J Clin Psychiatry.
2005 May;66(5):603-10. Related Articles, Links
Why Isn't Bupropion the Most Frequently Prescribed Antidepressant?
Zimmerman M, Posternak MA, Attiullah N, Friedman M, Boland RJ,
Baymiller S, Berlowitz SL, Rahman S, Uy KK, Singer S, Chelminski I.
From the Department of Psychiatry and Human Behavior, Brown University
School of Medicine, Rhode Island Hospital, Providence.
OBJECTIVE: Reviews of antidepressant medication efficacy suggest that
all antidepressants are equally effective. Bupropion is less likely than
other antidepressants to cause weight gain and sexual dysfunction, the
2 side effects that are of greatest concern to patients and that have
the greatest impact on long-term compliance. If bupropion is as effective
as other antidepressants, and it does not cause the side effects that
are the most frequent causes of long-term noncompliance, then why isn't
it the most frequently prescribed antidepressant medication? To understand
psychiatrists' decision making at the time an antidepressant is chosen,
we conducted the Rhode Island Factors Associated With Antidepressant Choice
Survey (FAACS). METHOD: For 1137 DSM-IV-diagnosed depressed patients initiated
on an antidepressant, the treating psychiatrist completed a 43-item questionnaire
listing factors that might have influenced the choice of medication. The
questionnaire was filled out immediately after the antidepressant was
prescribed to treat a depressive disorder. This study was conducted from
August 2001 to February 2002. RESULTS: Because the reasons for choosing
a medication to augment an existing regimen might be different from those
used in monotherapy, augmentation trials were excluded from the analysis,
leaving a sample of 965 patients. Bupropion was rarely prescribed when
the presence of comorbid anxiety disorders or symptoms reflecting central
nervous system activation influenced antidepressant selection. When the
desire to avoid side effects, especially sexual dysfunction and weight
gain, were the basis of selection, then bupropion was significantly more
often prescribed than other antidepressants (p < .001). CONCLUSIONS:
Although there is little evidence that patient factors predict differential
medication response, psychiatrists are strongly inclined to base antidepressant
selection on clinical profiles and avoid prescribing bupropion for depressed
patients with high anxiety. Possible reasons for the discrepancy between
psychiatrists' prescribing habits and the results of empirical study are
discussed.
Pharmacol Biochem Behav. 2005 May;81(1):65-70.
Effects of monoamine reuptake inhibitors on wet-dog shakes mediated
by 5-HT(2A) receptors in ACTH-treated rats.
Kawakami Y, Kitamura Y, Araki H, Kitagawa K, Suemaru K, Shibata
K, Gomita Y.
Department of Hospital Pharmacy, Okayama University Medical School,
2-5-1, Shikata-cho, Okayama, 700-8558, Japan.
We examined the influence of imipramine, a serotonin (5-HT) and noradrenaline
(NA) reuptake inhibitor, desipramine, a NA reuptake inhibitor, bupropion,
a dopamine reuptake inhibitor, fluvoxamine, a selective 5-HT reuptake
inhibitor, and mazindol, a catecholamine reuptake inhibitor, on a 5-HT(2A)
receptor-mediated behavior, (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane
(DOI)-induced wet-dog shakes, in naive and adrenocorticotropic hormone
(ACTH)-treated rats. Chronic administration of imipramine, desipramine
and mazindol suppressed the number of wet-dog shakes in naive rats. Chronic
ACTH (100 mug/rat, s.c.) treatment increased the number. Chronic administration
of imipramine did not decrease the number of wet-dog shakes in ACTH-treated
rats. On the other hand, desipramine and mazindol inhibited the increase
in wet-dog shakes in ACTH-treated rats. Fluvoxamine and bupropion did
not have any effect on the (+/-)-DOI-induced response in naive and ACTH-treated
rats. NA reuptake inhibitors may improve the hyperfunction of 5-HT(2A)
receptors induced by chronic ACTH treatment.
