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Page: Indications
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Smoking cessation
Bupropion's main use is for smoking cessation. It reduces the severity of nicotine cravings and addiction/withdrawal symptoms. Urge to smoke was a problem for 27% of subjects receiving bupropion vs 56% receiving placebo at the end of a 7-week treatment. 21% of the bupropion group reported mood swings vs 32% of the placebo group in the same study.[6] Bupropion treatment course lasts for seven to twelve weeks, with the patient halting the use of tobacco around ten days into the course. The efficacy of bupropion is similar to that of nicotine replacement therapy. Bupropion approximately doubles the chance of quitting smoking successfully after 3 months. 1 year after the treatment the odds of sustaining smoking cessation are still 1.5 higher in the bupropion group than in the placebo group. Combination of bupropion and nicotine appears not to further increase the cessation rate. In a direct comparison, recently approved varenicline (Chantix) showed superior efficacy. After 1 year the rate of continuous abstinency was 10% for placebo, 15% for bupropion, and 23% for varenicline. Bupropion slows down the weight gain occurring in the first weeks after quitting smoking (after 7 weeks, the placebo group had an average 2.7 kg increase in weight vs 1.5 kg for the bupropion group). However, with time this effect becomes negligible (after 26 weeks, both placebo and bupropion group recorded 4.8 kg weight gain).
Depression
Multiple placebo-controlled studies have confirmed efficacy of bupropion for depression. Equivalent antidepressant potency of bupropion and sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil) and escitalopram (Lexapro) was demonstrated in comparative clinical studies. A significantly higher remission rate for bupropion than for venlafaxine (Effexor) treatment was observed in a recent study. Unlike most other antidepressants, for the exception of mirtazapine (Remeron) and maprotiline (Ludiomil), bupropion does not cause sexual dysfunction and its rate of sexual side-effects is not different from placebo. Bupropion treatment is not associated with the weight gain; on the contrary, in every study comparing bupropion with placebo or other antidepressants the bupropion group ended up with lower average weight.
According to several surveys, adding bupropion to an SSRI (augmentation) is the preferred strategy among clinicians when the patient does not respond to the SSRI (treatment resistant depression). Although no placebo-controlled studies of bupropion augmentation have been conducted, multiple open-label trials and case reports generally support this strategy. For example, combination of bupropion and citalopram (Celexa) was observed to be more effective than switch to a single antidepressant. Addition of bupropion to venlafaxine (Effexor), fluoxetine (Prozac) or other SSRI resulted in improvement in patients who had an incomplete response to the corresponding first line antidepressant.
Sexual dysfunction
Although it is not an FDA-approved indication, a large body of evidence exists in favor of bupropion's use for sexual dysfunction. According to a survey, bupropion is the drug of choice among psychiatrists for the treatment of serotonin reuptake inhibitor (SSRI) induced sexual dysfunction. In that survey, 36 percent of the responding psychiatrists said they preferred switching their patients with sexual dysfunction to bupropion; however, 43 percent said they favored the addition of bupropion to the current medication (augmentation). There are studies demonstrating efficacy of both approaches, with improvement of desire and orgasm components of the sexual function being the most often noted. For the augmentation approach, indications exist that addition of at least 200 mg/day of bupropion to the SSRI medication is necessary to achieve statistically significant improvement, while addition of 150 mg/day of bupropion to the SSRI regimen of the patients with sexual dysfunction was equivalent to addition of placebo.
Several studies have indicated that bupropion also relieves sexual dysfunction among non-depressed patients. After a 12-weeks course in a mixed male/female double-blind study, 63% of subjects on bupropion rated their condition as improved or much improved vs. only 3% of subjects on placebo. Two studies, one of which was placebo-controlled, demonstrated efficacy of bupropion for women with hypoactive sexual desire resulting in significant improvement of arousal, orgasm and overall satisfaction. Bupropion also showed promise as a treatment for sexual dysfunction caused by chemotherapy for breast cancer and for orgasmic dysfunction. As with the treatment of SSRI-induced sexual disorder, a higher dose of bupropion (300 mg) may be necessary, since a randomized study, which employed a lower dose (150 mg), failed to find any significant difference between bupropion, sexual therapy or combined treatment. Interestingly, bupropion does not affect any measures of sexual functioning in healthy males.
[edit] Obesity
A recent review/meta-analysis of anti-obesity medications pooled the results of three double-blind placebo controlled trials of bupropion. This meta-analysis confirmed efficacy of bupropion (400 mg/day) for obesity. Over 6-12 months period, weight loss in the bupropion group (4.4 kg) was significantly greater than in the placebo group (1.7 kg). The same review found the differences in weight loss between bupropion and other established weight loss medications, such as sibutramine, orlistat and diethylpropion, to be statistically insignificant.
Other indications
Bupropion also has been investigated for several other disorders including attention-deficit hyperactivity disorder and restless legs syndrome.
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