Can Wellbutrin (bupropion) cause seizures in a teenager with a history of myoclonic seizures?

Wellbutrin (Bupropion) Should Not Be Used in a Teen with History of Myoclonic Seizures

Bupropion is contraindicated in this teenager with a history of myoclonic seizures due to its significant seizure risk and should not be prescribed under any circumstances. 1

Seizure Risk with Bupropion

Bupropion significantly lowers the seizure threshold and carries a documented risk of triggering seizures even in patients without a seizure history. The FDA drug label explicitly states that seizures were reported in approximately one-third of all bupropion overdose cases 1. Even at therapeutic doses, the seizure risk is approximately 0.4% 2, which is substantially higher than many other psychiatric medications.

For patients with a pre-existing seizure history, this risk is magnified:

• The FDA label specifically contraindicates bupropion in patients with seizure disorders 1
• Case reports document seizures occurring within days of starting bupropion, even in patients without prior seizure history 3, 4
• A history of myoclonic seizures specifically increases vulnerability to medication-induced seizures 5

Myoclonic Seizure History as a Risk Factor

The patient's history of myoclonic seizures at age 5 represents a significant risk factor:

• Myoclonic seizures can recur later in life, especially when triggered by medications that lower seizure threshold 5
• Guidelines for managing patients with a history of epilepsy specifically warn against medications that can lower seizure threshold 5
• Case reports document bupropion-induced myoclonus even in patients without prior seizure history 6

Alternative Approaches

For teenagers requiring treatment for depression or ADHD (common indications for bupropion), safer alternatives include:

• SSRIs for depression that don't significantly lower seizure threshold
• Non-stimulant ADHD medications like atomoxetine that have less impact on seizure threshold 5
• For smoking cessation (another common bupropion indication), nicotine replacement therapy offers a safer alternative

Monitoring Considerations if Bupropion Must Be Used

In the extremely rare situation where benefits might outweigh risks (which would be unusual given the availability of alternatives), the following would be required:

1. Consultation with a neurologist and psychiatrist
2. Starting at the lowest possible dose (150mg or less)
3. Extremely slow titration schedule
4. Regular EEG monitoring
5. Consideration of prophylactic anticonvulsant therapy
6. Immediate discontinuation at first sign of myoclonic activity

Conclusion

The evidence clearly demonstrates that bupropion poses an unacceptable seizure risk for a teenager with a history of myoclonic seizures. The FDA drug label, clinical guidelines, and case reports all support avoiding this medication in patients with seizure history. Alternative treatments with better safety profiles should be selected based on the specific indication for which bupropion was being considered.