Bupropion as an Augmenting Agent in Patients of Depression with Partial Response

Abstract

The objective of this study is to evaluate the effects of bupropion as an add-on therapy to selective serotonin reuptake inhibitor (SSRI) on patients of major depressive disorder with partial response. This prospective, randomized, controlled and single-blind study was conducted in sixty patients suffering from major depressive disorder as per Diagnostic and Statistical Manual (DSM)-IV TR criteria, who were having Hamilton depression rating scale (HDRS) score ≥16 after 4 weeks of treatment with SSRIs. Group A received SSRI plus placebo and group B received SSRI plus bupropion. Evaluation was performed based on changes in HDRS score, Montgomery and Asberg depression rating scale (MADRS), Amritsar depressive inventory (ADI) and spontaneously reported adverse effects. There was a significant decrease in the HDRS, MADRS and ADI scores as compared to baseline in both groups. However, the mean decrease in depression score was more in group B than in group A. The percentage decrease of remitters was also significantly more in group B (60% as per HDRS score and 63% as per MADRS score), as compared to group A (24% as per HDRS score and 27% as per MADRS score) (p < 0.05), at the end of treatment. In conclusion, bupropion add-on can act as augmenting agent in patients of depression with partial response to SSRIs.

Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant

“…A single-blind RCT [Gulrez et al 2012] Three open-label studies evaluated the addition of bupropion to citalopram or escitalopram, a SSRI that is highly selective for the serotonin reuptake transporter. A novel design naturalistic study by Lam and colleagues explored treatment strategies, whether to augment or switch medication, in 61 individuals taking either citalopram or bupropion SR (at a therapeutic dose but showing minimal improvement) for at least 6 weeks [Lam et al 2004].…”

A systematic review and meta-analysis of trials of treatment of depression from India

“…Besides imipramine other drugs which have been evaluated include amitriptyline (5 trials), sertraline (4 trials), citalopram (3 trials), sintamil (3 trials), venlafaxine (3 trials), mirtazapine (3 trials), escitalopram (3 trials), milnacipran (2 trials), ECT (2 trials), and rTMS (3 trials). Two trials used Selective Serotonin Reuptake Inhibitors (SSRIs) as a class for evaluation of efficacy of “add-on” antidepressants[6364] to various SSRIs and one trial has compared sertraline in depressed postmyocardial infarction patients with no therapy. [65] One trial each evaluated moclobamide, duloxetine, fluoxetine, bupropion, nortriptyline, fluphenazine add-on to nortriptyline, 5 hydroxytryptophan, duloxetine, niamide, phenelzine, centpropazine, iprindole, protriptyline, alprazolam, and sudarshan kriya.…”

“…The Jadad scores ranged from 0 to 5 with a median of 2 (mean of 1.97, mode 2). Newer studies had explicitly used intention-to-treat analysis,[34505458596364] while the older studies had not relied on such statistical procedures. [293032333640434748] When correlation of the year of publication was drawn with risk of bias (measured with Jadad scale), there was no statistically significant correlation (Kendall tau correlation of −0.031, P=0.813).…”

“…Active rTMS was found to be superior to sham rTMS with effect size of 0.74 (CI 0.396-1.084) based on three studies[606162] with a cumulative sample of 104 and considerable degree of heterogeneity (I 2 =54.89). Bupropion,[63] mirtazapine,[64] and fluphenazine[51] were found to be effective as an add-on treatment for depression (effect sizes of 0.859, 0.232, and 0.650, respectively). The forest plot of the included studies is shown in Figure 1.…”

Debate continues over the use of combination antidepressants in patients with treatment-resistant depression

“…[10][11][12][13][14][15][16][17] Although this work provides some support for the practice, the limited numbers of patients in the studies mean that the findings should not be extrapolated to underpin widespread use of the approach. y and may cause problems All of this is a timely reminder that vocal advocacy does not equate to substantiation.…”