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welbutrin and bipolar

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My pdoc has asked me for factual (as in peer-reviewed, reputable studies) evidence that Welbutrin actually does have the least chance of inducing mania in the bipolar population.

Sorry for the slangospeak!

Anyways, I have failed to find even a single such study.

I am horribly depressed and doing very badly indeed on a mood stabilizer alone, and this very nice jerk refuses to do anything to alleviate it. Save a lengthy and complicated change of pdocs, this is my last option to try and sway him.


(this has been crossposted...if the mods mind, well just remove)

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A double-blind trial of bupropion versus desipramine for bipolar depression

BACKGROUND: Although treatment of bipolar depression is a frequent clinical problem, double-blind studies of the treatment of bipolar depression are scarce. Some case series and uncontrolled data suggest antidepressants may differ in their propensity to induce mania or their efficacy for bipolar depression. METHOD: The authors conducted a prospective double-blind trial to assess efficacy and rate of treatment-emergent mood elevation in depressed bipolar patients when bupropion or desipramine was added to an ongoing therapeutic regimen of lithium or an anticonvulsant. Results were assessed after 8 weeks of acute treatment and during maintenance treatment up to 1 year. RESULTS: No difference was found for acute efficacy between the two drugs. Mania/hypomania was observed in 5 of 10 desipramine-treated patients, but only 1 of 9 bupropion-treated patients. The occurrence of hypomania or mania was correlated with treatment group (Kendall's tau correlation = 0.42; Z = -2.5, p < .012). CONCLUSION: These pilot findings suggest that bupropion is less likely to induce mood elevation than desipramine. For treatment of bipolar depression, bupropion and desipramine appear to have similar antidepressant efficacy.
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Bupropion as a promising approach to rapid cycling bipolar II patients.

Bupropion was added to lithium and/or levothyroxine in four female and two male bipolar II patients who had established baselines of at least 2 years of rapid cycling that had not responded to several of the most commonly used anticycling interventions. Although all six patients improved significantly, the response was dramatic in four (three female, one male) and is still sustained after an average of 2 years of continued treatment. Furthermore, unlike what happened in their prior course with more conventional antidepressants, none developed hypomania nor was rapid cycling observed during the course of continued pharmacotherapy. These findings, based on open but systematic clinical observation, suggest that bupropion may have special merit for rapid cycling, predominantly depressed bipolar patients and that, under close clinical vigilance, combining bupropion with appropriate doses of lithium is both efficacious and safe.
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