Clinical uses of Bupropion in patients with Parkinson’s disease and comorbid depressive or neuropsychiatric symptoms: a scoping review

Abstract

Objective Bupropion, an antidepressant inhibiting the reuptake of dopamine and noradrenaline, should be useful to treat depressive symptoms in patients with Parkinson’s disease (PD). Limited and conflicting literature data questioned its effectiveness and safety in depressed PD patients and extended its use to other neuropsychiatric symptoms associated with this disorder. Design The databases PubMed, Embase, Web of Sciences, Cochrane Library, and the grey literature were searched. Following a scoping review methodology, articles focusing on Bupropion uses in PD patients who manifested depressive or other neuropsychiatric alterations were reviewed. Results Twenty-three articles were selected, including 7 original articles, 3 systematic reviews or meta-analyses, 11 case reports, 1 clinical guideline, and 1 expert opinion. Bupropion showed considerable effectiveness in reducing depressive symptoms, particularly in relation to apathy. Solitary findings showed a restorative effect on compulsive behaviour secondary to treatment with dopamine as well as on anxiety symptoms. The effect on motor symptoms remains controversial. The safety profile of this medication seems positive, but additional precautions should be used in subjects with psychotic symptoms. Conclusion The available literature lacks good evidence to support the use of Bupropion in PD patients presenting depressive symptoms. Further investigations are needed to extend and confirm reported findings and to produce accurate clinical guidelines.

The use of sertraline to treat an adolescent of dystonia comorbid with major depressive disorder with psychotic features

“…23 Furthermore, SSRI or SNRI treatment significantly improved depression and freezing of gait in PD with good tolerability, 24 while bupropion, an NDRI, was effective for depressive symptoms, especially apathy. 25 Potential motor adverse effects, however, cause hesitation in using antidepressants movement disorders. Analyzing the World Health Organization pharmacovigilance database, SSRIs demonstrated increased risks of akathisia, bruxism, dystonia, myoclonus, parkinsonism, restless leg syndrome (RLS), tardive dyskinesia (TD), tics, and tremor, while SNRIs were associated with bruxism, RLS, TD, and tremor.…”

“…The International Parkinson Disease and Movement Disorder Society identified SSRIs, including sertraline, citalopram, paroxetine, and fluoxetine, and an SNRI, venlafaxine, as possibly useful for depression in PD 23 . Furthermore, SSRI or SNRI treatment significantly improved depression and freezing of gait in PD with good tolerability, 24 while bupropion, an NDRI, was effective for depressive symptoms, especially apathy 25 …”

“… 23 Furthermore, SSRI or SNRI treatment significantly improved depression and freezing of gait in PD with good tolerability, 24 while bupropion, an NDRI, was effective for depressive symptoms, especially apathy. 25 …”

Therapeutic applicability of cannabidiol and other phytocannabinoids in epilepsy, multiple sclerosis and Parkinson's disease and in comorbidity with psychiatric disorders

“…24 Indeed, neurological diseases, such as temporal lobe epilepsy, and psychiatric disorders, such as anxiety, psychosis and schizophrenia, were already reported in comorbidity. 25,26 Epigenetic modifications can be critical for the therapeutic efficacy of antidepressants and/or antipsychotic agents, 27 commonly prescribed for the treatment of patients with neurological diseases in comorbidity with psychiatric disorders, such as Parkinson's disease and depression, 28 epilepsy and psychosis, 29,30 multiple sclerosis and psychosis 31 and other comorbidities. The exposure of adolescents to psychotropic drugs, such as THC, during a "critical window" of enhanced neurophysiological vulnerability and chemical dependence causes long-term effects and contributes to the pathophysiology of schizophrenia and related primary psychotic disorders, 32 in which the clinical use of phytocannabinoids may be a useful therapeutic procedure.…”