A 24-year-old woman with major depression and a BMI of 17.5 with restrictive eating behaviour is being considered for bupropion. The psychiatrist avoids it primarily because:
- A Bupropion causes significant weight gain in malnourished patients
- B Bupropion is contraindicated in eating disorders because it lowers the seizure threshold ✓
- C Bupropion precipitates serotonin syndrome when combined with any SSRI
- D Bupropion causes severe hepatotoxicity requiring monthly LFT monitoring
Correct answer: B. Bupropion is contraindicated in eating disorders because it lowers the seizure threshold
Explanation
Bupropion is a norepinephrine-dopamine reuptake inhibitor with dose-dependent seizure risk, and this risk is markedly amplified in patients with bulimia nervosa or anorexia nervosa, likely related to electrolyte disturbances and malnutrition. It is therefore contraindicated in eating disorders. In contrast, it typically causes modest weight loss, which makes option A wrong, and it carries no serotonergic activity capable of causing serotonin syndrome.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
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