To the Editor: In his Clinical Crossroads discussion of a 51-year-old woman with bipolar disorder who wants to quit smoking, Dr Schroeder1 indicated that bupropion should be considered for smokers with chronic depression because it may benefit the depression as well as help with smoking cessation. However, this point is controversial in patients with bipolar disorders because of questions about efficacy and the risk of precipitating mania.
Bupropion, used to reduce tobacco smoking, is also widely used as an antidepressant. In a 26-week double-blind, placebo-controlled study in patients with bipolar depression,2 the use of standard antidepressant medication (including bupropion) as adjuncts to mood stabilizers was not associated with increased efficacy compared with the use of mood stabilizers alone; in addition, there was no increased risk of treatment-emergent affective switch. In randomized trials of bupropion, sertraline, or venlafaxine as an adjunct to a mood stabilizer,3 acute antidepressant augmentation was associated with a modest response rate; the rate of mania precipitation associated with bupropion use was 6.1% in the acute treatment trials and 12.5% in continuation trials lasting up to 1 year.4 However, bupropion was associated with a lower risk of such activation compared with venlafaxine.4
Although it is difficult to differentiate switches directly related to antidepressant treatment from those related to the natural course of bipolar illness, the prescribing information for bupropion5 states that it “is not approved for use in treating bipolar depression.” Since the patient in the Clinical Crossroads article was also treated with escitalopram, the risk of manic or hypomanic switch could increase with both antidepressants. Bupropion should be used with caution in patients with bipolar disorder.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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