A patient with severe anxiety and depression shall avoid which of the following antidepressants?
a. Mirtazapine
b. Bupropion
c. Paroxetine
d. Fluvoxamine
e. Duloxetine
Answer: (b), Bupropion. Bupropion hydrochloride (Wellbutrin) is an antidepressant of the aminoketone class. It is supplied for oral administration as 75-mg (yellow-gold) and 100-mg (red) film-coated tablets. It is indicated for the treatment of major depressive disorder (MDD).
The recommended starting dose is 200 mg per day, given as 100 mg twice daily. After 3 days of dosing, the dose may be increased to 300 mg per day, given as 100 mg 3 times daily, with at least 6 hours between successive doses. Dosing above 300 mg per day may be accomplished using the 75-or 100-mg tablets.
A maximum of 450 mg per day, given in divided doses of not more than 150 mg each, may be considered for patients who show no clinical improvement after several weeks of treatment at 300 mg per day. Administer the 100-mg tablet 4 times daily to not exceed the limit of 150 mg in a single dose.
To minimize the risk of seizure, increase the dose gradually. Increases in dose should not exceed 100 mg per day in a 3-day period. Due to its CNS stimulation property, it shall be avoided in patients suffering from severe anxiety. In such patients, instead Bupropion, one can use Mirtazapine or Paroxetine for its sedative effects.
Below is the list of antidepressants and their special effects:
- SSRI or SSNRI: May cause reduced libido and arousal, erectile dysfunction, and delayed or absent orgasm.
- Bupropion: Minimum weight gain. Contraindicated to use in patients suffering from anxiety and seizure.
- Mirtazapine: Strong antihistamine and sedation properties.
- Duloxetine: Useful in patients suffering from depression with fibromyalgia or diabetic neuropathic pain.