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PROBLEM. There are few studies of sustained-release bupropion in adolescents with major depression.
METHODS. Twenty-one adolescents with DSM-IV major depression were recruited through advertisement and self-referral; 11 began study medication and were rated weekly with an expanded Hamilton Depression Rating Scale (SIGH-SAD), as well as Clinical Global Impression-Improvement (CGI-I).
RESULTS. Of 11 subjects enrolled, 8 completed an 8-week trial of bupropion SR. Mean baseline SIGH-SAD scores of 31.3 decreased significantly by 74% to mean endpoint score of 8.2. Improvement on CGI-I that agreed closely between raters and patients was found in 8 of 11 subjects (72.3%). The mean daily dose of bupropion SR was 362 mg + or - 52 mg and was well tolerated; insomnia and weight loss were experienced by 55%; other adverse effects of dry mouth, headache, agitation, light-headedness, diarrhea, or rash were noted in a minority of subjects.
CONCLUSIONS. In this preliminary, small open study, depressed adolescents showed a marked response to bupropion SR.
Search terms: Adolescents, bupropion SR, major depressive disorder
Major depression affects about 8% of the adolescent population annually, with prevalence across ages 11 to 19 as high as 20% (Birmaher, Ryan, Williamson, Brent, & Kaufman, 1996). Consequences of untreated depression in adolescence include recurrent episodes or sustained illness in 70% of cases, worsening school performance and school dropout or other disability, co-morbid substance and alcohol use disorders, and suicide (Birmaher et al.). Despite advances in the treatment of major depressive disorder, there is little evidence that juvenile depression responds consistently to standard antidepressants better than to a placebo, even with presumably adequate doses (Hazell, O'Connell, Heathcote, Robertson, & Henry, 1995).
Until recently, most studies of the treatment of depression in children and adolescents have evaluated the short-term efficacy of tricyclic antidepressants (TCAs). Their controlled trials have consistently failed to demonstrate efficacy, however, even though they are effective in other pediatric conditions, notably attention deficit hyperactivity disorder (ADHD) and enuresis (Biederman, Baldessarini, Wright, Knee, & Harmatz, 1989; Donnelly et al., 1986). A meta-analysis of the 12 available placebo-controlled trials of TCAs in depressed patients 6-18 years of age concluded that the average difference between active treatment and placebo is not clinically significant (Hazell et al, 1995).
This poor outcome has encouraged consideration of newer antidepressants including serotonin...