Bupropion for PTSD: Limited Efficacy for Core Symptoms
Bupropion is not recommended as a first-line treatment for PTSD as it shows limited efficacy for core PTSD symptoms, though it may help with comorbid depression and smoking cessation in PTSD patients. 1, 2
Evidence on Bupropion for PTSD
Efficacy for Core PTSD Symptoms
- An open-label study of 17 male combat veterans with PTSD found that while 10 of 14 completers were classified as treatment responders on global improvement measures, there was no significant change in core PTSD symptoms (intrusion and avoidance) 1
- A placebo-controlled trial showed no significant difference between bupropion SR and placebo for PTSD symptom reduction 2
- Bupropion primarily improved depressive and hyperarousal symptoms in PTSD patients, but had minimal effect on the hallmark symptoms of PTSD 1
Special Populations and Considerations
- In patients with comorbid PTSD and methamphetamine use disorder, a small case series suggested potential benefit with bupropion for both PTSD symptoms and substance use outcomes 3
- For PTSD patients who smoke, bupropion may be beneficial for smoking cessation while treating comorbid symptoms 4
Treatment Algorithm for PTSD with Depression
First-line options:
- SSRIs/SNRIs are the established first-line pharmacotherapy for PTSD
- Consider sertraline or paroxetine which have stronger evidence for PTSD
When to consider bupropion:
- For PTSD patients with prominent depressive symptoms who failed SSRI/SNRI treatment
- For patients experiencing sexual dysfunction with SSRIs
- For patients with comorbid PTSD and need for smoking cessation
- For younger patients not currently on another antidepressant 2
Dosing considerations:
Important Clinical Caveats
- Contraindications: Avoid in patients with seizure disorders, brain lesions, or current alcohol/substance abuse due to increased seizure risk 5
- Monitoring: Watch for common side effects including insomnia, dry mouth, anxiety, decreased appetite, and headache 5
- Advantage: Bupropion has minimal sexual side effects compared to SSRIs, which may improve adherence in PTSD patients 1
- Combination therapy: In treatment-resistant MDD with PTSD, augmentation with aripiprazole showed better response rates (68.4%) than switching to bupropion (57.7%) 6
Discontinuation
- If discontinuing bupropion, implement gradual tapering (reduce to 150mg once daily for 1-2 weeks) to minimize withdrawal symptoms 5
- Monitor for withdrawal symptoms including depression, anxiety, irritability, insomnia, and headache 5
While bupropion may help with certain aspects of PTSD symptomatology (particularly depression and hyperarousal), the evidence does not support its use as a primary treatment for the core symptoms of PTSD. Consider it as part of a treatment plan when specific comorbidities like depression or nicotine dependence are present.