Bupropion as Add-On Strategy in
Difficult-to-Treat Bipolar Depressive Patients

Erfurth A, Michael N, Stadtland C, Arolt V.
Department of Psychiatry,
Munster University Hospital, Munster, Germany.
Neuropsychobiology 2002;45 Suppl 1:33-6


Bupropion, a selective norepinephrine and dopamine reuptake inhibitor, has been suggested for the treatment of bipolar depression, not only because of its efficacy, but also because of a probably lower risk of inducing switches to hypomania or mania. Most studies on bupropion treatment in bipolar patients have been performed in moderately ill out-patients. In contrast, we report on a sample of difficult-to-treat, predominantly severely ill, co-morbid, psychotic or therapy-refractory bipolar depressive in-patients. In this open and prospective study, 13 patients were treated with bupropion as an add-on strategy mainly to other antidepressants and to various mood stabilizers. Our data support the idea that bupropion is a first-line antidepressant in the treatment of severe bipolar depression. Eight of 13 patients showed a >50% reduction of Montgomery-Asberg Depression Scale ratings within 4 weeks. Co-medication with drugs commonly used in treatment-resistant bipolar disorder including venlafaxine, clozapine, lithium, topiramate and sodium valproate was safe in our small sample. While adhering to the suggestion of Goren and Levin not to exceed a daily dose of 450 mg of bupropion when treating bipolar depressed patients, we did not observe any switch from depression to hypomania or mania.
Bipolar disorder
Bipolar depression
The manic spectrum
Bupropion and mania
Bipolar polypharmacy
Drug-induced depression
Bupropion and nitric oxide
Bupropion for nicotine quitters
Antidepressant-induced mania
Bupropion used to augment SSRIs
Switching to bupropion from a SSRI
Bupropion and the dopamine transporter
Bupropion (Wellbutrin) for major depressive disorder
Bupropion (Wellbutrin): prescribing information (PDF)
Bupropion: pharmacology and therapeutic applications
Bupropion (Wellbutrin): neurochemical and psychotropic effects

and further reading

Future Opioids
BLTC Research
Utopian Surgery?
The Abolitionist Project
The Hedonistic Imperative
The Reproductive Revolution
Critique of Huxley's Brave New World

The Good Drug Guide
The Good Drug Guide

The Responsible Parent's Guide
To Healthy Mood Boosters For All The Family