Bupropion as Add-On Strategy in Difficult-to-Treat Bipolar Depressive Patients

Abstract

Bupropion, a selective norepinephrine and dopamine reuptake inhibitor, has been suggested for the treatment of bipolar depression, not only because of its efficacy, but also because of a probably lower risk of inducing switches to hypomania or mania. Most studies on bupropion treatment in bipolar patients have been performed in moderately ill out-patients. In contrast, we report on a sample of difficult-to-treat, predominantly severely ill, co-morbid, psychotic or therapy-refractory bipolar depressive in-patients. In this open and prospective study, 13 patients were treated with bupropion as an add-on strategy mainly to other antidepressants and to various mood stabilizers. Our data support the idea that bupropion is a first-line antidepressant in the treatment of severe bipolar depression. Eight of 13 patients showed a >50% reduction of Montgomery-Asberg Depression Scale ratings within 4 weeks. Co-medication with drugs commonly used in treatment-resistant bipolar disorder including venlafaxine, clozapine, lithium, topiramate and sodium valproate was safe in our small sample. While adhering to the suggestion of Goren and Levin not to exceed a daily dose of 450 mg of bupropion when treating bipolar depressed patients, we did not observe any switch from depression to hypomania or mania.

Antidepressant-like effects of Trichilia catigua (Catuaba) extract: evidence for dopaminergic-mediated mechanisms

“…Because chlorpromazine is a non-selective dopamine receptor antagonist and haloperidol blocks D 2 /D 3 and to some degree D 4 receptors, we might speculate that the antidepressant-like effects of T. catigua extract are linked to the activation of D 3 /D 4 receptors. To discuss the relevance of the present results, some important points should be considered: (1) the role of noradrenaline and mainly serotonin for the pathogenesis of depression has been largely explored, but newly reported evidence indicates a potential role for dopamine in this pathology (D'Aquila et al 2000;Pania and Gessab 2002); (2) most currently available therapies for the treatment of depression are based on the modulation of the serotoninergic system (Stahl 1998;Feighner 1999), but the search for new therapeutic options is still needed because of the lack of effect on some patients or the great number of collateral effects exhibited by these drugs; (3) some commercially available drugs, such as bupropion and nomifensine, which preferentially interfere with dopamine mechanisms (as described herein for T. catigua extract), have been employed with success for the treatment of refractory bipolar depression or addiction (Erfurth et al 2002;Jorenby et al 2002;Yamada et al 2004).…”

Computer‐Based De Novo Design, Synthesis, and Evaluation of Boronic Acid‐Based Artificial Receptors for Selective Recognition of Dopamine

“…[10,11] Among all the catecholamines, dopamine is especially important in neurochemistry. Dopaminergic functions are A C H T U N G T R E N N U N G implicated in Parkinson's disease, [15][16][17][18] mood modification, [19][20][21] and cocaine addiction, [22][23][24][25] and so recognition and detection of dopamine have been identified as important issues. [5,8,9] However, chemosensor work for the selective recognition of dopamine has been very limited.…”

Clozapine for treatment-resistant bipolar disorder: a systematic review

“…BD is often associated with high levels of unfavorable outcomes or treatment resistance (22)(23)(24). In contrast to schizophrenia, definitions of treatment-resistant bipolar disorder (TRBD) vary greatly (17,(25)(26)(27). However, a failure to respond to at least two trials of dissimilar treatments, involving an adequate dose and duration, could serve as a conservative definition (28)(29)(30)(31).…”