Suicidal bupropion ingestions in adolescents: increased morbidity compared with other antidepressants

Abstract

Adolescents who overdose on a single medication in a suicide attempt with bupropion have a statistically significant higher incidence of major outcomes and seizures. The risks of bupropion as a potential means of suicidal gesture by overdose must be considered, and weighed against its benefits and side effect profile when choosing an appropriate agent for the treatment of depression in adolescents.

Toxicity of Bupropion Overdose Compared With Selective Serotonin Reuptake Inhibitors

“…Sheridan et al conducted a study that also used NPDS data to compare adolescent poison center cases involving exposure bupropion to those involving tricyclic antidepressants, although during a slightly different time-period and allowing co-ingestion of ethanol. 8 Their study had many similar findings to ours, including higher rates of hallucinations, seizures, tachycardia, and vomiting in the bupropion cases. Another similarity was the overall finding that bupropion cases were more likely to have MMD outcomes and need for hospitalization when compared to either TCA or SSRI cases.…”

“…4 This is a major issue of interest to both medical and public health professionals, who have made it the focus of multiple studies. [4][5][6][7][8][9] As a result, in 2004, the FDA added a black box warning to prescribing information for all antidepressants noting increased risk of suicide in children, adolescents, and young adults. 10 It has been suggested that adolescents who attempt suicide may have greater impulsivity than their non-suicidal peers.…”

“…22 Notably, the QRS widening caused by bupropion is due to myocardial gap junction blockade rather than sodium-channel blockade, and is therefore often not responsive to usual therapy with sodium bicarbonate boluses. 23 Sheridan, et al showed that poison center cases with bupropion exposure were associated with significantly higher rates of morbidity than TCA cases 8 Major effect: the patient experiences life-threatening symptoms or has significant permanent dysfunction as a result of the exposure. This includes status epilepticus, symptomatic ventricular tachycardia, coma with hypotension, cardiac or respiratory arrest, ventricular fibrillation, renal failure, and rhabdomyolysis.…”

Determination of hydroxybupropion in human serum for routine therapeutic drug monitoring in psychiatry: A tool for dose‐individualization in treatment with bupropion

“…It is approved as a medication for treatment in MDD, seasonal depressive disorders and smoking‐cessation therapy (Brunen, Vincent, Baumann, Hiemke, & Havemann‐Reinecke, ; Wille et al, ). It shows fewer unwanted side effects like weight gain or sedation (Horst & Preskorn, ; Laib, Brunen, Pfeifer, Vincent, & Hiemke, ) and consequently its use is increasing (Sheridan, Lin, & Horowitz, ). In Germany, the increasing number of defined daily doses from 2015 to 2016 (+12.8%) demonstrated the growing importance of the drug (Schwabe et al, ).…”

“…In Germany, the increasing number of defined daily doses from 2015 to 2016 (+12.8%) demonstrated the growing importance of the drug (Schwabe et al, ). Nevertheless, in cases of bupropion overdosing in 13–19 year old patients there was a higher percentage of serious outcomes and hospitalizations compared with tricyclic antidepressants (Sheridan et al, ), and also suicides by overdosing with bupropion have been reported (Mercerolle, Denooz, Lachatre, & Charlier, ; Sheridan et al, ). Additionally, dose‐dependent effects of lowering the seizure threshold have been described for bupropion (Dersch, Zwernemann, & Voderholzer, ).…”