Antidepressants Beginning with the Letter "B"
Bupropion is the primary antidepressant medication that starts with the letter "B" and is FDA-approved for treating major depressive disorder.
Bupropion
Bupropion is a unique second-generation antidepressant with the following characteristics:
Mechanism of action: Bupropion is the only antidepressant currently available in the United States with combined effects on norepinephrine and dopamine neurotransmitters, with no appreciable activity on serotonin concentrations in the central nervous system 1.
Active metabolites: It is extensively metabolized into three active metabolites—hydroxybupropion, threohydrobupropion, and erythrohydrobupropion—each with substantial antidepressant activity 1.
Dosing considerations: The maximum dose is 450 mg per day for immediate-release formulations and 400 mg per day for sustained-release formulations, with gradual titration required to minimize seizure risk 1.
Onset of action: Clinical improvement typically begins at 2 weeks, with full efficacy attained at 4 weeks of treatment 1.
Guideline recognition: Bupropion is specifically mentioned in American College of Physicians guidelines as part of the second-generation antidepressant class used for treating major depressive disorder 2, 3.
Clinical Context
Efficacy: Bupropion produces similar depression remission rates when compared to SSRIs, with a median time to relapse of 44 weeks 1.
Additional indications: Beyond depression treatment, bupropion is FDA-approved for smoking cessation and may have a combined role in treating nicotine cravings and depression 1, 4.
Common adverse effects: Include agitation, dry mouth, insomnia, headaches, migraines, nausea, vomiting, constipation, and tremor 1.
Most serious side effect: Seizure development is the most concerning adverse effect, necessitating careful dose titration 1.