From the Guidelines
Bupropion can cause movement disorders, but the evidence provided does not specifically mention REM sleep movement disorders as a common side effect of bupropion. Bupropion, an antidepressant commonly sold under brand names like Wellbutrin and Zyban, works by inhibiting the reuptake of dopamine and norepinephrine in the brain. This mechanism can disrupt normal sleep architecture, but the provided evidence focuses more on its efficacy and safety in treating depression and smoking cessation rather than its effects on REM sleep.
Key Points to Consider
- The most recent and highest quality study provided is from 2016 1, which discusses bupropion's use in smoking cessation and mentions its safety profile, including a reduced seizure threshold and potential neuropsychiatric effects, but does not specifically address REM sleep movement disorders.
- Earlier studies, such as those from 2008 and 2009 1, provide information on bupropion's adverse effect profile, including insomnia and tremors, but again, do not specifically mention REM sleep movement disorders.
- Given the lack of direct evidence from the provided studies linking bupropion to REM sleep movement disorders, it is essential to consult more recent and specific research on this topic for a definitive answer.
Clinical Considerations
- If a patient experiences unusual movements during sleep while taking bupropion, it is crucial to discuss this with their healthcare provider.
- The provider may consider reducing the dose, changing the timing of administration, switching to a different medication, or implementing sleep safety measures to prevent injury during episodes, based on the patient's overall clinical presentation and response to treatment.
From the FDA Drug Label
Tremor Twitch
The FDA drug label mentions tremor and twitch, which are related to movement disorders. However, it does not explicitly mention REM movement disorders.
- Tremor is listed as an adverse reaction that occurred in at least 1% of patients treated with bupropion HCl sustained-release 300 mg/day and 400 mg/day.
- Twitch is also listed as an adverse reaction that occurred in at least 1% of patients treated with bupropion HCl sustained-release 400 mg/day. Since the label does not directly address REM movement disorders, no conclusion can be drawn about bupropion causing this specific condition 2.
From the Research
Bupropion and REM Sleep Movement Disorders
- Bupropion has been found to affect REM sleep in various studies, with some indicating an increase in REM sleep percent and REM time, as well as a reduction in REM latency 3.
- However, the relationship between bupropion and REM sleep behavior disorder (RBD) is more complex, with some studies suggesting that antidepressants, including bupropion, may trigger symptoms of RBD in up to 6% of users 4.
- RBD is a strong prodromal marker of Parkinson disease and other synuclein-mediated neurodegenerative syndromes, and it is unclear whether antidepressant-associated RBD is an independent pharmacologic syndrome or a sign of possible prodromal neurodegeneration 5, 4.
- One study found that patients with antidepressant-associated RBD had a lower risk of developing neurodegenerative disease than those without antidepressant use, but still had markers of prodromal neurodegeneration present 4.
Effects of Bupropion on REM Sleep
- Bupropion has been found to increase REM latency in responders to treatment, whereas non-responders showed a decrease in REM latency 6.
- Another study found that bupropion SR treatment did not suppress electrophysiologic measures of REM sleep, nor did it alter an indirect measure of global metabolism during either waking or REM sleep 7.
- However, bupropion SR treatment was found to reverse the deficit in anterior cingulate, medial prefrontal cortex, and right anterior insula activation from waking to REM sleep 7.