Introduction: Clinically bupropion has FDA approval of indications such as depression and tobacco addiction and widely used in psychiatric patients. Among frequent side effects of bupropion such as insomnia, constipation, headache, dry mouth; there are also less frequent ones like, alteration in attention, memory and perception, vivid dreams, visual hallucinations, delusions and catatonia.
Case: A 28-year-old female patient presented to psychiatry outpatient clinic with fatigue and loss of interest. Following a diagnosis of major depression according to DSM 4TR criteria, 150 mg/g bupropion was given. Starting from the 7th day of treatment, she has the complaints of having nightmares, suspiciousness, and hallucinations of bugs climbing on the wall, hypnopompic auditory hallucinations, reference and persecutory delusions. After cessation of bupropion, on consequential 12 days, psychotic symptoms regressed completely. In literature, relationship between bupropion and psychosis was first mentioned by Becker et al.a wide symptomology spectrum ranging from alterations in perception to catatonia. In 2011, Sanjeev and Kumar et al. published a review indicating that susceptible persons and high dose were related to onset of psychosis with a high probability. Liver cytochrome enzyme p450 2B6 which has role in metabolizing bupropion, displays variations according to age and genetics might predict this priority to psychosis amount different people. Bupropion is an agent commonly used in the treatment of depression and smoking cessation. Even low doses of bupropion can induce psychosis in people which don’t have any risk factors. Psychotic symptoms should be questioned at the first control after starting bupropion.