High-Dose Bupropion for Depression

What Is the Issue? Bupropion is a drug used in the treatment of depression. Bupropion is 1 of many treatment options available for depression and is associated with several side effects as well as the potential for misuse. The risk of side effects may be increased with higher daily doses of bupropion; therefore, it is important to determine the appropriate dosing for bupropion for the treatment of depression. What Did We Do? To help determine the appropriate dosing of bupropion for the treatment of major depressive disorder and treatment-resistant depression in adults, we sought to identify and summarize studies of the clinical efficacy and safety of high-dose (301 mg per day to 450 mg per day) versus standard-dose (≤ 300 mg per day) bupropion. We also sought to identify and summarize recommendations on the use of high-dose bupropion for the treatment of depression in evidence-based guidelines. We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence, published since 2014. One reviewer screened articles for inclusion, based on predefined criteria. What Did We Find? We did not identify any studies that evaluated the clinical efficacy and safety of high-dose versus standard-dose bupropion for the treatment of depression, which met our criteria for this review. We did not identify any evidence-based guidelines that included recommendations on the use of high-dose bupropion in adults with depression that met our criteria for this review. What Does it Mean? We cannot draw conclusions on the use of high-dose bupropion for the treatment of major depressive disorder or treatment-resistant depression in adults due to the lack of identified studies or evidence-based guidelines that met our criteria for this review. Future studies that compare high-dose and standard-dose bupropion for the treatment of depression could aid decision-making around the subject area of appropriate bupropion dosing.