Servicio de Psiquiatría-CAS Vall d’Hebron
Agencia de Salud Pública de Barcelona (ASPB)
Programa Clínico DepresiónServicio de Psiquiatría
3Servicio de Psiquiatría del Parc Sanitari Sant Joan de Déu
Instituto Clínico de NeurocienciasHospital Clínic de Barcelona
Hospital Universitari de Bellvitge-IDIBELLCIBERSAM
bupropion in the treatment of addiction in patients with cocaine dependence who are receiving maintenance treatment
Dual pathology is defined as the coexistence of an
with methadone6 or even in patients affected by an attention
addiction in persons suffering another mental disorder.1 The
deficit hyperactivity disorder (ADHD) or dual ADHD.5
course, prognosis and treatment of patients are different from those who do not have dual pathology.2 It is known that smoking determines worse prognosis and greater
TREATMENT WITH BUPROPION OF DEPRESSED
clinical severity of bipolar disorder (BD), schizophrenia and
PATIENTS WITH DUAL PATHOLOGY
Bupropion can be used in the treatment of depressive
It has been described that patients with mental disorders
patients with dual pathology, aiming to obtain the
smoke more and spend more on this habit than the general
antidepressant effect or to facilitate smoking cessation,
population and have a greater frequency of associated medical
since its efficacy as smoking cessation treatment is
conditions.4 In patients with schizophrenia and SAD, nicotine
independent of its antidepressant action.8
dependence has been related with a higher rate of suicide attempts and with alcohol and cannabis consumption.3
It is known that drug abuse in depressed patients is
Treatments effective in the general population are also
associated to greater suicidal risk and attempts, earlier onset
effective in patients with psychiatric disorders and little
of depression, more anxiety disorders and functioning
attention has been given to this population.4 Bupropion is a
alterations. 9 However, treatment of patients with dual
norepinephrine-dopamine reuptake inhibitor and is one of
pathology has been studied little and the results of its
the treatments used most for smoking cessation and as an
efficacy have not always been consistent. 10 In relationship
antidepressant drug.5 However, few specific works exist on
to smoking cessation treatment, in spite of the strong
the use of bupropion in patients with dual pathology, even
association between smoking and depression, the studies on
though it has been used as a drug for smoking cessation, in
smoking cessation usually exclude depressed patient11 or
patients with dual diagnosis of affective and psychotic
this population has been studied little.4 Of these specific
disorders. Furthermore, there are signs about the use of
works, it is known that patients with backgrounds of major depressive disorders benefit the same as the general
* Francisca Almansa, Carmen Barral, Milagrosa Blanca, Nagore Benito, Joan Cadevall,
population from psychotherapy and pharmacological
Horacio Casté, Nuria Custal, Anna Falcés, Eva Fontova, Juan Manuel Goicolea, Georgina González, Paul Ernesto González, Ana Herrero, Rafael Martín, Leticia Medeiros, Javier
treatments for smoking cessation. 4 However, drug usage can
Merino, Laura Mora, Josep Mª Otín, Adolfo Pellejero, Rosa Pi, Cristina Pinet, Dolors Robles, Alejandro Rodriguez, Ferran Romaguera, Carme Romero, Carme Sarri, Joan Seguí,
modulate the efficacy of these treatments. The risk of failure
Sara Solé, Carmen Sotelo, Josep Tort, Marc Valentí.
or relapse in alcohol-dependent patients who quit smoking
has been related with the severity and type of alcohol
consumption. Specifically, patients with elevated or very
Servicio de PsiquiatriaHospital Universitari de Bellvitge-IDIBELL, CIBERSAM
frequent alcohol consumption have more relapses.12 Thus,
the existence of dual pathology should be taken into account
08907Correo electrónico: [email protected]
Actas Esp Psiquiatr 2011;39(Suppl. 2):17-9
Scientific evidence indicates that treatment with
trials in which patients with schizophrenia were included
bupropion in addicts who also smoke is effective, regardless
reported that the use of bupropion is superior to placebo
of whether there is associated depression.10 When the use of
in smoking cessation, the results being maintained at 6
bupropion combined with nicotine patches in patients who
months.22-23 With the known data, it can be stated that
receive cognitive behavioral therapy has been studied, it has
bupropion can be used as a drug that facilitates cessation
been demonstrated that abstinence and the depressive
symptoms improve in patients who smoke and who have current or have had past unipolar major depression.11 The
The use of bupropion in patients suffering from SAD
type of association of treatments in patients who smoke and
should be evaluated with caution due to the possibility of
are depressed is not clear since, although bupropion has
precipitating a manic episode. In general, all patients
advantages in regards to smoking cessation, a ceiling effect
affected by psychosis treated with bupropion require
due to the interventions received has been detected in those
periodic psychopathological evaluation and regular medical
control due to the risk of seizures because of its effect on the decrease of the seizure threshold.20
In the patient with behavior disorder, this drug has been
used successfully used in the treatment of the depressive phases of the disease and is considered to be first-line
OPINION OF THE EXPERTS OF THE WORK GROUP
treatment, as the selective serotonin reuptake inhibitors (SSRI).13 Up to date, there are no specific studies with
Knowledge on the indications, use and management of
bupropion in patients with dual bipolar disorder, although
bupropion in patients with dual condition are partial.
the increased risk of mania induced by antidepressants is known in bipolar patients with a past history of drug
There is clinical experience and increasingly greater
evidence obtained in clinical trials performed in patients with depression or schizophrenia that point to its utility, both as an antidepressant as well as a smoking cessation
TREATMENT OF DUAL PSYCHOTICS
Bupropion is well tolerated when combined with other
There are clinical experiences with limited cohorts of
schizophrenic patients treated with antipsychotics in which bupropion was used as an antidepressant. In these
This drug should be used with precaution in patients
studies, improvement of the depressive symptoms with
with risk of appearance of manic pictures.
good tolerability was described.15 On the other hand, there is little experience with the treatment of depressive symptoms in dual schizophrenics. Fundamentally, REFERENCES
bupropion has been used in the treatment of nicotine dependence in psychotic patients in addition to nicotine
1. Casas M, Prat G, Santís R. Trastornos por dependencia de
patches or gum. In these patients, treatment with
sustancias psicotropas. In: Cervilla JA, García-Ribera C.
bupropion has provided positive efficacy results, good
Fundamentos biológicos en psiquiatría. Barcelona: Masson,
tolerability and even a significant reduction in the negative
symptoms characteristic of the evolution of the disease,3,
2. Roncero C, Barral C, Grau-López L, Esteve O. Casas M. Protocolos
16 so that its use has been recommended.17, 16 Most of the
de intervención en patología dual: Esquizofrenia. Edikamed.
studies conducted in patients with schizophrenia and SAD
Barcelona 2010. Available at www.patología dual.es.
3. López-Ortiz C, Roncero C, Miquel L, Casas M. Fumar en las
have not detected psychotic decompensation in
psicosis afectivas: revisión sobre el consumo de nicotina en el
relationship with this drug,18 except for some isolated
trastorno bipolar y esquizoafectivo. Adicciones 2011 (in press).
case.19 Bupropion reduces tobacco consumption and
4. Kisely S, Campbell LA. Use of smoking cessation therapies in
improves the negative symptoms, without destabilizing
individuals with psychiatric illness : an update for prescribers.
the psychotic and depressive symptoms although its long-
term benefit is modest.20 In subsequent works, positive
5. Clayton AH. Extended-release bupropion: an antidepressant
results have been described in psychotic patients when
with a broad spectrum of therapeutic activity?. Expert Opin
bupropion was administered in combined treatment. In a
6. Castells X, Casas M, Pérez-Mañá C, Roncero C, Vidal X, Capellà D.
clinical trial was 58 schizophrenic patients under treatment
Efficacy of psychostimulant drugs for cocaine dependence.
with bupropion together with nicotine patches,21 it was
Cochrane Database Syst Rev. 2010;2:CD007380.
demonstrated that this condition was well tolerated and
7. Wilens TE, Prince JB, Spencer T, Van Patten SL, Doyle R, Girard K,
that the results were better than when only nicotine
et al. An open trial of bupropion for the treatment of adults
patches were used. Meta-analysis reviews of 7 clinical
with attention-deficit/hyperactivity disorder and bipolar
Actas Esp Psiquiatr 2011;39(Suppl. 2):17-9
disorder. Biol Psychiatry. 2003;54:9-16.
15. Englisch S, Inta D, Eer A, Zink M. Bupropion for depression in
8. Hayford KE, Patten CA, Rummans TA, Schroeder DR, Offord KP,
schizophrenia. Clin Neuropharmacol. 2010;33(5):257-9.
Croghan IT, et al. Efficacy of bupropion for smoking cessation in
16. George TP, Vessicchio JC, Sacco KA, Weinberger AH, Dudas MM,
smokers with a former history of major depression or alcoholism.
Allen TM, et al. A placebo-controlled trial of bupropion combined
with nicotine patch for smoking cessation in schizophrenia. Biol
9. Davis LL, Frazier E, Husain MM, Warden D, Trivedi M, Fava M, et
al. Substance use disorder comorbidity in major depressive
17. Evins AE, Cather C, Deckersbach TH, Freudenreich O, Culhane
disorder: a confirmatory analysis of the STAR*D cohort. Am J
MA, Olm-Shipman CM, et al. A double-blind placebo-controlled
trial of bupropion sustained-release for smoking cessation in
10. Torrens M, Fonseca F, Mateu G, Farré M. Efficacy of antidepressants
schizophrenia. J Clin Psychopharmacol. 2005;25(3):218-25.
in substance use disorders with and without comorbid depression.
18. Smith RC, Lindenmayer JP, Davis JM, Cornwell J, Noth K, Gupta
A systematic review and meta-analysis. Drug Alcohol Depend.
S, et al. Cognitive and antismoking effects of varenicline in
patients with schizophrenia or schizoaffective disorder.
11. Evins AE, Culhane MA, Alpert JE, Pava J, Liese BS, Farabaugh A,
et al. A controlled trial of bupropion added to nicotine patch
19. Javelot H, Baratta A, Weiner L, Javelot T, Nonnenmacher C,
and behavioral therapy for smoking cessation in adults with
Westphal JF, et al. Two acute psychotic episodes after
unipolar depressive disorders. J Clin Psychopharmacol.
administration of bupropion: a case of involuntary rechallenge.
12. Leeman RF, McKee SA, Toll BA, Krishnan-Sarin S, Cooney JL,
20. Noordsy DL, Green AI. Pharmacotherapy for schizophrenia and
Makuch RW, et al. Risk factors for treatment failure in smokers:
co-occurring substance use disorders. Curr Psychiatry Rep.
relationship to alcohol use and to lifetime history of an alcohol use disorder. Nicotine Tob Res. 2008; 10(12):1793-809.
13. Yatham LN, Kennedy SH, Schaffer A, Parikh SV, Beaulieu S,
21. George TP, Vessicchio JC, Termine A, Bregartner TA, Feingold A,
O’Donovan C, et al. Canadian Network for Mood and Anxiety
Rounsaville BJ, et al. A placebo controlled trial of bupropion for
Treatments (CANMAT) and International Society for Bipolar
smoking cessation in schizophrenia. Biol Psychiatry.
Disorders (ISBD) collaborative update of CANMAT guidelines for
the management of patients with bipolar disorder: update 2009.
22. Tsoi DT, Porwal M, Webster AC. Interventions for smoking
cessation and reduction in individuals with schizophrenia.
14. Manwani SG, Pardo TB, Albanese MJ, Zablotsky B, Goodwin FK,
Cochrane Database Syst Rev. 2010; 16(6):CD007253.
Ghaemi SN. Substance use disorder and other predictors of
23. Tsoi DT, Porwal M, Webster AC. Efficacy and safety of bupropion
antidepressant-induced mania: a retrospective chart review. J
for smoking cessation and reduction in schizophrenia: systematic
review and meta-analysis. Br J Psychiatry. 2010;196(5):346-53.
Actas Esp Psiquiatr 2011;39(Suppl. 2):17-9
Schulmedizin und Alternativmedizin – Die Sicht der Schulmedizin Prof. Dr. Rudolf Joss, Luzern „Natural-born killers“ – so titelte kürzlich die angesehene Zeitschrift Nature Medicine einen Beitrag über Phytotherapie. Steve Bechler, ein Baseball-Spieler der Baltimore Orioles hatte mit Hilfe sogenannter „herbal supplements“, also mit pflanzlichen Nahrungsmittelzusätzen vers
Team leader name: P. Vicendo Laboratory/ Service: IMRCP Title of the team: Colloids and Nanomedicine Project (CNP) Research staff: Permanent staff: Fitremann J (CR CNRS); Gauffre F (CR CNRS) ; Gineste S (IE CNRS) ; Lauth de Viguerie N (Pr.) ; Lonetti B (CR CNRS); Marty J-D (MdC); Mingotaud C (DR CNRS); Mingotaud A-F (CR CNRS); Souchard J-P (Pr.); Vicendo P. (CR CNRS) Non perman