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Bupropion (Wellbutrin) versus ...

Bupropion vs Fluoxetine (Prozac)

Depression

Onset of action -- no difference in speed of onset of action between bupropion and fluoxetine14.

Results of placebo-controlled comparison of bupropion sustained release and fluoxetine 5. Bupropion SR Fluoxetine
Dosage 150-400 mg per day 20 to 60 mg per day
Efficacy Similarly effective in the treatment of depressive symptoms.
Sexual side effects   More frequently associated with sexual dysfunction
Results of double-blind comparison of bupropion and fluoxetine for depression 13. Bupropion SR Fluoxetine
Dosage 225-450 mg per day 20-80 mg per day
50% or greater reduction in the HAM-D scores, number of patients, % 37 of 61 patients, 63% 35 of 62 patients, 58%
Much or very much improved number of patients, % 40 of 61 patients, 68% 35 of 62 patients, 58%
Prematurely discontinuation of treatment, number of patients 16 of 61 patients, 26% 18 of 62 patients, 29%


Premenstrual Dysphoric Disorder

Results of placebo-controlled comparison of bupropion sustained release and fluoxetine 4. Bupropion Fluoxetine
Dosage 100 mg 3 times daily 20 mg per day
Efficacy Some improvement was noted. Fluoxetine was superior to bupropion. Patients satisfaction was far greater with fluoxetine.

Bupropion vs Escitalopram (Lexapro)

Depression

Results of 2 randomized, double-blind, placebo-controlled studies of dupropion extended release versus escitalopram 2. Bupropion XL Escitalopram
Orgasm dysfunction, % of patients in study 1 13% 32%
Orgasm dysfunction, % of patients in study 2 16% 29%
17-item Hamilton Rating Scale for Depression remission rates and Hospital Anxiety and Depression total scores in patients with MDD
similar

Generalized Anxiety Disorder

Results of pilot controlled trial of bupropion XL versus escitalopram in generalized anxiety disorder 3. Bupropion XL Escitalopram
Anxiolytic efficacy
comparable

Bupropion vs Paroxetine (Paxil)

Depression

Results of randomized, double-blind study comparing bupropion versus paroxetine for depression in the elderly. 1. Bupropion SR Paroxetine
Measurements of efficacy
similar
Headache, insomnia, dry mouth, agitation, dizziness, and nausea, % of patients > 10% > 10%
Somnolence, diarrhea, constipation, and anorexia, % of patients   > 10%

Bupropion vs. Sertraline (Zoloft)

Depression

Results of double-blind comparison of bupropion SR and sertraline in depression 8. Bupropion SR Sertraline
Efficacy
similar
Orgasm dysfunction, nausea, diarrhea, somnolence, and sweating   more frequently


Results of placebo-controlled comparison of of bupropion SR and sertraline. 7. Bupropion SR Sertraline
Efficacy measures
similar improvements
Orgasm dysfunction   significantly more patients
Headache, % of parients 30-40% 30-40%
Nausea, % of parients 18% 31%
Diarrhea , % of parients 7% 26%
Insomnia, % of parients 13% 18%
Somnolence, % of parients 3% 17%
Dry mouth, % of parients 19% 14%
Decrease in mean body weight -1.06 kg -1.06 kg


Results of retrospective cohort study of bupropion versus sertraline in depressive patients with binge eating disorder 12. Bupropion Sertraline
Effectiveness in reducing weight and improving sexual performances more effective  
Effectiveness in reducing anxious-depressive symptoms and binge frequency
similar


Results of retrospective analysis of the effects of bupropion SR and sertraline on anxiety in patients with recurrent major depressive disorder 9. Bupropion SR Sertraline
Effectiveness in reducing depressive symptoms
similar
Effect on anxiety symptoms
similar
Median time to reach a clinically significant anxiolytic effect 4 weeks 4 weeks
Somnolence   more common

Bupropion vs Trazodone

Depression

Results of comparison of bupropion and trazodone for severe major depression 10. Bupropion Trazodone
Efficacy
similar
Percentage of patients much or very much improved
58%
46%
Weight measurements at the time of discontinuation 2.5-lb mean weight loss 1.2-lb mean weight gain
Edverse effects anorexia and anxiety somnolence, appetite increase, and edema

Bupropion vs Naltrexone (ReVia)

Pathological gambling

Results of preliminary blind-rater study sustained-release bupropion versus naltrexone for pathological gambling11 Bupropion Naltrexone
Full responders, number of patients (%) 9 of 12 patients
(75%)
10 of 13 patients
(76%)
Partial responders, number of patients (%) 3 of 12 patients
(25%)
3 of 13 patients
(23%)
Conclusion Bupropion SR may be effective as naltrexone in the treatment of pathological gambling.

Further reading
References
  • 1. Weihs KL, Settle EC Jr, Batey SR, Houser TL, Donahue RM, Ascher JA. Bupropion sustained release versus paroxetine for the treatment of depression in the elderly. J Clin Psychiatry 2000 Mar; 61(3):196-202 PubMed
  • 2. Clayton AH, Croft HA, Horrigan JP, Wightman DS, Krishen A, Richard NE, Modell JG. Bupropion extended release compared with escitalopram: effects on sexual functioning and antidepressant efficacy in 2 randomized, double-blind, placebo-controlled studies. J Clin Psychiatry. 2006 May;67(5):736-46. PubMed
  • 3. Bystritsky A, Kerwin L, Feusner JD, Vapnik T.A pilot controlled trial of bupropion XL versus escitalopram in generalized anxiety disorder. Psychopharmacol Bull. 2008;41(1):46-51.
  • 4. Pearlstein TB, Stone AB, Lund SA, Scheft H, Zlotnick C, Brown WA. Comparison of fluoxetine, bupropion, and placebo in the treatment of premenstrual dysphoric disorder. J Clin Psychopharmacol. 1997 Aug;17(4):261-6. PubMed
  • 5. Coleman CC, King BR, Bolden-Watson C, Book MJ, Segraves RT, Richard N, Ascher J, Batey S, Jamerson B, Metz A. A placebo-controlled comparison of the effects on sexual functioning of bupropion sustained release and fluoxetine. Clin Ther. 2001 Jul;23(7):1040-58. PubMed
  • 6. Feighner JP, Gardner EA, Johnston JA, Batey SR, Khayrallah MA, Ascher JA, Lineberry CG. Double-blind comparison of bupropion and fluoxetine in depressed outpatients. J Clin Psychiatry. 1991 Aug;52(8):329-35. PubMed
  • 7. Croft H, Settle E Jr, Houser T, Batey SR, Donahue RM, Ascher JA. A placebo-controlled comparison of the antidepressant efficacy and effects on sexual functioning of sustained-release bupropion and sertraline. Clin Ther. 1999 Apr;21(4):643-58. PubMed
  • 8. Kavoussi RJ, Segraves RT, Hughes AR, Ascher JA, Johnston JA. Double-blind comparison of bupropion sustained release and sertraline in depressed outpatients. J Clin Psychiatry. 1997 Dec;58(12):532-7. PubMed
  • 9. Trivedi MH, Rush AJ, Carmody TJ, Donahue RM, Bolden-Watson C, Houser TL, Metz A. Do bupropion SR and sertraline differ in their effects on anxiety in depressed patients? J Clin Psychiatry. 2001 Oct;62(10):776-81. PubMed
  • 10. Weisler RH, Johnston JA, Lineberry CG, Samara B, Branconnier RJ, Billow AA. Comparison of bupropion and trazodone for the treatment of major depression. J Clin Psychopharmacol. 1994 Jun;14(3):170-9. PubMed
  • 11. Dannon PN, Lowengrub K, Musin E, Gonopolski Y, Kotler M. Sustained-release bupropion versus naltrexone in the treatment of pathological gambling: a preliminary blind-rater study. J Clin Psychopharmacol. 2005 Dec;25(6):593-6. PubMed
  • 12. Calandra C, Russo RG, Luca M. Bupropion versus sertraline in the treatment of depressive patients with binge eating disorder: retrospective cohort study. Psychiatr Q. 2012 Jun;83(2):177-85. PubMed
  • 13. Feighner JP, Gardner EA, Johnston JA, Batey SR, Khayrallah MA, Ascher JA, Lineberry CG. Double-blind comparison of bupropion and fluoxetine in depressed outpatients. J Clin Psychiatry. 1991 Aug;52(8):329-35. PubMed
  • 14. George MS, Lydiard RB. Speed of onset of action of the newer antidepressants--fluoxetine and bupropion. Int Clin Psychopharmacol. 1991 Winter;6(4):209-17.

Published: March 31, 2008
Last updated: March 24, 2014

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