Bupropion for Major Depressive Disorder or Persistent Depressive Disorder (Dysthymia)

Direct and indirect evidence from 6 systematic reviews did not demonstrate a difference in treatment response or remission rates, or functional outcomes, with bupropion as compared to other antidepressants in adults with major depressive disorder. Direct and indirect evidence from 5 systematic reviews did not demonstrate a difference in overall adverse events, overall withdrawals, or withdrawals due to adverse events apart from a possible decreased risk of withdrawal due to adverse events with vortioxetine in a single indirect comparison. Direct and indirect evidence from 2 systematic reviews supports that the risk of sexual dysfunction may be lower with bupropion than other antidepressants (escitalopram, paroxetine, sertraline, and fluoxetine), while 1 systematic review showed no significant difference in sexual function scores between bupropion and venlafaxine. There is limited evidence supporting the cost-effectiveness of bupropion to augment citalopram, and dominance of vortioxetine compared to bupropion, for major depressive disorder with inadequate response to initial therapy. There is a lack evidence surrounding the comparative clinical or cost-effectiveness of bupropion in dysthymia.