Bupropion w leczeniu depresji - skuteczność, objawy uboczne i bezpieczeństwo leku

• Authors: Małgorzata Urban

Title variants

EN

Bupropion for depression treatment – efficacy, side effects and safety of drug

• Languages of publication: EN PL

Abstracts

EN

The precise mechanism of action of bupropion is unknown. However, it is probably connected with weak selective inhibition of norepinephrine and dopamine reuptake. Bupropion is a more potent inhibitor of dopamine reuptake than of norepinephrine reuptake. Moreover, it does not have serotonin activity, antihistamine activity. It has no effect on monoamine oxidase, does not affect release of neurotransmitters, does not bind to postsynaptic receptors including histamine, acetylcholine, serotonin, dopamine or α- or β-adrenergic receptors. In many randomised placebo-controlled and active comparator – controlled studies, the effectiveness of bupropion was confirmed for treatment of major depressive disorder similar to other antidepressants. It is also effective in high level anxiety depression treatment. There are few data about its use in anxiety disorders without depression. Bupropion is usually well tolerated by patients. It does not cause sleepiness, weight gain and sexual dysfunction. During the therapy patients report dry mouth (22%), headache (20%), nausea (15%), insomnia (14%) and constipation (9%). There is a dose-dependent risk of seizures associated with the use of bupropion. Before the treatment it is necessary to find out whether there are factors increasing the risk of seizures. Bupropion is significantly less cardiotoxic in case of overdose than tricyclic antidepressants. In patients with hypertension the blood pressure should be controlled. Bupropion therapy is often accompanied by insomnia which is associated with its REM sleep suppression. It also causes dermatological side effects more often than other antidepressants. It is relatively safe above therapeutical doses. In case of overdose tachycardia, blood pressure increase, gastrointestinal symptoms, agitation, seizures, hallucinations are most often observed. There is no antidote. The best results are obtained with activated charcoal therapy.

PL

Dokładny mechanizm działania bupropionu pozostaje nadal nieznany, jednakże prawdopodobnie wiąże się on ze słabym selektywnym wychwytem zwrotnym noradrenaliny (NA) i dopaminy (DA) - silniej działa na wychwyt DA niż NA. Ponadto nie wykazuje aktywności serotoninergicznej, działania antyhistaminowego, nie hamuje monoaminooksydazy, nie wpływa na uwalnianie neurotransmiterów, nie wiąże się z postsynaptycznymi receptorami histaminowymi, muskarynowymi, serotoninergicznymi, dopaminergicznymi ani a- i P-adrener-gicznymi. W licznych badaniach randomizowanych z placebo i z aktywnym komparatorem wykazano, iż skuteczność bupropionu w leczeniu dużej depresji jest porównywalna ze skutecznością innych leków przeciwde-presyjnych. Skuteczne działanie leku stwierdzono także w leczeniu depresji z dużym nasileniem lęku. Niewiele jest natomiast danych o jego skuteczności w izolowanych zaburzeniach lękowych. Bupropion jest uważany za lek dobrze tolerowany przez pacjentów. Nie powoduje senności, przyrostu masy ciała, korzystnie wpływa na funkcje seksualne. W czasie terapii chorzy najczęściej zgłaszają suchość w jamie ustnej (22%), bóle głowy (20%), nudności (15%), bezsenność (14%) i zaparcia (9%). Ryzyko wystąpienia drgawek podczas przyjmowania bupropionu jest uzależnione od dawki. Przed rozpoczęciem leczenia należy ustalić, czy istnieją inne czynniki zwiększające ryzyko napadu padaczkowego. Bupropion jest istotnie mniej kardiotoksyczny w przypadku przedawkowania w porównaniu z trójpierścieniowymi lekami przeciwdepresyjnymi. U pacjentów chorujących na nadciśnienie tętnicze należy kontrolować wartości RR podczas terapii tym lekiem. Często leczeniu towarzyszy bezsenność związana z supresyjnym działaniem bupropionu na sen REM. Częściej także niż inne leki przeciwdepresyjne wywołuje on odczyny skórne. Bupropion jest stosunkowo bezpiecznym lekiem w przypadku przekroczenia dawek terapeutycznych. Po przedawkowaniu najczęściej obserwuje się tachykar-dię, wzrost wartości RR, objawy żołądkowo-jelitowe, pobudzenie, drgawki, halucynacje. Nie istnieje antidotum. Najlepsze rezultaty uzyskuje się dzięki zastosowaniu węgla aktywowanego.

Keywords

EN

anxiety; bupropion; depresja; depression; lęk; objawy uboczne; poisoning; side effects; zatrucie

Discipline

• MEDICINE: MEDICINE

• Journal: Psychiatria i Psychologia Kliniczna
• Year: 2008
• Volume: 8
• Issue: 2
• Pages: 112-117

Contributors

author

Małgorzata Urban

• Klinika Zaburzeń Afektywnych i Psychotycznych Uniwersytetu Medycznego w Łodzi. Kierownik Kliniki: prof. dr hab. n. med. Jolanta Rabe-Jabłońska,

References

• 1. Damaj M.I., Carroll F.I., Eaton J.B. i wsp.: Enantioselective effects of hydroxy metabolites of bupropion on behavior and on function of monoamine transporters and nicotinic receptors. Mol. Pharmacol. 2004; 66: 675-682.
• 2. Fava M., Rush A.J., Thase M.E. i wsp.: 15 years of clinical experience with bupropion HCl: from bupropion to bupropion SR to bupropion XL. Prim. Care Companion J. Clin. Psychiatry 2005; 7: 106-113.
• 3. Papakostas G.I., Nutt D.J., Hallett LA. i wsp.: Resolution of sleepiness and fatigue in major depressive disorder: a comparison of bupropion and the selective serotonin reuptake inhibitors. Biol. Psychiatry 2006; 60: 1350-1355.
• 4. Thase M.E., Haight B.R., Richard N. i wsp.: Remission rates following antidepressant therapy with bupropion or selective serotonin reuptake inhibitors: a meta-analysis of original data from 7 randomized controlled trials. J. Clin. Psychiatry 2005; 66: 974-981.
• 5. Papakostas G.I., Montgomery S.A., Thase M.E. i wsp.: Comparing the rapidity of response during treatment of major depressive disorder with bupropion and SSRIs: a pooled survival analysis of 7 double-blind, randomized clinical trials. J. Clin. Psychiatry 2007; 68: 1907-1912.
• 6. Coleman C.C., Cunningham LA., Foster VJ. i wsp.: Sexual dysfunction associated with the treatment of depression: a placebo-controlled comparison of bupropion sustained release and sertraline treatment. Ann. Clin. Psychiatry 1999;11:205-215.
• 7. Croft H., Settle E. Jr, Houser T. i wsp.: A placebo-controlled comparison of the antidepressant efficacy and effects on sexual functioning of sustained-release bupropion and sertraline. Clin. Ther. 1999; 21: 643-658.
• 8. Weihs K.L., Settle E.C. Jr, Batey S.R. i wsp.: Bupropion sustained release versus paroxetine for the treatment of depression in the elderly. J. Clin. Psychiatry 2000; 61: 196-202.
• 9. Fava M., Rush A.J., Trivedi M.H. i wsp.: Background and rationale for the sequenced treatment alternatives to relieve depression (STAR*D) study. Psychiatr. Clin. North Am. 2003; 26: 457-494.
• 10. Thase M.E., Clayton A.H., Haight B.R. i wsp.: A doubleblind comparison between bupropion XL and venlafaxine XR: sexual functioning, antidepressant efficacy, and tolerability. J. Clin. Psychopharmacol. 2006; 26: 482-488.
• 11. Feighner J., Hendrickson G., Miller L., Stern W: Doubleblind comparison of doxepin versus bupropion in outpatients with a major depressive disorder. J. Clin. Psychopharmacol. 1986; 6: 27-32.
• 12. Masco H.L., Kiev A., Holloman L.C. i wsp.: Safety and efficacy of bupropion and nortriptyline in outpatients with depression. Curr. Ther. Res. Clin. Exp. 1994; 55: 851-863.
• 13. Mendels J., Amin M.M., Chouinard G. i wsp.: A comparative study of bupropion and amitriptyline in depressed outpatients. J. Clin. Psychiatry 1983; 44: 118-120.
• 14. Clayton A.H., Croft H.A., Horrigan J.P. i wsp.: Bupropion extended release compared with escitalopram: effects on sexual functioning and antidepressant efficacy in 2 randomized, double-blind, placebo-controlled studies. J. Clin. Psychiatry 2006; 67: 736-746.
• 15. Settle E.C., Stahl S.M., Batey S.R. i wsp.: Safety profile of sustained-release bupropion in depression: results of three clinical trials. Clin. Ther. 1999; 21: 454-463.
• 16. Dhillon S., Yang L.P.H., Curran M.P: Bupropion: a review of its use in the management of major depressive disorder. Drugs 2008; 68: 653-689.
• 17. Pesola G.R., Avasarala J.: Bupropion seizure proportion among new-onset generalized seizures and drug related seizures presenting to an emergency department. J. Emerg. Med. 2002; 22: 235-239.
• 18. Dunner D.L., Zisook S., Billow A.A. i wsp.: A prospective safety surveillance study for bupropion sustained-release in the treatment of depression. J. Clin. Psychiatry 1998; 59: 366-373.
• 19. Balit C.R., Lynch C.N., Isbister G.K.: Bupropion poisoning: a case series. Med. J. Aust. 2003; 178: 61-63.
• 20. Ruffmann C., Bogliun G., Beghi E.: Epileptogenic drugs: a systematic review. Expert Rev. Neurother. 2006; 6: 575-589.
• 21. Spiller H.A., Ramoska EA., Krenzelok E.P i wsp.: Bupro-pion overdose: a 3-year multi-center retrospective analysis. Am. J. Emerg. Med. 1994; 12: 43-45.
• 22. Paris P.A., Saucier J.R.: ECG conduction delays associated with massive bupropion overdose. J. Toxicol. Clin. Toxicol. 1998; 36: 595-598.
• 23. Shrier M., Diaz J.E., Tsarouhas N., Johnson R.W.: Cardiotoxicity associated with bupropion overdose. Ann. Emerg. Med. 2000; 35: 100.
• 24. Jorenby D.E., Leischow S.J., Nides M.A. i wsp.: A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N. Engl. J. Med. 1999; 340: 685-691.
• 25. Mayers A.G., Baldwin D.S.: Antidepressants and their effect on sleep. Hum. Psychopharmacol. 2005; 20: 533-559.
• 26. Preskorn S.H.: Comparison of the tolerability of bupropion, fluoxetine, imipramine, nefazodone, paroxetine, sertraline, and venlafaxine. J. Clin. Psychiatry 1995; 56 supl. 6: 12-21.
• 27. Lineberry T.W., Peters G.E. Jr, Bostwick J.M.: Bupropion-induced erythema multiforme. Mayo Clin. Proc. 2001; 76: 664-666.
• 28. McCollom R.A., Elbe D.H., Ritchie A.H.: Bupropion-induced serum sickness-like reaction. Ann. Pharmacother. 2000; 34: 471-473.
• 29. Huff J.C., Weston W.L., Tonnesen M.G.: Erythema multiforme: a critical review of characteristics, diagnostic criteria, and causes. J. Am. Acad. Dermatol. 1983; 8: 763-775.
• 30. Shepherd G., Velez L.I., Keyes D.C.: Intentional bupropion overdoses. J. Emerg. Med. 2004; 27: 147-151.
• 31. Wang T.S., Shiah I.S., Yeh C.B., Chang C.C.: Acute psychosis following sustained release bupropion overdose. Prog. Neuropsychopharmacol. Biol. Psychiatry 2005; 29: 149-151.
• 32. Munhoz R.P.: Serotonin syndrome induced by a combination of bupropion and SSRIs. Clin. Neuropharmacol. 2004; 27: 219-222.
• 33. Clayton A.H., Pradko J.F., Croft H.A. i wsp.: Prevalence of sexual dysfunction among newer antidepressants. J. Clin. Psychiatry 2002; 63: 357-366.
• 34. Clayton A.H., Warnock J.K., Kornstein S.G. i wsp.: A placebo-controlled trial of bupropion SR as an antidote for selective serotonin reuptake inhibitor-induced sexual dysfuncion. J. Clin. Psychiatry 2004; 65: 62-67.
• 35. Croft H., Houser T.L., Jamerson B.D. i wsp.: Effect on body weight of bupropion sustained-release in patients with major depression treated for 52 weeks. Clin. Ther. 2002; 24: 662-672.
• 36. Doraiswamy P.M., Krishnan K.R., Oxman T. i wsp.: Does antidepressant therapy improve cognition in elderly depressed patients? J. Gerontol. A Biol. Sci. Med. Sci. 2003; 58: M1137-M1144.
• 37. Nebes R.D., Pollock B.G., Houck P.R. i wsp.: Persistence of cognitive impairment in geriatric patients following antidepressant therapy: a randomized, double-blind clinical trial with nortriptyline and paroxetine. J. Psychiatr. Res. 2003; 37: 99-108.
• 38. Butters M.A., Becker J.T., Nebes R.D. i wsp.: Changes in cognitive functioning following treatment of late-life depression. Am. J. Psychiatry 2000; 157: 1949-1954.
• 39. Cassano G.B., Puca F., Scapicchio P.L., Trabucchi M.; Italian Study Group on Depression in Elderly Patients: Paroxetine and fluoxetine effects on mood and cognitive functions in depressed nondemented elderly patients. J. Clin. Psychiatry 2002; 63: 396-402.
• 40. Schmitt J.A., Kruizinga M.J., Riedel W.J.: Non-serotonergic pharmacological profiles and associated cognitive effects of serotonin reuptake inhibitors. J. Psychopharmacol. 2001; 15: 173-179.
• 41. Furlan P.M., Kallan M.J., Ten Have T. i wsp.: Cognitive and psychomotor effects of paroxetine and sertraline on healthy elderly volunteers. Am. J. Geriatr. Psychiatry 2001; 9: 429-438.
• 42. Kerr J.S., Powell J., Hindmarch I.: The effects of reboxetine and amitriptyline, with and without alcohol on cognitive function and psychomotor performance. Br. J. Clin. Pharmacol. 1996; 42: 239-241.
• 43. Gualtieri C.T., Johnson L.G.: Bupropion normalizes cognitive performance in patients with depression. Medscape General Medicine 2007; 9: 22.
• 44. Zimmerman M., Posternak M., Friedman M. i wsp.: Which factors influence psychiatrists' selection of antidepressants? Am. J. Psychiatry 2004; 161: 1285-1289.
• 45. Zimmerman M., PosternakM.A., Attiullah N. i wsp.: Why isn't bupropion the most frequently prescribed antidepressant? J. Clin. Psychiatry 2005; 66: 603-610.
• 46. Coleman C.C., King B.R., Bolden-Watson C. i wsp.: A placebo-controlled comparison of the effects on sexual functioning of bupropion sustained release and fluoxetine. Clin. Ther. 2001; 23: 1040-1058.
• 47. Trivedi M.H., Rush A.J., Carmody T.J. i wsp.: Do bupropion SR and sertraline differ in their effects on anxiety in depressed patients? J. Clin. Psychiatry 2001; 62: 776-781.
• 48. Rush A.J., Batey S.R., Donahue R.M. i wsp.: Does pretreatment anxiety predict response to either bupropion SR or sertraline? J. Affect. Disord. 2001; 64: 81-87.
• 49. Rush A.J., Trivedi M.H., Carmody T.J. i wsp.: Response in relation to baseline anxiety levels in major depressive disorder treated with bupropion sustained release or sertraline. Neuropsychopharmacology 2001; 25: 131-138.
• 50. Dewan M.J., Anand V.S.: Evaluating the tolerability of the newer antidepressants. J. Nerv. Ment. Dis. 1999; 187: 96-101.
• 51. Settle E.C. Jr: Bupropion sustained release: side effect profile. J. Clin. Psychiatry 1998; 59 supl. 4: 32-36. 52. Dunlop B.W., Nemeroff C.B.: The role of dopamine in the pathophysiology of depression. Arch. Gen. Psychiatry 2007; 64: 327-337.

• Document Type: article