From the Guidelines
Bupropion (Wellbutrin) is not effective as a primary treatment for schizophrenia and should not be used for this purpose. The standard first-line treatments for schizophrenia are antipsychotic medications such as risperidone, olanzapine, quetiapine, aripiprazole, or haloperidol, which work primarily by blocking dopamine D2 receptors 1. Bupropion, on the other hand, is primarily approved for depression and smoking cessation. It works by inhibiting the reuptake of dopamine and norepinephrine, which can actually increase dopamine activity in certain brain regions. This mechanism of action could potentially worsen psychotic symptoms in schizophrenia, as excessive dopamine activity in the mesolimbic pathway is associated with positive symptoms of schizophrenia such as hallucinations and delusions.
According to recent studies, antipsychotics have been used as the primary pharmacological treatment of schizophrenia, and they often have a good effect on reducing positive symptoms, but may not markedly improve negative symptoms or cognitive defects 1. In fact, at least 20% of individuals with schizophrenia do not receive a clear benefit from monotherapy with antipsychotics, and 70% of patients with schizophrenia require long-term, even lifetime, medication to control their symptoms and do not achieve complete recovery.
If a patient has both schizophrenia and depression, the depression should be addressed with antidepressants that have less risk of worsening psychosis, and only after the psychotic symptoms are adequately controlled with appropriate antipsychotic medication under close psychiatric supervision. The use of bupropion in patients with schizophrenia is not recommended due to its potential to exacerbate psychotic symptoms, and alternative treatments such as antipsychotic polypharmacy or other psychotropic treatment augmentation strategies may be considered in certain cases 1.
Some key points to consider when treating schizophrenia include:
- Antipsychotic monotherapy should be strived for, and clozapine should be tried if two monotherapy trials with other antipsychotics have failed and no absolute contraindications exist 1
- Long-acting injectables or blood concentration measurements should be considered to affirm compliance and proper serum levels 1
- Antipsychotic polypharmacy should be considered and discussed with patients from whom the aforementioned procedures do not produce a satisfactory treatment result 1
From the Research
Bupropion as a Primary Treatment for Schizophrenia
- Bupropion is not typically used as a primary treatment for schizophrenia, but rather as an aid for smoking cessation in patients with schizophrenia 2, 3, 4, 5.
- The studies suggest that bupropion can be effective in helping patients with schizophrenia quit smoking, with significant increases in smoking abstinence rates compared to placebo 2, 4, 5.
- Bupropion has also been shown to be well-tolerated and safe for use in patients with schizophrenia, without worsening their mental state 2, 3, 4, 5.
Efficacy of Bupropion for Schizophrenia Symptoms
- There is limited evidence to suggest that bupropion has a significant impact on the primary symptoms of schizophrenia, such as positive or negative symptoms 2, 4.
- However, some studies suggest that bupropion may have a positive effect on depressive and negative symptoms in patients with schizophrenia 6, 5.
- Further research is needed to fully understand the potential benefits and risks of using bupropion as a treatment for schizophrenia symptoms 6.
Safety and Risks of Bupropion in Schizophrenia
- While bupropion is generally considered safe for use in patients with schizophrenia, there is a risk of bupropion-induced psychoses, particularly in patients not taking concomitant antipsychotic medication 6.
- The risk of bupropion-induced psychoses appears to be negligible in patients taking stable antipsychotic regimens 6.
- Electroencephalographic abnormalities have been reported in patients taking bupropion, but the clinical significance of this is unclear 6.