CLINICAL QUESTION

Is bupropion a safe and effective antidepressant for adolescents 12 to 20 years of age?

EVIDENCE-BASED ANSWER

Bupropion is an effective therapy for adolescents with major depressive disorder and may decrease rates of hospitalizations for depression and medication discontinuation. An increased risk of overdose and seizures may be possible for up to 24 hours after dosing.¹ Bupropion may be an option for adolescents with major depressive disorder, although those at increased risk of suicide, seizures, and eating disorders should be excluded. There may be additional benefits for weight loss, smoking cessation, and concurrent attention-deficit/hyperactivity disorder (ADHD). This is a key recommendation for clinicians for antidepressant therapy in adolescents 12 to 20 years of age. (Strength of Recommendation: B, patient-oriented evidence from meta-analysis and randomized trials.)

EVIDENCE SUMMARY

A 2019 retrospective chart review investigated the effectiveness and safety of bupropion for depressive disorders in children and adolescents.² The review included 127 participants with a mean age of 15.3 years. Two independent child psychiatrists confirmed a diagnosis of depressive disorder. Researchers used the Clinical Global Impressions-Depression-Severity Scale (CGI Depression Scale) to evaluate for changes with treatment. The CGI Depression Scale is a 7-point clinician-led assessment that evaluates the severity of and changes in mental illness (1 = normal, not at all ill, and 7 = extremely ill). The study found that 58 patients (45.7%) responded to treatment, defined by a score of less than 2. Among the patients determined to be responders, 82.8% had a primary diagnosis of major depression. Although 42.5% of participants reported adverse events, most spontaneously resolved within the 12-week study, and participants continued the medication. Importantly, 36.2% of participants discontinued bupropion because of irritability before completing 12 weeks of treatment.