A 22-year-old college student seeks treatment for depressed mood, low energy, poor concentration, and feelings of worthlessness and guilt following a breakup with her partner of 2 years. She is diagnosed with major depression and treated with bupropion and psychotherapy. After 3 weeks of treatment, the patient reports that her energy and motivation have improved somewhat. Her grades, which had been deteriorating, have stabilized. The patient is also continuing to receive psychotherapy and believes that it is beneficial. However, she still feels "really down" at times and has a poor appetite. Further history suggests that the patient consumes very little food each day (a pattern that preceded her use of bupropion) and exercises excessively. Due to her ongoing mood problems, increasing the dose of her antidepressant medication is considered. Which of the following potential side effects of the increased dose would be of primary concern?

Question

A 22-year-old college student seeks treatment for depressed mood, low energy, poor concentration, and feelings of worthlessness and guilt following a breakup with her partner of 2 years.  She is diagnosed with major depression and treated with bupropion and psychotherapy.  After 3 weeks of treatment, the patient reports that her energy and motivation have improved somewhat.  Her grades, which had been deteriorating, have stabilized.  The patient is also continuing to receive psychotherapy and believes that it is beneficial.  However, she still feels "really down" at times and has a poor appetite.  Further history suggests that the patient consumes very little food each day (a pattern that preceded her use of bupropion) and exercises excessively.  Due to her ongoing mood problems, increasing the dose of her antidepressant medication is considered.  Which of the following potential side effects of the increased dose would be of primary concern?

Quizplus · Accepted Answer

Bupropion is an antidepressant that works by inhibiting the reuptake of norepinephrine and dopamine. It is commonly used to treat major depression and is often preferred by patients because it does not cause weight gain or sexual side effects. Seizures are a potential side effect of bupropion therapy, especially when the medication is given at high doses. The risk is even greater in patients with pre-existing seizure disorders or eating disorders with potential electrolyte imbalances. Bupropion is therefore contraindicated in patients with seizure disorders or current or prior diagnosis of bulimia or anorexia nervosa. This patient's possible food restriction and excessive exercise suggest the possibility of an eating disorder, and the increased seizure risk with a higher dosage of bupropion would be of primary concern. (Choice A) Agranulocytosis is a side effect related to treatment with the antipsychotic clozapine. The mood-stabilizing agents carbamazepine and valproate can also be associated with bone marrow abnormalities. (Choice B) Bupropion has minimal effects on blood pressure. The serotonin-norepinephrine reuptake inhibitor venlafaxine has been associated with increased blood pressure, especially at higher doses. (Choice D) Sexual dysfunction is a relatively common side effect of selective serotonin reuptake inhibitors (SSRIs), which limits their use for many patients. Bupropion has no effect on serotonin and does not cause sexual dysfunction. It can be used as an adjunct to treat SSRI-related sexual dysfunction. (Choice E) Rash, including life-threatening Stevens-Johnson syndrome, rarely occurs with bupropion. It is more commonly seen with the anticonvulsant lamotrigine, which is used to treat bipolar depression. (Choice F) Bupropion is either weight neutral or associated with mild weight loss. Educational objective: Bupropion is a first-line antidepressant that is not associated with sexual side effects or weight gain. However, it is associated with an increased seizure risk at high doses and is contraindicated in patients with seizure disorders, anorexia nervosa, and bulimia. __________ References: Seizure secondary to bupropion extended release preparation: a report. (http://www.ncbi.nlm.nih.gov/pubmed/28841450) Epileptic seizures, coma and EEG burst-suppression from suicidal bupropion intoxication. (http://www.ncbi.nlm.nih.gov/pubmed/28246063)

A 22-Year-Old College Student Seeks Treatment for Depressed Mood, Low