An 18-year-old woman with major depression has a body mass index of 15 and admits to induced vomiting after meals. Her physician wants an antidepressant that avoids sexual dysfunction and weight gain. Which drug is contraindicated in her?

• A Mirtazapine
• B Duloxetine
• C Escitalopram
• D Bupropion ✓

Explanation

Bupropion, a dopamine and norepinephrine reuptake inhibitor, is dose-dependently associated with seizures and is contraindicated in eating disorders such as bulimia nervosa and anorexia nervosa, where electrolyte disturbance and malnutrition further lower the seizure threshold. Although its side-effect profile (no weight gain, no sexual dysfunction) suits this patient, the eating disorder excludes it. Mirtazapine would be undesirable here because it increases appetite and weight.

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

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