Bupropion for Major Depressive Disorder or Persistent Depressive Disorder (Dysthymia)

Major depressive disorder (MDD) has a high disease burden in Canada. It was estimated that in 2012, the lifetime prevalence in Canada was 9.9%, and more than 1.5 million Canadians aged 15 or older experienced a major depressive episode that year. In Ontario, Canada’s largest province, the total burden of MDD as measured in health-adjusted life-years has been estimated to be greater than the breast, colorectal, lung, and prostate cancers combined. MDD is diagnosed with the occurrence of at least 1 major depressive episode. An episode is defined as a period of at least 2 weeks in which 5 or more of the following symptoms are experienced: anhedonia, depressed mood, psychomotor retardation or agitation, poor concentration, sleep disturbances, thoughts of worthlessness or guilt, recurrent thoughts of death or suicide, and weight or appetite changes. In contrast, dysthymia is a form of persistent depressive disorder lasting 2 or more years, with at least 2 of the following 6 symptoms: appetite changes, hopelessness, low energy, sleep disturbances, poor concentration, and poor self-esteem.Guidelines from the Canadian Network for Mood and Anxiety Treatments recommend second-generation antidepressants as first-line therapy for patients with a major depressive episode of moderate or great severity. These include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), agomelatine, bupropion, mirtazapine, and vortioxetine. The guidelines additionally recommend that physician expertise, as well as patients’ preferences and perceptions, should guide the selection of the antidepressant drug: patient and medication factors (including efficacy, tolerability, drug interactions, convenience, cost, and availability) should be taken into consideration for an individualized approach. Treatment should generally be continued for 6 to 9 months and for 2 years or more in the presence of risk factors for recurrence. These include frequent, chronic, severe, or difficult-to-treat episodes, the presence of other psychiatric or medical conditions, and the presence of residual symptoms.Bupropion, a dopamine and norepinephrine reuptake inhibitor, is marketed in 2 formulations in Canada: sustained release (SR) and extended release (the XL form)., Bupropion is indicated for symptomatic relief of MDD, prevention of seasonal major depressive episodes, as well as smoking cessation. Seizures are a dose-related adverse effect of bupropion, occurring in clinical trials with an incidence of 0.1%. When crushed or dissolved and injected or inhaled, cases of seizures and death have been reported. The most common adverse events occurring with an incidence of greater than 5% in clinical trials are dry mouth, nausea, constipation, insomnia, dizziness, anxiety, and decreased appetite., Bupropion is structurally related to amphetamine, and can have mild stimulating effects; this may increase the potential for abuse.,The objective of this report is to summarize the evidence regarding the comparative clinical and cost-effectiveness of bupropion for MDD and dysthymia.