Manic shift due to the use of bupropion in bipolar depression: Two case reports

Abstract

Bupropion is a selective norepinephrine and dopamine reuptake inhibitor. It is used in the treatment of depression and nicotine addiction. When compared to the other antidepressants, bupropion has a relatively lower risk of triggering shift to hypomania or mania in bipolar depression treatment. Here we report two cases of bipolar depression patients with manic shift when bupropion was used as an adjunct to mood stabilizer treatment. The first was a 43-year old female patient. Manic symptoms occurred after bupropion was added to lithium and quetiapine treatment for bipolar disorder (BD) depressive episode. Her manic symptoms regressed rapidly after discontinuing bupropion treatment. The second patient was a 26-year old male on lithium and valproate therapy with a BD diagnosis. After bupropion was added to his treatment for depressive symptoms, psychotic mania ensued and he had to be admitted to the hospital. Significant improvement was noted shortly after bupropion was discontinued and antipsychotic treatment was initiated.