Study of the relationship between bupropion and the onset of psychotic symptoms.

Review of the literature about this subject and review of the patient's history.

Mr D. was a 20 years old patient attended in our psychiatric unit for psychosis due to drug abuse that was exacerbated after the beginning of the treatment with Bupropion.

He showed a depressive episode at the age of 17, being diagnosed of Personality disorder (Cluster B), and he had history of substance abuse including cannabis (habit described as occasional), cocaine (only once in the past) and MDMA (only the 31 December 2008).

The patient recognized an intake of MDMA on the 31 December 2008, after which he showed visual hallucinations and insomnia in the following 48 hours. From the 3TH to 7TH OF January no symptom was observed although he had cannabis in unspecified amounts, appearing abnormal behaviour around January 8TH. On the 11th, his GP prescribed Bupropion at doses up to 150mg/day for smoking cessation, appearing two days later psychotic symptoms that included hallucinations, soliloquies, unmotivated laughter and an exacerbation of behavioral disturbances.

The symptoms disappeared after a week of treatment with antipsychotics.

Bupropion causes inhibition of dopamine reuptake, which would have created, an excess of this neurotransmitter that could explain the appearance of the psychotic symptoms.

We consider it appropriate to include in the contraindications section of this product, the use of bupropion among patients with history of psychotic symptoms in the context of consumption of toxic substances.