Bupropion for Treatment-Resistant Depression [Internet]

Major depressive disorder (MDD) is a common and disabling illness and 1 of the most common mood disorders. It affects the entire body and mind, leading to reductions in quality of life and significant costs to the health care sector and society. MDD is associated with a high risk of mortality with a relative risk of 1.81 compared with persons without depression. According to Statistics Canada’s 2012 Canadian Community Health Survey on Mental Health, it is estimated that 5.4% of the Canadian population aged 15 years and older have reported mood disorders in the previous 12 months, including 4.7% for major depression. A recent survey on COVID-19 and mental health during the last 3 months of 2020 found that 1 in 5 Canadians had a positive screening for at least 1 of the 3 mental disorders: MDD, generalized anxiety disorder, and post-traumatic stress disorder. MDD was the most prevalent mental disorder, with 15% Canadians screening positive with moderate or severe symptoms. A variety of antidepressant agents have been used for the treatment of patients with MDD including selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI), tricyclic antidepressant (TCA), monoamine oxidase inhibitor (MAOI), glutamate antagonist, and atypical antidepressants such as bupropion. Despite advances in understanding the efficacy and safety of those pharmacological agents, 10% to 15% of patients do not respond to their first course of antidepressant pharmacotherapy, and 30% to 40% achieve only partial remission. After proper diagnosis and adequate treatment of MDD with antidepressants, individuals who are still nonresponders or partial responders are considered to have treatment-resistant depression (TRD). Although there is no universally accepted definition of TRD, approximately half of clinical trials required a minimum of 2 treatment failures to be considered TRD. The pharmacological options for treating TRD are not well-established and remain a challenge for physicians. Options for treatment of TRD include augmentation and switching of the initial antidepressant.Bupropion is an atypical antidepressant which inhibits the reuptake of noradrenaline and dopamine and has been used for treatment of MDD. It is generally well-tolerated but can cause weight loss and low rates of sexual dysfunction. However, its clinical effectiveness and cost-effectiveness in the treatment of TRD is less well understood. The current report aims to review the clinical effectiveness and cost-effectiveness of bupropion for the treatment of adults with TRD.