Spotlight on Bupropion in Major Depressive Disorder
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Bupropion is presumed to be a dopamine-noradrenaline (norepinephrine) reuptake inhibitor and is an effective antidepressant. It is available as three oral formulations: (i) bupropion immediate release (IR) [Wellbutrin®] administered three times daily; (ii) bupropion sustained release (SR) [Wellbutrin SR®] administered twice daily; and (iii) bupropion extended/modified release (XR) [Wellbutrin XL®/Wellbutrin XR®] administered once daily. All three formulations are bioequivalent in terms of systemic exposure to bupropion.
Oral three-times-daily bupropion IR was effective and generally well tolerated in the treatment of major depressive disorder (MDD). It was as efficacious and as well tolerated as some TCAs and the SSRI fluoxetine. Moreover, it was associated with less somnolence and weight gain than some TCAs. Twice-daily bupropion SR was also efficacious and generally well tolerated in the treatment of MDD. It was as effective as and had a generally similar tolerability profile to some SSRIs, but had the advantage of less somnolence and sexual dysfunction. The efficacy of bupropion XR in terms of primary efficacy measures was established in two of six well designed placebo-controlled studies. Bupropion XR also demonstrated efficacy in terms of some secondary outcomes in five of these studies. Additionally, bupropion XR was similar, in terms of the primary efficacy outcomes, to the SSRI escitalopram in two placebo-controlled trials and to the serotonin-noradrenaline reuptake inhibitor (SNRI) venlafaxine extended release (XR) in two trials (one of which was placebo-controlled), but not in a third placebo-controlled trial where venlafaxine XR was better than bupropion XR. It was generally as well tolerated as escitalopram and venlafaxine XR, but was associated with less sexual dysfunction than escitalopram. Available clinical data suggest that bupropion is an effective and generally well tolerated option in the treatment of MDD, with the newer formulations having the advantage of reduced frequency of daily administration.
KeywordsMajor Depressive Disorder Sustained Release Bupropion Major Depressive Disorder Escitalopram
- 2.GlaxoSmithKline. Wellbutrin (bupropion hydrochloride): US prescribing information [online]. Available from URL: http://www.fda.gov/cder/foi/label/2007/018644s036lbl.pdf [Accessed 2008 Jan 15]
- 3.GlaxoSmithKline. Wellbutrin SR (bupropion hydrochloride sustained-release tablets): US prescribing information [online]. Available from URL: http://www.fda.gov/cder/foi/label/2007/020358s043lbl.pdf [Accessed 2008 Jan 15]
- 4.GlaxoSmithKline. Wellbutrin XL (bupropion hydrochloride extended-release): US prescribing information [online]. Available from URL: http://www.fda.gov/cder/foi/label/2007/021515s020lbl.pdf [Accessed 2008 Jan 15]
- 5.Heads of Medicines Agencies. Wellbutrin XR: summary of product characteristics [online]. Available from URL: http://db.cbg-meb.nl/mri/spc/nlh-0785-001-002.pdf [Accessed 2008 Mar 4]
- 8.GlaxoSmithKline. Steady-state bioequivalence evaluation of bupropion sustained-release and bupropion immediate-release tablets in healthy male volunteers (study no. 206) [online]. Available from URL: http://ctr.gsk.co.uk [Accessed 2008 Jan 15]
- 9.GlaxoSmithKline. A two-way, crossover, steady state, multiple-dose, open-label, fasting, comparative bioavailability study of bupropion HCl 300mg extended release tablets (1 × 300mg q.d.) versus Wellbutrin 100mg tablets (t.i.d.) in normal healthy non-smoking male and female subjects (study no. AK1BI-OVAIL2543) [online]. Available from URL: http://ctr.gsk.co.uk [Accessed 2008 Jan 15]
- 28.Thase ME, Clayton AH, Chrzanowski W, et al. Bupropion extended release and venlafaxine extended release for the treatment of depression: results from three multicenter trials [abstractno. 146]. 14th Congress of Psychiatry of the Association of European Psychiatrists; 2006 Mar 4–8; NiceGoogle Scholar
- 29.Jefferson JW, Rush AJ, Nelson JC, et al. Extended-release bupropion for patients with major depressive disorder presenting with symptoms of reduced energy, pleasure, and interest: findings from a randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2006 Jun; 67(6): 865–73PubMedCrossRefGoogle Scholar
- 30.Hewett K, Chrzanowski W, Rousseau R, et al. Efficacy and safety of bupropion XL in elderly patients with major depressive disorder [abstract no. P.2.c.006 plus poster]. Eur Neuropsychopharmacol 2006; 16Suppl. 4: S315–16Google Scholar
- 33.Croft HA, Wightman D, Hewett K, et al. Additional data on the safety and tolerability of bupropion extended-release: newly accumulated data extends previous findings in placebo controlled clinical trials [abstract no. NR484 plus poster]. 159th Annual Meeting of the American Psychiatric Association; 2006 May 20–25; Toronto (ON)Google Scholar