Significant Treatment Effect of Bupropion in Patients With Bipolar Disorder but Similar Phase-Shifting Rate as Other Antidepressants

Abstract

Bupropion is widely used for treating bipolar disorder (BD), and especially those with depressive mood, based on its good treatment effect, safety profile, and lower risk of phase shifting. However, increasing evidence indicates that the safety of bupropion in BD patients may not be as good as previously thought.The aim of this study was to summarize data on the treatment effect and safety profile of bupropion in the treatment of BD via a meta-analysis.Electronic search through PubMed and ClinicalTrials.gov was performed.The inclusion criteria were: (i) studies comparing changes in disease severity before and after bupropion treatment or articles comparing the treatment effect of bupropion in BD patients with those receiving other standard treatments; (ii) articles on clinical trials in humans. The exclusion criteria were (i) case reports/series, and (ii) nonclinical trials.All effect sizes from 10 clinical trials were pooled using a random effects model. We examined the possible confounding variables using meta-regression and subgroup analysis.Bupropion significantly improved the severity of disease in BD patients (P < 0.001), and the treatment effect was similar to other antidepressants/standard treatments (P = 0.220). There were no significant differences in the dropout rate (P = 0.285) and rate of phase shifting (P = 0.952) between BD patients who received bupropion and those who received other antidepressants.We could not perform a detailed meta-analysis of every category of antidepressant, nor could we rule out the possible confounding effect of concurrent psychotropics or include all drug side effects. Furthermore, the number of studies recruited in the meta-analysis was relatively small.Our findings reconfirm the benefits of bupropion for the treatment of bipolar depression, which are similar to those of other antidepressants. However, the rate of phase shifting with bupropion usage was not as low compared to other antidepressants as previously thought, which should serve to remind clinicians of the risk of phase shifting when prescribing bupropion to BD patients regardless of the suggestions of current clinical practice guidelines.

Affective Switch Associated With Oral, Low Dose Ketamine Treatment in a Patient With Treatment Resistant Bipolar I Depression. Case Report and Literature Review

“…The patient described in this report was treated with mood stabilizers, but also received bupropion. According to one metanalysis bupropion, previously associated with low risk of polarity switch in bipolar disorder causes it as often as other antidepressants (19). Our observation and previous case reports suggest increased risk of switch associated to ketamine administered together with antidepressants.…”

Comprehensive comparison of monotherapies for psychiatric hospitalization risk in bipolar disorders

“…2,[16][17][18][19] Aripiprazole has been consistently reported to have the most favorable hospitalization outcomes among SGAs in retrospective studies, 1,13,20,21 whereas a recent review of BD randomized controlled trials on adjunctive antipsychotics showed only one study with an SGA superior to lithium, namely quetiapine. 22 The literature on bupropion suggests that it has equivalent effectiveness to other ADs in treatment of depressive states, [23][24][25] with contradictory data on manic switch risk. [25][26][27] Our findings on the reduced risk of hospitalization associated with bupropion were unexpected, since psychostimulants are known to significantly increase the probability of psychiatric hospitalization due to psychoses and mania.…”

“…22 The literature on bupropion suggests that it has equivalent effectiveness to other ADs in treatment of depressive states, [23][24][25] with contradictory data on manic switch risk. [25][26][27] Our findings on the reduced risk of hospitalization associated with bupropion were unexpected, since psychostimulants are known to significantly increase the probability of psychiatric hospitalization due to psychoses and mania. 28 The observation of bupropion's lower risk might be dose-dependent or relevant to certain subgroups of patients in their early course of BD/ SCAD.…”

Manic Shift Due to the Use of Bupropion in Bipolar Depression: Two Case Reports

“…Yakın tarihli bir meta-analizde daha önceki verilerden farklı olarak bupropiyonun diğer antidepresanlara göre manik/ hipomanik kayma risk oranı daha düşük bulunmamıştır. Bu meta-analiz sonucunda klinisyenlerin bipolar bozuklukta mevcut klinik uygulama kılavuzlarının aksine bupropiyon reçete ederken olası faz kayma riskini akıllarında tutmalarının önemi vurgulanmıştır (Li ve ark. 2016).…”