Bupropion

Brand Name:

Wellbutrin

Drug Class:

Norepinephrine and Dopamine Reuptake Inhibitor (NDRI)

How it works:

Boosts the effects of two neurotransmitters found in the brain called dopamine and norepinephrine.

What makes it unique: 

Has a nice balance in regards to boosting the effect of dopamine. It occupies 10-30% of dopamine transporter receptors. This is enough to cause its effect without going overboard. Dopamine transporter occupancy of 50% or higher can cause sudden but short-lived euphoria and addiction. It is also the only antidepressant used to help people to stop using tobacco.

Side effects:

Dry mouth, constipation, weight loss, insomnia, hypertension, myalgia. Bupropion can also cause ear-ringing, vivid dreams, and agitation.

Rare side effects include seizures, induction of mania, and activation of suicidal ideation in people age 24 and younger.

How effective is it:

(1) A study reviewed 7 trials to compare Bupropion with medications from the SSRI drug class. Bupropion was shown to have similar efficacy as compared to SSRI medication but had the benefit of causing less sexual side effects.

(2) A review study was conducted to compare Bupropion to the SNRI medication, Venlafaxine. 1,117 patients were analyzed. The response and remission rates were similar between the two medications.

Clinical experience:

This is a very common medication. It can be used on its own or can be added to other antidepressants for a combined effect. This may be a good choice for someone with low energy who is depressed and who has had sexual side effects to other classes. Also it may help the patient to stop using tobacco as an added benefit. Pharmaceuticals should never be used as the sole treatment for mental illnesses. Therapy, exercise, meditation or other treatments should always accompany prescriptions.

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References:

1. Thase ME, Haight BR, Richard N, et al. Remission rates following antidepressant therapy with bupropion or selective serotonin reuptake inhibitors: a meta-analysis of original data from 7 randomized controlled trials. J Clin Psychiatry. 2005 Aug;66(8):974-81.

2. Maneeton N, Maneeton B, Eurviriyanukul K, et al. Efficacy, tolerability, and acceptability of bupropion for major depressive disorder: a meta-analysis of randomized-controlled trials comparison with venlafaxine. Drug Des Devel Ther. 2013 Sep 27;7:1053-62.