Introduction: Bupropion is a preferential dopamine and norepinephrine reuptake inhibitor. It has been shown to be effective in patients with depression and socialphobia, however data on its efficacy in body dysmorphic disorder (BDD) are lacking. So far, only two BDD cases have been reported to respond bupropion treatment. Herein, we report another case of a patient with BDD incidentally treated with sustained-release bupropion.
Case Report: Mr. H., a 26-year-old factory worker, visited a psychiatric outpatient clinic with the intent to quit smoking by seeking professional help. Bupropion sustained-release was initiated at 150mg/day during the first week and then raised to 300 mg/day, along with behavioral counseling. He was able to remain smoke free in the sixth week of the treatment. During his control visit on the 8th week, Mr. H. stated that his preoccupation about his face had also disappeared. Mr. H. looked normal but had been preoccupied with the appearance of his face since age 16. He reported thinking about his appearance for at least 5 to 6 hours a day and he worried that other people would notice him or judge him negatively because his skin looked so 'deformed'. For 3 to 7 hours a day, Mr. H. checked his face in mirrors and other reşecting surfaces and compared his face with the faces of other people. Because he was so preoccupied with, and distressed by his face, Mr. H. was often late for work, and his productivity suffered, which resulted in conşicts with his employer. Previously, he had been fired from three jobs because of these symptoms. As Mr. H. was so embarrassed about how he looked, and feared that other people would judge him negatively, Mr. H. avoided all contact with friends and saw his family only on special occasions. He did not seek help about his symptoms and he avoided mentioning his complaints because he felt ashamed of talking about his appearance. He was diagnosed as body dysmorphic disorder according to the DSM-IV criteria. Mr. H. reported that his preoccupation had diminished gradually during treatment and that he had been peaceful about his face for 2 weeks. During 3 months of follow-up, he was well maintained on sustained-release bupropion and there was no re-emergence of his symptoms.
Discussion: Currently, selective serotonine reuptake inhibitors (SSRI) are recommended as the first-line medication for BDD, including delusional BDD. SSRI antidepressants have been reported to be more efficacious for BDD than non-SSRI antidepressants or other types of psychotropic medications. The literature regarding the efficacy of bupropion in the treatment of BDD is restricted to a single report. Nardi et al have reported two cases with coexisting BDD and major depressive disorder (MDD) who were resistant to antidepressant pharmacotherapy and were treated with bupropion 300 mg/day. Our case responded well to bupropion treatment although he did not have comorbid MDD. According to our case report, bupropion may be a treatment option for some patients with BDD. Further studies and case reports are required to explore the efficacy of bupropion in the treatment of BDD.