Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant

Abstract

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. 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). 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. bipolar depression, elderly populations) and primary evaluation of side effects. 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. Most work on the coprescribing of bupropion with another antidepressant supports an additional effect, though many are open-label trials. 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. Effectiveness has been shown in 'other' populations, though there is an overall dearth of research. Bupropion is generally well tolerated, it has very low rates of sexual dysfunction, and is more likely to cause weight loss than gain. 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. 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. 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.

Quality of life, binge eating and sexual function in participants treated for obesity with sustained release naltrexone/bupropion

“…Sexual function results in NB + CLI participants from the current trial include significant reduction from baseline in percentage of patients with sexual dysfunction and greater improvement in ASEX scores when compared with participants treated with UC. These results are supportive of previous results describing improvements in sexual function observed in patients taking bupropion, a component of NB, for major depressive disease .…”

Antidepressant-Induced Sexual Side Effects: Incidence, Assessment, Clinical Implications, and Management

“…Despite the lack of evidence showing reversal, recent studies continue to show that bupropion induces fewer sexual side effects than other antidepressants. 30 Therefore, bupropion is an important choice for patients in whom sexual dysfunction must be prevented, but it should not be expected to reverse iatrogenic dysfunction.…”

Bioequivalence and Therapeutic Equivalence of Generic and Brand Bupropion in Adults With Major Depression: A Randomized Clinical Trial

“…6 The assumption of generic equivalency was highlighted in the case of bupropion XL 300 mg. 9,10 Bupropion is a mainstay in treating major depressive disorder. 11 Bupropion was marketed first in immediate release, then sustained release, then extended release (once-daily dosing, Wellbutrin XL, GlaxoSmithKline, Research Triangle Park, NC) forms, followed by generic sustained release and extended release XL 150 mg. The first generic bupropion XL 300 mg (Budeprion, Impax Laboratories/Teva Pharmaceuticals, Sellersville, PA) was approved after a waiver of bioequivalence testing.…”