Psychiatry and Clinical Psychopharmacology

Treatment of panic disorder with bupropion: a case report

Psychiatry and Clinical Psychopharmacology 2014; 24: Supplement S130-S131
Read: 2183 Published: 18 February 2021

Panic disorder is a relatively prevalent psychiatric condition that often is chronic and rarely resolves without medical intervention. First line medication treatments are the selective serotonin reuptake inhibitors (SSRIs) including escitalopram. However, better- tolerated compounds are often needed, because SSRIs can cause problematic side effects such as sexual side effects. Herein, we report the case of a 33-year-old male with panic disorder treated with bupropion, who had initially responded to escitalopram but developed sexual dysfunction. A 33-year-old male with a 15-year history of panic disorder (without agoraphobia) previously treated with SSRIs antidepressants presented to the outpatient clinic with panic attacks. He had been symptom-free for six months without any medication prior to the admission. During the previous month, he suffered from 4 panic attacks per day each lasting 1 to 2 hours on average and consisting of shortness of breath, chest pain, intermittently unreliable vision, nausea, diarrhea, and a sense of impending doom. He was treated with escitalopram, initially 5 mg/day and gradually increased to 20 mg/day. Although the treatment worked well and resolved all his symptoms in 2 months, he developed sexual dysfunction (decreased libido, erectile impotence). This side effect did not subside despite dose reduction. Escitalopram was stopped gradually and bupropion was started, initially 150 mg/day and increased to 300 mg/day. His sexual dysfunction had resolved within a week of changing his medication. He denied any further panic attacks at his 1- and 4-month visits. Only a few previous studies in the literature investigated the efficacy of bupropion in panic and anxiety disorders with inconsistent findings. For example, Sheehan et al. have found that bupropion was inefficacious in the treatment of panic disorder with phobias. On the other hand, in their open trial, Simon et al. have shown that bupropion SR was effective for the treatment of panic disorder. Moreover, the anxiolytic efficacy of bupropion XL (150 to 300 mg/day) was found to be comparable to that of escitalopram (10 to 20 mg/day) in outpatients diagnosed with generalized anxiety disorder. Our case report shows that bupropion (300 mg daily) was effective not only in reducing or in eliminating panic attacks, but also in reversing SRI-induced sexual dysfunction. Further systematic longitudinal studies are required to test the effectiveness and safety of bupropion in the treatment of anxiety disorders.

EISSN 2475-0581