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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The safety and efficacy of bupropion in the preventive care of depression was studied in a long-term open trial. Forty patients from an active general psychiatric practice which emphasizes the treatment of affective disorders have been followed for an average of 336 days (range, 44-791) and seen at least monthly for evaluation with the Hamilton Depression Scale, Zung Self-Rating Scales for Depression and Anxiety, Clinical Global Impression Scale and an adverse reaction report form. One third of the patients had received a diagnosis of bipolar disorder and 50% a diagnosis of recurrent major depressive disorder by DSM-III criteria; all patients were intolerant of tricyclic and other antidepressants. Although several patients were not severely depressed when placed on bupropion, there was a significant improvement on the Zung Self-Rating Scales. There was a striking reduction in the frequency and intensity of adverse reactions, particularly anticholinergic effects, appetite and weight gain, and sexual dysfunction, compared to tricyclics. Also, there were no cardiovascular changes and no physical, ECG, EEG, or laboratory evidence of toxicity. Bupropion represents a significant advance in the treatment of depression, particularly for patients who require long-term preventive care and in whom adverse reactions, which might be tolerated in acute treatment, may lead to noncompliance.
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PMID:Long-term preventive care in depression: the use of bupropion in patients intolerant of other antidepressants. 640 49

Bupropion and placebo were compared in hospitalized nonpsychotic depressed patients over a 28-day period. It was found that bupropion was significantly more effective than placebo in alleviating depression and that the incidence of adverse effects was similar in bupropion- and placebo-treated patients.
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PMID:The use of bupropion in hospitalized depressed patients. 640 71

In an open study, 20 patients with schizo-affective disorder, depressed type, were randomly assigned to treatment with either bupropion alone or bupropion combined with haloperidol. Bupropion plus haloperidol was significantly more efficacious than bupropion alone, as judged by improvement in clinical ratings on the Hamilton Depression Scale and the Brief Psychiatric Rating Scale. Of 9 patients treated with bupropion alone, 3 experienced exacerbation of psychotic symptoms. While treatment of schizo-affective disordered patients with bupropion and haloperidol is efficacious, the use of bupropion alone carries a significant risk of exacerbation of psychotic symptoms. This finding is probably related to bupropion's dopaminergic effects. Further work is needed to evaluate the relative contribution of bupropion to the improvement in schizo-affective patients treated with both bupropion and haloperidol.
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PMID:Comparison of bupropion alone and with haloperidol in schizo-affective disorder, depressed type. 640 68

Bupropion HCl, a new nontricyclic antidepressant, produced marked improvement in 49 hospitalized patients with primary depression at doses of 300-600 mg/day. Bupropion resulted in statistically significant differences from placebo as early as day 5, and by the end of the 4-week study 79% (N = 27) of the bupropion patients and 13% (N = 2) of the placebo patients showed much to very much improvement. Bupropion and placebo had similar side effect profiles. Tremor and sweating were reported more often with bupropion and headache, nausea, and tiredness with placebo.
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PMID:A double-blind study of bupropion and placebo in depression. 642 79

Bupropion is an antidepressant, thought to be an indirect dopaminergic agonist. No significant sympathomimetic, anti-cholinergic, or MAO inhibitor effects have been reported. We evaluated this drug in 20 patients with idiopathic Parkinson's disease. Parkinsonism lessened by at least 30% (Northwestern University Disability Scale or Modified New York University Parkinson's Disease Scale) in half the patients. Depression, present in 12 of 20, was alleviated in only 5. Bupropion is mildly efficacious in Parkinson's disease, although side effects were frequent and were dose-limiting in five patients.
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PMID:Bupropion in Parkinson's disease. 643 14

Tricyclic antidepressant (TCA) medications are among the most widely used pharmacologic treatments for depression. However, a substantial number of patients fail to respond to these agents. Few standardized trials of pharmacologic treatments for TCA nonresponders are available. Bupropion has an apparently different mechanism of action than TCAs and represents a possible treatment for the TCA nonresponder. Based on positive results from pilot studies, a standardized study evaluating bupropion in TCA nonresponders was conducted. Forty-one depressed outpatients who had failed to respond to adequate documented TCA treatment, defined by specific criteria of dosage, duration, and plasma concentrations, entered a 1-week single-blind placebo phase, followed by an open 8-week bupropion treatment phase utilizing doses of up to the maximum daily dose of 450 mg. Response was measured by change on the Hamilton Depression Rating Scale (HAM-D), Clinical Global Impressions-Severity (CGI-S) and Improvement (CGI-I) Scales, and the Hamilton Anxiety Rating Scale (HAM-A). Bupropion treatment resulted in an improvement in depression on all outcome measures. Forty-nine percent were considered "responders," in that they achieved > or = 50% improvement on the 28-item HAM-D. Fifty-four percent were classified as responders based on a CGI-I rating of much or very much improved. Statistically significant improvement in depressive symptoms, measured by mean scores for the HAM-D, CGI-S, and HAM-A, was achieved at the end of the study (as compared to baseline). Twelve patients (32%) had a HAM-D score of < or = 10 at termination.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bupropion in tricyclic antidepressant nonresponders with unipolar major depressive disorder. 788 95

Major depression is a common and disabling disorder with far-reaching social and economic implications. Nonetheless, major depression is treatable by one of the many currently available antidepressants with response rates of approximately 65-70%. Treatment of depression has improved in recent years because of the availability of effective and well-tolerated antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs). The currently available antidepressants are generally equally effective and are distinguished primarily by side-effect profiles. The side effects of tricyclic antidepressants (TCAs) are attributed to their nonspecific interaction with cholinergic, histaminergic, serotonergic, and dopaminergic receptors in the central nervous system. The secondary amine TCAs, nortriptyline and desipramine, are preferred among the TCAs because of a more favorable side-effect profile. The TCAs are cardiotoxic, and overdoses are frequently fatal. Adverse effects, including potentially fatal drug and food interactions, limit the use of the monoamine oxidase inhibitors (MAOIs); however, these agents have a role in the treatment of depression with comorbid anxiety, refractory depression, atypical depression, and bulimia. The SSRIs possess a class side-effect profile of headache, nausea, and sexual dysfunction. Individual differences in side effects may distinguish fluoxetine (nervousness, restlessness), sertraline (diarrhea, loose stools), and paroxetine (dry mouth). The SSRIs all inhibit certain cytochrome P450 isoenzymes involved in the metabolism of drugs, such as the TCAs, and each SSRI has been reported to increase plasma concentrations of concomitantly administered TCAs. Bupropion therapy is associated with a risk of seizure development, which can be minimized by multiple daily doses. Trazodone is sedating and can rarely cause priapism. The related compound, nefazodone, does not cause sexual dysfunction or priapism, but is associated with sedation. Venlafaxine, a recently available antidepressant that appears to have efficacy in treatment-refractory depression, may cause nausea that requires gradual upward dosage titration. Higher doses of venlafaxine may also cause elevations in blood pressure, heart rate, and serum cholesterol. As more is learned about the pathophysiology of depression, even more specific and well-tolerated antidepressants will be developed.
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PMID:Contemporary management of depression. 799 23

Nonpsychotic depressive and dysthymic states are reclassified and reorganized in order to maximize relevance to clinical psychopharmacology. In the initial phase of assessment, patients are divided into two easily recognized categories: mood-nonreactive (autonomous) depression and mood-reactive depression. After family and past history of response and cost of drug are considered, a tricyclic antidepressant is usually selected for autonomous depression patients, and mood-reactive depression patients are initially given a serotonin reuptake inhibitor. Nonresponders from either category are changed to the alternative medication or have it added to their first drug. Nonresponders to both of these initial trials are then assessed for the presence of atypical depression symptoms by the Columbia criteria. If these symptoms are present, the patients may be offered a third medication trial with a monoamine oxidase inhibitor. Bupropion could be the choice if the monoamine oxidase inhibitor cannot be given expeditiously. This completes the initial assessment and treatment phase. Autonomous and mood-reactive patients who do not respond to this sequence of interventions are then reassessed for the presence of characterologic syndromes and comorbidity with some frequently encountered conditions. These may determine the choice of medication and the prognosis for a positive result from the next choices selected. When possible, specific recommendations are given for the various situations.
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PMID:A systematic approach to the classification and pharmacotherapy of nonpsychotic major depression and dysthymia. 802 27

Up to 15% of elderly women may suffer from depression. Patients with this disorder present with change in mood or diminished interest or pleasure in usual activities, as well as a variety of other neurovegetative symptoms. Depression is amenable to treatment, and a wide range of drug and nonpharmacologic modalities may be useful. The mere action of seeking professional help signals that the depressed patient has begun to take control of the situation and serves as a promising sign for recovery. The tricyclic antidepressants have a long history of use for the treatment of depression and are probably the most widely used agents for this indication, despite numerous adverse effects. Bupropion and the new selective serotonin reuptake inhibitors are effective in treating depression and are better tolerated than the tricyclics. For this reason, they may be particularly useful for treating depression in the elderly.
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PMID:Depression in the elderly: a treatable disorder. 850 61

Acute bipolar depression (ABD) and breakthrough depression occurring during maintenance therapy of bipolar disorder are associated with significant morbidity and an increased risk of suicide. Lithium is an effective mood stabilizer for ABD, but its onset of antidepressant action is slow and additional antidepressant therapy is often prescribed. The extent to which other mood stabilizers (e.g., carbamazepine and valproate) have antidepressant activity is unclear. Preliminary initial research suggests three potential advantages that selective serotonin reuptake inhibitors have over tricyclic antidepressant for ABD: possibly greater efficacy, fewer adverse effects, and a lower frequency of antidepressant-induced mania. Bupropion may also have significant advantages. However, further research is needed to confirm these findings. Monoamine oxidase inhibitors are the antidepressant of choice for atypical bipolar depression. Electroconvulsive therapy (ECT) has the highest response rate of all treatments for ABD. Further research is needed to explore combination treatments with mood stabilizers and antidepressants for the effective treatment of ABD.
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PMID:Management of the depressive component of bipolar disorder. 916 51


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