Bupropion

Bupropion, sold under the brand names Wellbutrin and Zyban among others, is a medication primarily used to treat major depressive disorder and to support stopping smoking. It is an effective antidepressant on its own, but is also used as an add-on medication in cases of incomplete response to first-line SSRI antidepressants. Bupropion is taken in tablet form and is available only by prescription in most countries. Common side effects include dry mouth, trouble sleeping, agitation, and headaches. Serious side effects include an increased risk for epileptic seizures and suicide. The risk of seizures caused the drug to be withdrawn from the market for some time and then the recommended dose to be reduced. In comparison to some other antidepressants, it does not cause as much sexual dysfunction or sleepiness, and may result in weight loss. It is unclear if use during pregnancy or breastfeeding is safe. Bupropion is an atypical antidepressant. It acts as a norepinephrine–dopamine reuptake inhibitor (NDRI) and a nicotinic receptor antagonist. Chemically, bupropion is an aminoketone that belongs to the class of substituted cathinones and is similar to phenethylamines. Bupropion was first made by Nariman Mehta and patented by Burroughs Wellcome in 1974. It was first approved for medical use in the United States in 1985. It was originally called by the generic name amfebutamone, before being renamed in 2000. In the United States the wholesale cost per dose is less than US$0.50 as of 2018. In 2016 it was the 28th most prescribed medication and 4th most prescribed antidepressant in the United States with more than 23 million prescriptions. A 2018 meta-analysis found only weak evidence supporting use of bupropion for depression, with only a few available trials; and the little evidence that was available showed that bupropion had a weak antidepressant effect. A 2016 meta-analysis found that bupropion therapy for depression is superior to placebo. Most of the trials which compared bupropion to other drugs for depression showed similar effectiveness, but this finding is based in part upon low-quality evidence. A meta-analysis from 2009 found that bupropion is as effective as several other widely prescribed drugs, including fluoxetine and paroxetine, although trends favoring the efficacy of escitalopram, sertraline, and venlafaxine over bupropion have been observed. It also found that mirtazapine is more effective than bupropion. Bupropion was approved by the U.S. Food and Drug Administration (FDA), in 2006, for the prevention of seasonal affective disorder (SAD). In some countries (including Australia, New Zealand and the UK) depression treatment and SAD prevention are off-label uses. A Cochrane review on the use of extended-release bupropion for the treatment of seasonal affective disorder found that bupropion is effective in preventing the recurrence of the disorder; however, three out of four individuals who take the drug will not benefit from treatment and may be at risk for harm. Bupropion has several features that distinguish it from other antidepressants: for instance, unlike the majority of antidepressants, it does not usually cause sexual dysfunction. Bupropion treatment also is not associated with the sleepiness or weight gain that may be produced by other antidepressants. In depressed people who experience symptoms of sleepiness and fatigue, bupropion has been found to be more effective than selective serotonin reuptake inhibitors (SSRIs) in alleviating these symptoms. There appears to be a modest advantage for the SSRIs over bupropion in the treatment of anxious depression. The addition to a prescribed SSRI is a common strategy when people do not respond to the SSRI, even though this is not an officially approved indication. The addition of bupropion to an SSRI (most commonly fluoxetine or sertraline) may result in an improvement in some people who have an incomplete response to the first-line antidepressant.