title: Bupropion as add-on strategy in difficult-to-treat bipolar depressive patients.
abstract: 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.
authors.affiliation: Department of Psychiatry, Münster University Hospital, Germany. erfurth@uni-muenster.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Erfurth
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Michael
authors.forename: Cornelis
authors.initials: C
authors.lastname: Stadtland
authors.forename: Volker
authors.initials: V
authors.lastname: Arolt
mesh_terms: D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D016642:Bupropion / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D006801:Humans
chemical_list: D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion