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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #113

Fear Anxiety Depression Woman  - mohamed_hassan / Pixabay

Have a patient with anxiety? Is this patient interested in losing weight? Are they possibly on an SSRI that has contributed to their increased weight? Then seriously consider Bupropion.

Bupropion is not usually considered for treating anxiety and is not considered the first line agent, but a double-blind controlled trial with 24 patients who had confirmed Generalized Anxiety Disorder (GAD) found endpoint scores favored Bupropion vs. Escitalopram in reducing anxiety.

I have multiple men’s health patients on bupropion for anxiety, weight loss, and even both. Many have commented that not only did they lose 10-20lbs over 4 months, but that their overall mood and anxiety improved as well.

So, consider bupropion at 300mg daily if you have patients with GAD who might need to lose weight or vice versa.

9 Responses

  1. If that isn’t the most accurate picture of anxiety that I’ve ever seen, I don’t know what is!!! Thanks for this pearl, short and to the point!

  2. Agree that this is a great anti-depressant, w/o sexual s/e, but for patients with anxiety, it is like pouring gasoline on a fire. I’ve seen it many times. I steer clear of bupropion for patients with hx of anxiety.

    In fact, anxiety is not even listed as an indication for bupropion or an off-label use.

    Use: Labeled Indications
    Major depressive disorder (unipolar [excluding Zyban]): Treatment of major depressive disorder (MDD)

    Seasonal affective disorder (24-hour extended release [Aplenzin, Wellbutrin XL]): Prevention of seasonal major depressive episodes in patients with a diagnosis of seasonal affective disorder (SAD)

    Smoking cessation (12-hour extended release [sustained release; Zyban]): As an aid to smoking cessation treatment

    Use: Off-Label: Adult
    Attention-deficit/hyperactivity disorder; Bipolar depression; Selective serotonin reuptake inhibitor-induced sexual dysfunction, augmentation

    Per UTD: CNS stimulation & neuropsychiatric effects
    Bupropion can cause CNS stimulation in patients, including increased energy, insomnia, agitation, and nervousness, and, in more significant cases, anxiety or panic. On rare occasions, more significant neuropsychiatric effects, including abnormality in thinking, paranoid ideation, delusion, hallucination, psychosis, suicidal ideation, and homicidal ideation, may occur.

    References

    Bailey J, Waters S. Acute psychosis after bupropion treatment in a healthy 28-year-old woman. J Am Board Fam Med. 2008;21(3):244-245. doi:10.3122/jabfm.2008.03.070236 [PubMed 18467537]

    Foley KF, DeSanty KP, Kast RE. Bupropion: pharmacology and therapeutic applications. Expert Rev Neurother. 2006;6(9):1249-1265. doi:10.1586/14737175.6.9.1249 [PubMed 17009913]

    Stahl SM, Pradko JF, Haight BR, Modell JG, Rockett CB, Learned-Coughlin S. A review of the neuropharmacology of bupropion, a dual norepinephrine and dopamine reuptake inhibitor. Prim Care Companion J Clin Psychiatry. 2004;6(4):159-166. doi:10.4088/pcc.v06n0403 [PubMed 15361919]

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