appears to be much less likely to cause sexual dysfunction (<or=10% of patients). Mirtazapine also appears to be associated with a low rate of sexual adverse effects. In a review of research. Antidepressant-induced sexual dysfunction. Gregorian RS, Golden KA, Bahce A, Goodman C, Kwong WJ, Khan ZM. Ann Pharmacother 2002 Oct;36(10):1577-89; In another review of DB PC studies covering over 6000 patients, mirtazapine joins venlafaxine and SSRIs in higher sexual adverse effects group (36%-46%). Prevalence of sexual dysfunction among newer antidepressants. Even bupropion had quite a few reports. Bupropion SR (25%) was non-significantly worse than regular generic bupropion (22%). Clayton AH, Pradko JF, Croft HA, Montano CB, Leadbetter RA, Bolden-Watson C, Bass KI, Donahue RM, Jamerson BD, Metz A. J Clin Psychiatry 2002 Apr;63(4):357-66

Seizure Rare in Bupropion Treatment: Data for all patients prescribed bupropion within The Health Improvement Network (a computerised general practice database) were extracted and the self-controlled case-series method was used. Of 9329 individuals prescribed bupropion with 17,586 person-years of follow-up, the relative incidence of seizures during the first 28 days of treatment was 3.62, equivalent to one additional seizure per 6219 first time bupropion users. There was no increased risk of sudden death. Bupropion and the risk of sudden death: a self-controlled case-series analysis using The Health Improvement Network. Hubbard R, et al. University of Nottingham, UK. Richard.Hubbard@Nottingham.ac.uk. Thorax  2005 Oct;60(10):848-50.

Sex Side-Effects High with SSRIs: The incidence of any type of sexual dysfunction was compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine, 62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine, 24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higher severity. About 40% of patients showed low tolerance of their sexual dysfunction. U Salamanca, Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. J Clin Psychiatry 2001;62 Suppl 3:10-21

Bupropion Increases Vesicular Dopamine Uptake: The vesicular monoamine transporter-2 (VMAT-2) is principally involved in regulating cytoplasmic dopamine (DA) concentrations within terminals by sequestering free DA into synaptic vesicles. There is a correlation between striatal vesicular DA uptake through VMAT-2 and inhibition of the DA transporter (DAT). Methylphenidate (MPD), a DAT inhibitor, increases vesicular DA uptake through VMAT-2 in a purified vesicular preparation; an effect associated with a redistribution of VMAT-2 protein within DA terminals. Bupropion rapidly, reversibly, and dose-dependently increased vesicular DA uptake; an effect also associated with VMAT-2 protein redistribution. Bupropion increases striatal vesicular monoamine transport. Rau KS, et al. University of Utah. Neuropharmacology 2005 Nov;49(6):820-30.