MAOIs Bupropion

Ischemic heart disease SSRIs Bupropion MAOIs... 

If the depressive symptoms do not resolve when treatment with one of the aforementioned mood stabilizers has been maximized, adjunctive therapy with an antidepressant or second mood stabilizer should be considered. SSRIs and bupropion are well tolerated by bipolar patients and appear to hold less potential to induce mania than TCAs. Nevertheless, treatment with any antidepressant should not be started until it has been confirmed that the patient s mood stabilizer is at a therapeutic level. If treatment with two or more of these first-line antidepressants is unsuccessful, a MAOI should be considered. 

Drugs that may affect bupropion include amantidine, levodopa, carbamazepine, MAOIs, nicotine replacement, and ritonavir. 

Drugs that may increase the effects or side effects of bupropion include levodopa, MAOIs, ritonavir, antidepressants, antipsychotics, beta blockers, type 1C antiarrhythmics. 

C. Nortriptyline (Pamelor) is a TCA, and as a class these drugs require at least one steady-state blood level to safely and effectively use the medication. Paroxetine, venlafaxine, and bupropion have not had blood levels correlated to response, and their relatively low toxicity does not require therapeutic blood monitoring. Nardil is a MAOI, which can be... 

Bupropion was developed over 30 years ago in an attempt to synthesize a novel antidepressant. Researchers wanted the agent to be efficacious for the existing screening models, but be different structurally and biochemically from the tricyclics and MAOIs. The compound was to be devoid of sympathomimetic, anticholinergic, and cardiac depressant effects (Soroko and Maxwell, 1983). 

Because bupropion is metabolized in the liver, medications that alter hepatic enzyme metabolism, such as carbamazepine or cimetidine, may effect blood concentrations. Bupropion should not be administered in combination with the MAOIs because of risk of hypertensive crisis. Levo-dopa use in conjunction with bupropion has been associated with confusion, hallucinations, and dyskinesia. Although generally well tolerated, there are case reports documenting that the... 

Inattentiveness, impulsivity, hyperactivity 50% will continue to manifest the disorder into adulthood Stimulants (70% response for uncomplicated ADHD caution in patients with tic disorders) TCAs (70% response, first line for patients with comorbid MD or anxiety disorders, and for patients with ADHD + tics) requires serum levels and cardiovascular monitoring Bupropion Clonidine, guan-facine (first line for patients with ADHD + tics) MAOIs Combined pharmacotherapy for treatment-resistant cases... 

In adults, mood stabilizers reduce the risk of cycling and have modest antidepressant effects (APA, 1994b). For patients with bipolar depression who do not respond to mood stabilizers alone, an antidepressant should be added to the treatment. It appears that bipolar depressed patients may be less likely to respond to TCAs than patients with unipolar depressions, who may show a more favorable response to bupropion, SSRI, or MAOIs. Furthermore, some studies, but not all, have also suggested that bupropion and the MAOIs are less likely to produce mania and less rapid cycling (APA, 1994b Compton and Nemeroff, 2000). 

The clinical efficacy of classic TCAs and MAOIs in major affective disorder is not in question. Controlled studies also support the efficacy of bupropion, although dose-response relationships have not been established. 

The combination of bupropion with an M AOI is potentially dangerous, but less so than the combination of serotonergic drugs and MAOIs. Although the practice is not recommended, MAOIs and bupropion have been combined in patients with refractory depression. 

Although more stimulating antidepressants (e.g., bupropion, SSRIs, venlafaxine, or certain MAOIs) do not potentiate alcohol, they can produce insomnia. To minimize this problem, the dose may be given earlier in the day. TCAs may cause episodes of excitement (rare), confusion, or mania, usually in patients with an underlying psychotic illness, suggesting that a preexisting disorder must be present for these drugs to exert any psychotomimetic effects. 

There is a great disparity of current knowledge regarding the effects of antidepressants on GYP enzymes. There have been almost no studies to test the potential effects of TCAs, MAOIs, and trazodone on GYP enzymes. There has only been one study with bupropion but it demonstrated that bupropion produces substantial inhibition of GYP 2D6 comparable with the effect of fluoxetine and paroxetine. In contrast to studies in these antidepressants, there have been extensive in vitro and in vivo studies of SSRIs, nefazodone, and venlafaxine. 

Bupropion is metabolized primarily by CYP2B6, and its metabolism may be altered by drugs such as cyclophosphamide, which is a substrate of 2B6. The major metabolite of bupropion, hydroxybupropion, is a moderate inhibitor of CYP2D6 and so can raise desipramine levels. Bupropion should be avoided in patients taking MAOIs. 

Antidepressants (with caution because antidepressants can destabilize mood in some patients, including induction of rapid cycling or suicidal ideation in particular consider bupropion also SSRIs, SNRIs, others generally avoid TCAs, MAOIs)... 

MAOIs and bupropion have not been studied extensively. 

Antidepressant drugs A major class of psychotropic drugs with diverse chemical configurations including the monoamine oxidase inhibitors (MAOIs), the heterocyclic drugs (composed of mono-, di-, tri-, and hetero-cyclics), the serotonin reuptake inhibitors (fluoxetine, paroxetine, sertraline, trazodone, and venlafaxine), and bupropion are more recent innovations. Antidepressants usually must be taken for several weeks to have the desired effect and they often have a low therapeutic index, so they must be closely monitored. 

Bupropion (brand name Wellbutrin) An antidepressant drug known to induce seizures and therefore administered with specific recommendations on dosage ranges. It should not be administered concurrently with MAOIs. 

DA agonists levodopa, bromocriptine, ropinirole, pramipexole, selegiline AAAD inhibitor carbidopa M-blockers benztropine, trihexiphenidyl MAOIs phenelzine, tranylcypromine TCAs amitriptyline, imipramine, clomipramine SSRIs fluoxetine, paroxetine, sertraline Others bupropion, mirtazapine, nefazodone, trazodone... 

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