Switching to bupropion in fluoxetine-resistant major depressive disorder
by
Fava M, Papakostas GI, Petersen T, Mahal Y, Quitkin F, Stewart J, McGrath P.
The Depression Clinical and Research Program,
Massachusetts General Hospital, Harvard Medical School,
Boston, Massachusetts 02114, USA.
Ann Clin Psychiatry. 2003 Mar;15(1):17-22

ABSTRACT

Up to 50% of patients with major depressive disorder (MDD) fail to respond to an antidepressant trial, with most taking a selective serotonin reuptake inhibitor (SSRI) as an initial treatment. Switching to bupropion, for depressed patients not responding to SSRIs, is a popular strategy among clinicians. This study assesses the efficacy of bupropion SR in the management of MDD resistant to a prospective trial of fluoxetine. Twenty-nine patients with MDD refractory to an 8- to 12-week open-trial of fluoxetine were enrolled in an 8-week open-trial of bupropion SR. Both a completer analysis (n = 20) and a modified intent-to-treat analysis (n = 26) were performed to evaluate bupropion SR response rates. Using a completer analysis, seven patients (35.0%) were classified as responders, five (25.0%) partial responders, and eight (40.0%) nonresponders. A modified intent to treat analysis resulted in nine (34.6%) patients classified as responders, eight (30.8%) partial responders, and nine (34.6%) nonresponders. The overall proportion of remitters was 6/20 (30.0%) using a completer analysis and 6/26 (23.1%) using an MITT analysis. Approximately 60% of patients with MDD resistant to a prospective trial of fluoxetine experienced a full or partial response to bupropion SR. Bupropion SR should be considered as a potential treatment for patients who remain depressed despite treatment with SSRIs

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Bupropion and REM
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Bupropion v idazoxan
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Bupropion versus paroxetine
Bupropion and its metabolites
Antidepressant-induced mania
Bupropion used to augment SSRIs
Bupropion SR in adolescent major depression
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Bupropion: pharmacology and therapeutic applications

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