Bupropion is also structurally unique and works by initiating reuptake inhibition of both norepinephrine and dopamine, the former more than the latter. It also interacts with few other medications and has a favorable side-effect profile due to its minimal anticholinergic and antihistaminic effects. It is being used also to aid in smoking cessation.
Common side effects include some initial restlessness and insomnia that typically resolves within 2 weeks. It is noted for having the lowest incidence of sexual side effects, which are common with other antidepressants, including SSRIs. In fact, when bupropion is added for SSRI-induced sexual dysfunction, sexual functioning improves in many patients. One concern with this drug had been a dose-related increase in the incidence of seizures. However, further study has shown no higher incidence at usual therapeutic dosages compared with other antidepressants. Caution should be taken when using this drug in patients with bulimia or metabolic disturbances predisposing to seizures. Likewise, individual doses greater than 200 mg and daily dosages greater than 400 mg should be avoided. Combination with an MAOI is to be avoided as well. Bupropion may be the least likely of all antidepressants to precipitate a switch into mania.
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