International Journal of Clinical Pharmacy

, Volume 34, Issue 1, pp 9–12 | Cite as

Agitated delirium associated with therapeutic doses of sustained-release bupropion

  • Diana R. MackEmail author
  • Liza Barbarello-AndrewsEmail author
  • Mei T. Liu
Case Report


Case description We report a case of a patient initiated on therapeutic doses of sustained-release bupropion for the management of major depressive disorder who subsequently developed acute agitated delirium that required ICU level care. This patient’s history was significant for alcohol and cannabis abuse but he was currently detoxified and beyond the withdrawal period. Throughout the course of treatment, all maintenance medications, including bupropion, were discontinued and the patient required escalating doses of benzodiazepines and typical antipsychotics to resolve symptoms. The patient’s delirium subsided after approximately 5 days. Conclusion Dopamine is thought to play a role in the pathophysiology of delirium and given the mechanism of action of this drug and the presence of delirium risk factors in our patient, we are faced with a likely causative factor of this acute delirious episode.


Agitation Adverse drug events Bupropion Delirium Psychosis 




Conflicts of interest

The authors have no conflicts of interest to disclose.


  1. 1.
    Mann JJ. The Medical Management of Depression. N Engl J Med. 2005;353(17):1819–34.PubMedCrossRefGoogle Scholar
  2. 2.
    GlaxoSmithKline. Wellbutrin SR (bupropion SR) package insert. Research Triangle Park, NC; 2007.Google Scholar
  3. 3.
    Meagher DJ. Delirium: Optimizing Management. BMJ. 2001;322:144–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Bailey J, Waters S. Acute Psychosis After Bupropion Treatment in a Healthy 28-Year-Old Woman. J Am Board Fam Med. 2008;21(3):244–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Neumann M, Livak V, Paul HW, Laux G. Acute Psychosis after Administration of Bupropion Hydrochloride (Zyban™). Pharmacopsychiatry. 2002;35:247–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Javelot H, Baratta A, Weiner L, et al. Two acute psychotic episodes after administration of bupropion: a case of involuntary rechallenge. Pharm World Sci. 2009;31:238–40.PubMedCrossRefGoogle Scholar
  7. 7.
    Hahn M, Hajek T, Alda M, Gorman JM. Psychosis Induced by Low-Dose Bupropion: Sensitization of Dopaminergic System by Past Cocaine Abuse? Journal of Psychiatric Practice. 2007;13(5):336–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Chan CH, Liu HC, Huang MC. Delirium Associated With Concomitant Use of Low-Dose Bupropion Sustained Release and Fluoxetine. J Clin Psychopharmacoplogy. 2006;26:677–9.CrossRefGoogle Scholar
  9. 9.
    Van Putten T, Shaffer I. Delirium Associated with Bupropion. J Clin Psychopharmacol 1990;10:3:234.Google Scholar
  10. 10.
    Strouse TB, Salehmoghaddam S, Spar JE. Acute Delirium and Parkonsonism in a Bupropion-Treated Liver Transplant Recipient. J Clin Psych. 1993;54(12):489–90.Google Scholar
  11. 11.
    Liberzon I, Dequardo JR, Silk KR. Bupropion and Delirium. Am J Psychiatry. 1990;147:1689–91.PubMedGoogle Scholar
  12. 12.
    Howard WT, Warnock JK. Bupropion-induced psychosis. Am J Psychiatry. 1999;156:2017–8.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Department of Pharmacotherapy and Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondUSA
  2. 2.University Medical Center at Princeton, Ernest Mario School of PharmacyRutgers, The State University of New JerseyPiscatawayUSA

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