Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-25T08:41:31.492Z Has data issue: false hasContentIssue false

Drug combination with bupropion: a case of southern comforts

Published online by Cambridge University Press:  13 June 2014

Seàn Ó Domhnaill*
Affiliation:
Louth/Meath Mental Health Services, Clonard House, Market Square, Navan, Co. Meath, Ireland
*
Correspondence Email: [email protected]

Abstract

A patient with a 20-year history of dysthymia had been treated with a range of anti-depressants over a period of two decades. He had experienced no clinically significant symptomatic relief for 14 years until he was recommenced on fluoxetine, a drug which had been of limited benefit to him previously. He showed no improvement in motivation, chronic anergia or easy fatiguability. He commenced an anti-smoking agent, bupropion hydrochloride (Zyban), without informing his treating psychiatrist and following the manufacturers' instructions, took the drug for four weeks, while initially continuing to smoke. He failed to discontinue smoking. However, his energy, motivation and general sense of wellbeing improved markedly, to the extent that his friends and colleagues commented upon the change.

Bupropion hydrochloride is a well-known anti-depressant agent not currently licensed for use in Ireland. His combination of fluoxetine and bupropion has improved his functioning to its best level in 20 years. The improvement has been sustained for over six months. We examine the issues raised by this unusual combination, which I have termed ‘southern comfort’, in recognition of its geographical site of clinical impact.

Type
Case reports
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. ICD-10. World Health Organisation. 10th Edition 1992.Google Scholar
2.Keller, et al.Children of parents with major affective disorder: a review. Am J Psychiatry 1983; 140(6): 825832.Google Scholar
3.Keks, NA, Burrows, GB, Copolov, DLet al.Beyond the evidence; Is there a place for antidepressant combinations in pharmacotherapy of depression? MJA 2007; 186(3): 142144.Google Scholar
4.Zyban, S.P.C. Glaxo Smithkline Beecham. First authorisation June 7th 2000.Google Scholar
5.Zisook, et al.Use of bupropion in combination with serotonin reuptake inhibitors. Biological Psychiatry, Volume 59, Issue 3, Pages 203210.CrossRefGoogle Scholar
6.Kennedy, et al.Combining bupropion SR With venlafaxine, paroxetine, or fluoxetine: a preliminary report on pharmacokinetic, therapeutic, and sexual dysfunction effects. J Clin Psychiatry 2002; Mar 63(3): 181186.CrossRefGoogle ScholarPubMed
7.Rasmussen, et al.Modafinil augmentation in depressed patients with partial response to antidepressants: A pilot study on self-reported symptoms covered by the Major Depression Inventory (MDI) and the Symptom Checklist (SCL-92) Nord J Psychiatry. 2005;59(3): 173178.CrossRefGoogle ScholarPubMed