Therapeutic use of Wellbutrin
Clinical studies on a double-blind method with placebo confirmed the efficacy of bupropion in the treatment of clinical depression. Comparative clinical studies have demonstrated the equivalence of bupropion and sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil) and escitalopram (Lexapro) as antidepressants. Studies in the early 2000s showed a significantly higher level of remission for bupropion than for venlafaxine (Effexor). Unlike other antidepressants other than mirtazapine (Remeron), maprotiline (Ludiomil) and tianeptine (Stablon), bupropion does not cause sexual dysfunction and the likelihood of sexual side effects does not differ from placebo.
Treatment with bupropion is not accompanied by an increase in the weight of the patient; on the contrary, by the end of each clinical study that compared the effect of bupropion with placebo or with other antidepressants, the bupropion group had a lower average weight. Bupropion is more effective than SSRIs in improving the symptoms of hypersomnia and fatigue in depressed patients. In comparative meta-studies, the moderate advantage of SSRIs over bupropion in the treatment of depressions with high anxiety was found, while in the treatment of depressions with moderate and low anxiety, drugs are equivalent.
According to some surveys, co-prescribing SSRIs with bupropion is the preferred strategy for treating patients who are not susceptible to SSRIs. For example, the combination of bupropion and citalopram (Celexa) was more effective than switching to another antidepressant. The addition of bupropion to SSRIs (primarily fluoxetine or sertraline) led to a significant improvement in 70-80% of patients who had incomplete susceptibility to first-line antidepressants. Bupropion improved the patient's “vigor”, depressed by taking SSRIs; there were improvements in mood and motivation, as well as some improvements in cognitive and sexual function. The quality of sleep and the level of anxiety in most cases have not changed. In the STAR * D study, patients who were immune to citalopram (Celexa) were randomly assigned to bupropion or buspirone (Buspar). About 30% of patients in both groups achieved remission. However, the combination with bupropion gave the best results for the evaluation of the patients themselves and was better tolerated by them. The authors concluded: "... these data suggest that the combination of prolonged-acting bupropion with citalopram provided a more favorable outcome than the combination of buspiron with citalopram." In the same study, there is a higher likelihood of remission in the case of prescription of a combination of citalopram with bupropion to be resistive to citalopram compared with a simple transition to bupropion (30% vs. 20%).
A 2009 study showed the effectiveness of combining bupropion with mirtazapine. Thanks to this combination, the number of patients who have achieved a long, sustained remission has doubled compared with the use of a single antidepressant. The combination of antidepressants of different groups is used to treat severe depressions, if one antidepressant does not help. In particular, bupropion, mirtazapine and one of the drugs of the SSRI group, such as fluoxetine, escitalopram, paroxetine, sertraline, can be taken in combination; or bupropion, mirtazapine and an antidepressant from the group of SSRIs (venlafaxine, milnacipran or duloxetine).
A meta-analysis of obesity drugs published in 2005 collected the results of three trials of bupropion using placebo and a double-blind method. This analysis confirmed the effectiveness of taking 400 mg of bupropion per day for the treatment of obesity. Over the period of 6-12 months, the average weight loss in the group treated with bupropion was significantly greater (4.4 kg) than in the placebo group (1.7 kg). The same review notes the statistical identity of weight loss results when taking bupropion and when taking other reputable weight loss drugs, such as sibutramine, orlistat, and diethylpropion. Studies are currently underway on the effect on the obesity of a combination of bupropion with zonisamide (Empatic) and bupropion with naltrexone (Contrave). In September 2014, the combination drug bupropion / naltrexone was approved by the FDA for the treatment of obesity. In the EU, approval was obtained in the spring of 2015, and this combination drug will be marketed under the name Mysimba.
Bupropion has shown some success in treating social phobia and anxiety accompanying depression, but not panic disorders with agoraphobia. Its anxiolytic (sedative) effect is comparable to sertraline and doxepin. However, in some patients, bupropion, especially in high doses, can cause agitation and often, like methylphenidate, anxiety.
Bupropion reduces the severity of nicotine withdrawal and the associated withdrawal syndrome. After 7 weeks of treatment, only 27% of patients taking bupropion reported that quitting smoking was a problem for them (56% of patients in the placebo group). In the same study, 21% of patients from the bupropion group reported mood swings, and in the placebo group, 32% were patients. Reception of bupropion lasted from 7 to 12 weeks, during which the patient had to stop smoking for 10 days. Bupropion almost doubled the probability of quitting smoking after three months. One year after taking the drug, persistent smoking cessation in the bupropion group was one and a half times higher than in the placebo group. Combined use of bupropion and nicotine does not increase smoking cessation. When directly comparing varenicline (Chantix) with bupropion, the latter showed high efficacy: after one year, the level of persistent tobacco cessation was 10% for placebo, 15% for bupropion, and 23% for varenicline. Bupropion slows weight gain, which is often observed in the first weeks of quitting (after 7 weeks in the placebo group, the average weight gain was 2.7 kg, versus 1.5 kg in the bupropion group). However, over time, this effect disappeared (after 26 weeks in both groups, the average weight gain was 4.8 kg).
Bupropion is one of the few antidepressants that do not cause sexual dysfunction. As shown by psychiatric polls, it is the preferred drug for treating sexual dysfunction caused by taking SSRIs, although this preference does not indicate FDA approval. 36% prefer switching patients with sexual dysfunction caused by taking SSRIs to bupropion, and 43% prescribe bupropion in addition to the drug already taken. There are studies confirming the effectiveness of both approaches; the most common improvement in sexual function is sexual desire and orgasm. In the case of complex therapy, in order to achieve an improvement in the patient’s condition, at least 200 mg of bupropion per day should be added to the received SSRIs, since with the addition of 150 mg per day, there was no statistically significant result compared to placebo.
Some studies have shown that bupropion also improved sexual function in people who are not depressed. In a double-blind, double-blind study of a 12-week course of bupropion, 63% of the subjects rated their condition as “improvement” or “significant improvement”, against only 3% of patients in the placebo group. Two studies, one of which was performed using placebo, demonstrated the efficacy of bupropion in women with hypoactive sexual desire, with significant improvements in excitability, orgasm, and overall satisfaction. Also bupropion has shown itself to be very promising in the treatment of sexual dysfunction caused by chemotherapy of breast cancer, as well as orgasm dysfunction. As with the treatment of sexual dysfunction caused by the treatment of the SSRIs, a higher dose of the drug (300 mg) is necessary: in a randomized study using a lower dose (150 mg), there was no noticeable difference between bupropion, sexual therapy or combination therapy. treatment. Bupropion does not affect the sexual functions of healthy men.
Attention deficit hyperactivity disorder
Although attention deficit hyperactivity disorder (ADHD) is not an undisputed disease, bupropion has been shown to be effective against adults with ADHD. There are also many positive results from independent studies and other uncontrolled studies of the effects of bupropion on ADHD adolescents. However, in the current largest double blind study by GlaxoSmithKline, the results were mixed. Aggressiveness and hyperactivity, according to teachers, have changed significantly for the better as compared with placebo; in contrast, parents and doctors did not find a difference between the effects of bupropion and placebo. Treatment guidelines for ADHD from the American Academy of Child and Adolescent Psychiatry in 2007 refer to the fact that the effectiveness of bupropion is "significantly weaker" compared with FDA-approved drugs. Its effectiveness may also be "... significantly less than that of approved active ingredients ... On this basis, it is wiser for doctors to recommend behavioral (behavioral) therapy, instead of switching to second-line drugs." Similarly, the 2006 Texas Department of Health guidelines recommend that bupropion and tricyclic antidepressants be considered as fourth-line drugs after using two different stimulants and atomoxetine (Strattera).
According to the Cochrane Review, which included six randomized controlled clinical trials (relevance February 2017), "Bupropion may lead to a slight improvement in ADHD, as well as reduce the severity of symptoms associated with ADHD." Adverse effects occurred "no more than when taking a placebo." The quality of evidence in the review was low due to the fact that a small number of studies were found; five of these studies were small, and all six RCTs were conducted improperly. In total, they covered only 438 people with ADHD. The studies have not studied the effect of bupropion on various aspects of the daily functioning of patients, and also did not evaluate the long-term effects of the drug.
Surprising results were obtained from a study of the use of bupropion for the prevention of smoking among adolescents with ADHD. Teenagers who took bupropion began to smoke with a probability twice as high as that of the placebo group, which is an indicator close to statistically significant. However, since the degree of statistical significance was still not achieved, this difference was considered to be accidental. Thus, the study did not show a connection between taking bupropion and the occurrence of addiction to smoking. At the same time, a subgroup of patients taking stimulants together with bupropion (or placebo) showed a five-fold lower risk of starting to smoke.
- High blood pressure
- No properly controlled studies of the use of bupropion in Parkinson's disease have been conducted. In 1984, a small study was conducted by the manufacturer of bupropion, which showed that a combination of bupropion and carbidopa or levodopa improved parkinsonian symptoms in ten of twenty patients; however, side effects such as nausea and vomiting were often manifested. The American Psychiatric Association noted that "... there is no evidence in favor of any antidepressant in terms of therapeutic efficacy for patients with Parkinson's disease, complicated by depression."
- There is considerable disagreement about whether antidepressants, including bupropion, should be added as mood stabilizers to the treatment of patients with bipolar depression.
- Bupropion, as well as other antidepressants, is ineffective in treating chronic back pain. However, its surprisingly high efficacy in the treatment of neuropathic pain was found.