Sexual function during bupropion or paroxetine treatment of major depressive disorder

Efficacy of bupropion and the selective serotonin reuptake inhibitors in the treatment of anxiety symptoms in major depressive disorder: a meta-analysis of individual patient data from 10 double-blind, randomized clinical trials

The goal of this work was to compare the efficacy of the norepinephrine-dopamine reuptake inhibitor bupropion with the selective serotonin reuptake inhibitors (SSRIs) in the treatment of anxiety symptoms in major depressive disorder (MDD). Ten double-blind, randomized studies, involving a total of 2890 bupropion-, SSRI- or placebo- treated patients were pooled. Anxiety symptoms of depression were defined using the Hamilton depression rating scale (HDRS) Anxiety-Somatization factor (HDRS-AS) score, as well as the Hamilton anxiety scale (HAM-A) score. Both bupropion and the SSRIs led to a comparable degree of improvement in anxiety symptoms, defined using the HDRS-AS score (-3.8+/-2.8 vs. -3.9+/-2.8, p=0.130) or HAM-A score (-8.8+/-7.2 vs. -9.1+/-7.0, p=0.177). There was no consistent difference in the time to anxiolysis between the two treatment groups. In addition, there was no difference in the proportion of bupropion- and SSRI- remitters who continued to experience residual anxiety, defined as a HDRS-AS score >0 at endpoint (69.2% vs. 74.7%, p=0.081) or a HAM-A score >7 at endpoint (9.5% vs. 8.4%, p=0.284). Finally, there was no statistically significant difference in the severity of residual anxiety symptoms between bupropion- or SSRI- treated patients with remitted depression, defined using the HDRS-AS (1.15+/-1.14 vs. 1.25+/-1.09, p=0.569), or HAM-A scores at endpoint (3.30+/-2.89 vs. 3.31+/-2.89, p=0.552). Contrary to clinician impression, there does not appear to be any difference in the anxiolytic efficacy of bupropion and the SSRIs when used to treat MDD.

Agomelatine: an antidepressant with a novel mechanism of action

Despite advances in understanding potential disease mechanisms in depression and in therapeutic approaches to the management of major depressive disorder, the disease continues to carry an enormous personal, social and economic burden. Agomelatine is a melatonergic antidepressant with melatonin (MT1 and MT2) agonistic and serotonin (5-HT2C) antagonistic properties. It represents a promising approach to treating depression through a unique synergistic mechanism. There is also preliminary evidence to suggest that agomelatine has anxiolytic properties in depressed patients. Clinical data confirm that agomelatine, in a dose range of 25–50 mg daily, is an effective antidepressant with a very favorable side-effect profile. In particular, sleep restorative effects in the absence of daytime sedation and a favorable effect on sexual function suggest that agomelatine will offer a high efficacy–tolerability index for patients with major depressive disorder. Such results have been anticipated based on preclinical studies using various animal models of both depression and anxiety.

Resolution of sleepiness and fatigue in major depressive disorder: A comparison of bupropion and the selective serotonin reuptake inhibitors

BACKGROUND

The purpose of this study was to examine whether the treatment of major depressive disorder (MDD) with the norepinephrine-dopamine reuptake inhibitor (NDRI) bupropion results in a greater resolution of sleepiness and fatigue than with the selective serotonin reuptake inhibitors (SSRIs).

METHODS

Six double-blind, randomized clinical trials comparing bupropion (n = 662) with an SSRI (n = 655) for the treatment of MDD were pooled. Hypersomnia scores were defined as the sum of scores of the Hamilton Depression Rating Scale (HDRS) items #22, 23, and 24. Fatigue scores were defined as the score of HDRS item #13.

RESULTS

There was a greater improvement in hypersomnia scores among bupropion-treated than SSRI-treated (p < .0001) or placebo-treated patients (p = .0008). There was also a greater improvement in fatigue scores among bupropion-treated (p < .0001) and SSRI-treated (p = .0005) than placebo-treated patients as well as a greater improvement in fatigue scores among bupropion-treated than SSRI-treated patients (p = .0078). Fewer bupropion-remitters than SSRI-remitters experienced residual hypersomnia (20.5% vs. 32.1%; p = .0014) or residual fatigue (19.5% vs. 30.2%; p = .0020).

CONCLUSION

Treatment of MDD with the NDRI bupropion resulted in a greater resolution of sleepiness and fatigue than SSRIs treatment. Although preliminary, these results warrant prospectively designed studies examining potential differences between bupropion and the SSRIs on these specific depressive symptoms.

Strategies for managing antidepressant-induced sexual dysfunction: a review

Sexual dysfunction is a common side effect of most antidepressants. Lower rates are reported with some newer agents such as reboxetine and bupropion. The evidence base for its management is limited but growing, with most approaches only tested in a small number of trials. Available strategies include watchful waiting, the use of short drug holidays, and a change of antidepressant. Many specific antidotes have been trialed but with lack of convincing benefit in most cases. However, where antidepressants cause erectile dysfunction, the use of sildenafil has the largest and most consistent evidence base.