Bupropion

INTRODUCTION

Indications

Treatment of depression (with psychotherapy). Depression in patients with seasonal affective disorder (XL only). Smoking cessation (Zyban only). Unlabeled Use: Treatment of ADHD in adults (SR only). To increase sexual desire in women.

Action

Decreases neuronal reuptake of dopamine in the CNS. Diminished neuronal uptake of serotonin and norepinephrine (less than tricyclic antidepressants). Therapeutic Effects: Diminished depression. Decreased craving for cigarettes.

Adverse Reactions/Side Effects

CNS: SEIZURES, SUICIDAL THOUGHTS, agitation, headache, insomnia, mania, psychoses. GI: dry mouth, nausea, vomiting, change in appetite, weight gain, weight loss. Derm: photosensitivity. Endo: hyperglycemia, hypoglycemia, syndrome of inappropriate ADH secretion. Neuro: tremor.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Be alert for increased depression or expression of suicidal thoughts, especially in the initial period of drug therapy, and in children and teenagers. Notify physician or other mental health professional immediately if patient exhibits worsening depression or suicidal ideology.

• Be alert for agitation, mania, psychosis, or other alterations in mental status. Notify physician promptly if these symptoms develop (See Appendix D).

• Watch for signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Patients with diabetes mellitus should check blood glucose levels frequently.

• Monitor signs of fluid-electrolyte imbalance due to syndrome of inappropriate antidiuretic hormone (SIADH). SIADH causes increased water retention that leads to relatively low sodium concentration (hyponatremia). Symptoms include confusion, lethargy, weakness, myoclonus, and depressed reflexes. Severe or sudden onset may also cause seizures, ataxia, nystagmus, tremor, dysarthria, dysphagia, and coma. Notify physician if these signs occur.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or weight loss.

Interventions

• Help patient explore nonpharmacologic methods to reduce depression or quit smoking (exercise, counseling, support groups, etc.).

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

Patient/Client-Related Instruction

• Advise patient that antidepressant effects may not occur immediately; it may take 2 wk or more before an improvement in mood is observed.

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

• Instruct patient to report other bothersome side effects such as severe or prolonged headache, sleep loss, or GI problems (nausea, vomiting, dry mouth).