Psychotropic Use during Pregnancy
“Bert” Bertis Britt Little in Drugs and Pregnancy, 2022
Bupropion is used as an antidepressant and also in tobacco smoking cessation treatment. Bupropion use in the first trimester was not associated with an increased risk of congenital anomalies among 354 infants whose mothers used the drug during the first trimester (12 birth defects, or 3.4 percent) (Bupropion Registry, 2004). One study reported no birth defects in 105 infants after first trimester exposure to bupropion (Chun-Fai-Chan et al., 2005), another study reported no increased frequency in 1213 (Cole et al., 2007), and among 675 infants exposed to the drug during organogenesis the rate of congenital anomalies was not increased (2.7 percent) (GlaxoSmithKline, 2008). Among 8856 infants exposed to bupropion during organogenesis, the frequency of congenital heart defects was not increased (Huybrechts et al., 2014). Bupropion is an FDA category B drug under the old classification. In a recent analysis of 229 infants whose mothers used bupropion during the first trimester, the frequency of diaphragmatic hernia and intestinal atresia were increased in frequency (Anderson et al., 2020).
Stimulant Use Disorder
James MacKillop, George A. Kenna, Lorenzo Leggio, Lara A. Ray in Integrating Psychological and Pharmacological Treatments for Addictive Disorders, 2017
Bupropion is an atypical antidepressant with stimulant properties that is approved for treatment of nicotine dependence. Bupropion inhibits dopamine reuptake and is thought to increase dopamine transmission in the prefrontal cortex and nucleus accumbens [44]. Use of bupropion might remediate the frontal hypodopaminergic state observed in individuals affected by chronic PUD [45]. Treatment trials with bupropion in cocaine dependence show mixed results. When given as an adjunct to CBT, it has no effect [46, 47]; however, bupropion improved the duration of abstinence when given with CM [48]. In another study, its effect to increase abstinence rates was limited to a subgroup of individuals with significant depressive symptoms [49]. It has been shown to reduce methamphetamine craving [50]. Bupropion has been effective in increasing abstinence with 1.27–1.39 higher odds of having an abstinent week compared to placebo in low using, albeit still dependent stimulant users [51]. In this same sample, bupropion showed overall efficacy when comparing individuals that had more than one week of abstinence and completed treatment [52]; however, these results were inconsistent in another study that found null results [46]. Bupropion is well tolerated and adherence is good.
Pharmacotherapy
G. Michael Steelman, Eric C. Westman in Obesity, 2016
Contrave is a combination of bupropion, an antidepressant that is a weak inhibitor of neuronal reuptake of norepinephrine and dopamine, and naltrexone, a μ-opioid receptor antagonist originally approved for the treatment of alcohol and opiate addiction. Bupropion stimulates hypothalamic proopiomelanocortin (POMC) neurons to release α-melanocyte-stimulating hormone (α-MSH). α–MSH is an agonist of melanocortin 4 receptors that initiates a cascade leading to decreased energy intake and increased energy expenditure, resulting in weight loss. As POMC neurons release α-MSH, they also release a μ-opioid receptor agonist that induces diminution of α-MSH release. Naltrexone blocks this negative feedback, working synergistically with bupropion, thereby amplifying the weight loss effect. Bupropion is a substituted phenethylamine, but there have been no suggestions of addiction potential. The combination is not classified as a controlled substance.
When is pharmacotherapy necessary for the treatment of seasonal affective disorder?
Published in Expert Opinion on Pharmacotherapy, 2022
Jean-Baptiste Belge, Amber CF Sabbe, Bernard GCC Sabbe
Given the well-known morbidity of a depressive episode and the predictability of these episodes inherent to the SAD diagnosis, preventive treatment may be necessary, especially for those individuals who are known to experience severe depressive episodes. Until today, bupropion extended release (XR) is the only antidepressant with a proven prophylactic efficacy for SAD and is as such approved by the US FDA. Three double-blind randomized controlled trials demonstrated bupropion’s superior prophylactic efficacy to placebo [12,13]. Recurrence of depressive episodes was significantly lower in the bupropion group when started in autumn, before the onset of symptoms and continued until spring [12,13]. However, side-effects of bupropion include headaches, insomnia and nausea and affect around 20–30% of patients [12,13]. While an efficacious intervention for the prevention of recurrence of depressive episodes, the Cochrane working group stated that the numbers needed to treat for additional beneficial outcomes (NNTB) will vary strongly by baseline risks [14]. For a population with a yearly recurrence rate of 30%, the NNTB is 8, while for populations with yearly recurrence rates of 50% and 60%, NNTBs are 5 and 4 [14].
Systematic review of preclinical, clinical, and post-marketing evidence of bupropion misuse potential
Published in The American Journal of Drug and Alcohol Abuse, 2019
Andrew C Naglich, E. Sherwood Brown, Bryon Adinoff
Orally dosed bupropion has known side effects including lowered seizure threshold, agitation, gastrointestinal disturbance, and issues with sleep (11). User experiences describing the effects of ingestion of doses between one and six times the maximum recommended daily dose of bupropion detail a variety of adverse reactions including jitteriness and anxiety (3/14), nausea and vomiting (5/14), formication (1/14), and auditory or visual hallucinations (12/14). Erowid users who have orally taken supratherapeutic doses of bupropion frequently report no positive effects (9/14), feelings of euphoria (5/14), or enhanced perception of light and sound (2/14). The number of cases of bupropion use as the sole intoxicant is markedly smaller by the number of reports with caffeine (54) and prescription d-amphetamine (98).
Suicidal bupropion ingestions in adolescents: increased morbidity compared with other antidepressants
Published in Clinical Toxicology, 2018
David C. Sheridan, Amber Lin, B. Zane Horowitz
In early 2004, the Federal Drug Administration issued its first public health advisory about the increased risk of suicidality specifically in adolescent and young adults, on all currently available antidepressants, which included bupropion [3]. Within 6 months of this initial public health announcement the advisory committee recommended adding a black-box warning for all antidepressants. Although bupropion now shares this Black Box warning with all antidepressants, since its release, the prescription patterns of medications for adolescent depression have changed with decline in SSRI usage [3]. Currently, bupropion has Food and Drug Administration-approved indications for the treatment of major depressive disorder, smoking cessation, seasonal affective disorder, and as an adjunct agent for weight-loss when co-formulated with naltrexone. Often bupropion is used in the adolescent population, and may be preferred by some physicians and patients, as an agent more likely to improve energy and result in weight loss – a frequent issue in adolescent self-image and mental health [4]. A report of medication errors that examined drug errors for antidepressants found that bupropion was the second most common antidepressant that has issues when providers initiate therapy [4]. This is a concerning finding as bupropion has also been shown in the past to cause significant side effects when incorrectly taken or ingested for self-harm including a high prevalence of neurologic toxicity [5].
Related Knowledge Centers
- Adjuvant Therapy
- Hepatotoxicity
- Hypersomnia
- Major Depressive Disorder
- Selective Serotonin Reuptake Inhibitor
- Smoking Cessation
- Somnolence
- Atypical Antidepressant
- Placebo
- Seizure