![]() ![]() Disappointing data indicate that about half of patients discontinue their treatment during such an initial time frame. A so-called ‘therapeutic trial’ of a minimum recognized dose over about 6 weeks is ordinarily recommended before changing medication, and treatment resistance is usually defined as failure to respond to two such trials. Guidelines generally advocate selective serotonergic reuptake inhibitors (SSRIs) as the first-line pharmacological intervention, primarily due to their more benign side-effect profile rather than any superiority in efficacy. Major depressive disorders (MDD) are a leading global cause of morbidity affecting up to a fifth of individuals, four fifths of whom will have multiple illness episodes. There are some data to support bupropion targeting specific symptoms, but insufficient information to reliably inform such prescribing, and it remains uncertain whether bupropion pharmacodynamically truly augments other drugs. However there are notable gaps in the literature, including less information on treatment naïve and first presentation depression, particularly when one considers the ever-reducing rates of response in more refractory illness. Our findings support the use of bupropion as a sole or coprescribed antidepressant, particularly if weight gain or sexual dysfunction are, or are likely to be, significant problems. Bupropion is generally well tolerated, it has very low rates of sexual dysfunction, and is more likely to cause weight loss than gain. Effectiveness has been shown in ‘other’ populations, though there is an overall dearth of research. Several large multi-medication trials, most notably STAR*D, also support a therapeutic role for bupropion in general, it demonstrated similar effectiveness to other medications, though this literature highlights the generally low response rates in refractory cohorts. Most work on the coprescribing of bupropion with another antidepressant supports an additional effect, though many are open-label trials. Methodologically more robust trials support the superiority of bupropion over placebo, and most head-to-head antidepressant trials showed an equivalent effectiveness, though some of these are hindered by a lack of a placebo arm. bipolar depression, elderly populations) and primary evaluation of side effects. This systematic review and meta-analysis identified 51 studies, dividing into four categories: bupropion as a sole antidepressant, bupropion coprescribed with another antidepressant, bupropion in ‘other’ populations (e.g. It has a unique pharmacology, inhibiting the reuptake of noradrenaline and dopamine, potentially providing pharmacological augmentation to more common antidepressants such as selective serotonergic reuptake inhibitors (SSRIs). Bupropion has been used as an antidepressant for over 20 years, though its licence for such use varies and it is typically a third- or fourth-line agent.
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