A 26-year-old woman with bulimia nervosa and a prior electroconvulsive therapy course is being considered for bupropion as an antidepressant. This choice should be avoided primarily because bupropion:

• A Causes severe weight gain in eating disorders
• B Causes irreversible extrapyramidal symptoms
• C Produces profound orthostatic hypotension
• D Lowers the seizure threshold in a dose-dependent manner ✓

Explanation

Bupropion is a norepinephrine-dopamine reuptake inhibitor whose best-known dose-related toxicity is seizure, with incidence rising sharply above 450 mg/day. Seizure risk is further increased by eating disorders through electrolyte disturbance and purging, head injury, and abrupt alcohol withdrawal, making bulimia a formal contraindication. Bupropion typically causes weight loss, does not cause significant orthostatic hypotension, and has minimal extrapyramidal liability.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

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