A psychiatrist plans bupropion for a depressed 22-year-old woman because she is worried about sexual side effects and weight gain. Which comorbidity in her history should make the clinician avoid bupropion?

• A Seasonal pattern of depressive episodes
• B Concomitant oral contraceptive use
• C Family history of bipolar disorder
• D Comorbid anorexia nervosa with recent rapid weight loss ✓

Explanation

Bupropion is a norepinephrine-dopamine reuptake inhibitor with no serotonergic activity, so it spares libido and weight. Its principal dose-related hazard is seizure, occurring in roughly 0.4 percent of patients at standard doses, and eating disorders with electrolyte disturbance and vomiting are a recognised contraindication. Family history of bipolar disorder warrants monitoring for switching but is not an absolute contraindication, and contraception poses no interaction concern.

Reference: Stahl's Essential Psychopharmacology, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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