Abuse of Antidepressant for Weight Loss Leads to Seizures in Patient With Bulimia Nervosa
Abuse should be considered among eating disorder patients who present with seizures.
A recently published report in the International Journal of Eating Disorders describes the case of a 22-year old female patient who abused bupropion XR for the purpose of appetite suppression and weight loss.
The patient, who was suffering from bulimia nervosa and complex post-traumatic stress disorder, was admitted to the Jerusalem Mental Health Center for inpatient treatment of abuse of bupropion XR as well as a suicide attempt. Her past medical history was significant for anorexia nervosa, major depression, self-mutilation, multiple suicide attempts, and attention-deficit/hyperactivity disorder. The authors also noted that the patient had a history of abusing several other medications including benzodiazepines, sleeping pills, levothyroxine, and methylphenidate.
According to the authors, the patient obtained prescriptions for bupropion XR from psychiatrists and primary care physicians who were not aware of her past medical history. The patient began taking 300-450mg of bupropion XR daily, which she gradually increased to 1200–1500mg per day. Despite experiencing 2 grand-mal seizures after 6 months of abuse, the patient increased her bupropion dose to as much as 3-4.5g per day. During her most frequent abuse period, the patient reported experiencing headaches, tachycardia, anxiety, and insomnia.
Following an attempted suicide 1 year after her bupropion XR abuse began, the patient received treatment for pancreatitis, as well as psychiatric and eating disorder management over a 3 month period. Phenytoin was also prescribed to prevent future seizures. The patient was discharged taking fluoxetine, quetiapine, and phenytoin, and followed-up with a dietitian twice weekly as well as a psychotherapist once weekly. After not taking bupropion XR for nearly 1 year, the patient was readmitted and reported initiating bupropion XR again.
This case report demonstrates that bupropion XR may be an attractive medication for patients interested in losing weight. “Clinicians are reminded to screen for anorexia nervosa and bulimia nervosa histories prior to prescribing this medication, and to consider its abuse among eating disorder patients presenting with seizures,” the authors write. They added, “For patients abusing this medication, motivational interviewing in the context of a strong, ongoing therapeutic relationship might help some abusers achieve sustained periods of abstinence.”