Bupropion Shows Early Effectiveness, Tolerability in Pediatric Depression

Bupropion has demonstrated preliminary effectiveness and safety in treating depressive episodes in children and adolescents, according to study results recently published in Clinical Psychopharmacology and Neuroscience.

This 12-week retrospective chart review included 127 children and adolescents (mean age, 15.3±2.3 years; 52% boys) receiving bupropion extended-release for depression between January 2010 and December 2015 at a single center. Of these participants, 40.2% (n=51) had psychiatric disorders in their family history, 15% (n=19) had previously attempted suicide, 82.7% (n=105) had a diagnosis of major depressive disorder, 11% (n=14) had dysthymia, 8.7% (n=11) had adjustment disorder with depressive mood, and 5.5% (n=7) had depressive disorder not otherwise specified.

Two pediatric psychiatrists independently confirmed diagnoses through medical records. They assigned scores for illness at weeks 0, 4, 8, and 12 with the Clinical Global Impressions-Depression-Improvement (CGI-Depression-I) and/or the Clinical Global Impressions-Depression-Severity (CGI-Depression-S) and used repeated measures analysis of variance to assess changes in CGI-Depression-S scores at weeks 4, 8, and 12.

Bupropion was administered for a mean duration of 33.9±53 weeks (range 7-295 weeks), with a mean dose of 180±52.6 mg/d (range 75-300 mg/d). Among the participants, attention-deficit/hyperactivity disorder (ADHD) and anxiety were the most common comorbidities (33.9% and 18.9%, respectively). During the 12-week interval, CGI-Depression-S scores decreased significantly (F=132.125; partial η²=0.514; P <.001), with 45.7% (n=58) of participants classifying as responders (CGI-Depression-I score ≤2) at 12 weeks. Researchers identified a significant association between being a responder and having previously attempted suicide (P =.006).

The rate of discontinuation of bupropion was 36.2% (n=46), with 15% (n=19) discontinuing because of adverse events and 11.8% (n=15) switching drugs because of lack of efficacy. A total 42.5% (n=54) of participants reported adverse events, the most common being irritability (9.4%; n=12), which improved spontaneously in 8 patients and after switching to another drug in 4 patients. Bupropion’s tolerability profile was generally favorable.

Limitations to this study include lack of control for certain parameters such as concomitant treatments and psychiatric comorbidities, lack of a control group, the fact that 1 chart reviewer was involved in participant treatment, lack of structured interviews for diagnosis bases, and potential underreporting of adverse events.

The study researchers concluded that bupropion appears to be “effective and generally tolerable in children and adolescents with depressive disorder.”

Furthermore, “bupropion showed effectiveness both for subjects with and without comorbid ADHD,” although bupropion’s effect on “depressive and ADHD symptoms should be studied further.”

Reference
Kweon K, Kim HW. Effectiveness and safety of bupropion in children and adolescents with depressive disorders: a retrospective chart review. Clin Psychopharmacol Neurosci. 2019;17(4):537-541.