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Spotlight on Bupropion in Major Depressive Disorder

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Abstract

Bupropion is presumed to be a dopamine-noradrenaline (norepinephrine) reuptake inhibitor and is an effective antidepressant. It is available as three oral formulations: (i) bupropion immediate release (IR) [Wellbutrin®] administered three times daily; (ii) bupropion sustained release (SR) [Wellbutrin SR®] administered twice daily; and (iii) bupropion extended/modified release (XR) [Wellbutrin XL®/Wellbutrin XR®] administered once daily. All three formulations are bioequivalent in terms of systemic exposure to bupropion.

Oral three-times-daily bupropion IR was effective and generally well tolerated in the treatment of major depressive disorder (MDD). It was as efficacious and as well tolerated as some TCAs and the SSRI fluoxetine. Moreover, it was associated with less somnolence and weight gain than some TCAs. Twice-daily bupropion SR was also efficacious and generally well tolerated in the treatment of MDD. It was as effective as and had a generally similar tolerability profile to some SSRIs, but had the advantage of less somnolence and sexual dysfunction. The efficacy of bupropion XR in terms of primary efficacy measures was established in two of six well designed placebo-controlled studies. Bupropion XR also demonstrated efficacy in terms of some secondary outcomes in five of these studies. Additionally, bupropion XR was similar, in terms of the primary efficacy outcomes, to the SSRI escitalopram in two placebo-controlled trials and to the serotonin-noradrenaline reuptake inhibitor (SNRI) venlafaxine extended release (XR) in two trials (one of which was placebo-controlled), but not in a third placebo-controlled trial where venlafaxine XR was better than bupropion XR. It was generally as well tolerated as escitalopram and venlafaxine XR, but was associated with less sexual dysfunction than escitalopram. Available clinical data suggest that bupropion is an effective and generally well tolerated option in the treatment of MDD, with the newer formulations having the advantage of reduced frequency of daily administration.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Authors and Affiliations

  1. Wolters Kluwer Health ¦ Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore, Auckland, 0754, New Zealand

    Sohita Dhillon, Lily P. H. Yang & Monique P. Curran

  2. Wolters Kluwer Health, Conshohocken, Pennsylvania, USA

    Sohita Dhillon, Lily P. H. Yang & Monique P. Curran

Authors
  1. Sohita Dhillon
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  2. Lily P. H. Yang
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  3. Monique P. Curran
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Corresponding author

Correspondence to Sohita Dhillon.

Additional information

Adapted and reproduced from Drugs 2008; 68 (5): 653–689. The full text article[1] was reviewed by: I.M. Anderson, Neuroscience and Psychiatry Unit, University of Manchester, Manchester, England; P. Bech, Psychiatric Research Unit, Frederiksborg General Hospital, Hillerød, Denmark; P. Casey, Department of Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland; P. Cowen, University Department of Psychiatry, Warneford Hospital, Oxford, England; S. Curran, Calder Unit, Fieldhead Hospital, Wakefield, England; J.M. Donoghue, Medicines in Mental Health Ltd, Liverpool, England; M.H. Lader, Institute of Psychiatry, King’s College, London, England. The manufacturer of the agent under review was offered an opportunity to comment on the original article during the peer review process. Changes based on any comments received were made on the basis of scientific and editorial merit. The preparation of the original article and this spotlight was not supported by any external funding.

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Dhillon, S., Yang, L.P.H. & Curran, M.P. Spotlight on Bupropion in Major Depressive Disorder. CNS Drugs 22, 613–617 (2008). https://doi.org/10.2165/00023210-200822070-00006

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