Open AccessPossible manic switch induced by combination of bupropion and electroconvulsive therapy in recurrent unipolar depression: a case series
Author(s) -
Sahoo Saddichha,
Ashish Soy,
Pandey Vibha
Publication year - 2009
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr.06.2008.0107
Subject(s) - bupropion , electroconvulsive therapy , depression (economics) , medicine , psychiatry , major depressive disorder , bipolar disorder , pharmacotherapy , schizophrenia (object oriented programming) , lithium (medication) , smoking cessation , mood , pathology , economics , macroeconomics
Although there is sufficient evidence of manic switch induced by bupropion or electroconvulsive therapy (ECT) in bipolar depression, the evidence is not robust for unipolar recurrent depression. We present two patients with unipolar recurrent depression, with no family history of bipolarity or relevant personal medical history, who switched states while on a possible combination of bupropion and ECT. We believe that a hypersensitive state caused by ECT may have been aggravated by the dopamine synergistic action of bupropion, causing the switch. As current guidelines (American Psychiatric Association versus the National Institute for Health and Clinical Excellence) give contradictory advice regarding the treatment of patients with severe depression especially about combining pharmacotherapy and ECT, such patients need to be carefully evaluated before being treated with ECT.