The Primary Care Companion for CNS Disorders

CME Institute

Home | About Us | Mission Statement | All CME Activities | MyCME | CME Facebook | CME Twitter

JCP

Home | About JCP | Subscribe | Archive | Information for Authors | Information for Reviewers | Information for Advertisers | CNS Job Market | Customer Service | JCP Facebook | JCP Twitter

PCC

Home | About PCC | Register | Archive | Information for Authors | Information for Reviewers | PCC Facebook | PCC Twitter

Help

FAQ | About Psychiatrist.com | Terms of use | Privacy policy

magnifying glass for search

  • magnifying glass for search
  • Advanced Search

Login

Login  
Login | Login Help | Register | Subscribe
Register | Elerts

Quick Links

Font: A | A | A

Top

Purchase PDF

Vol 19, No 6
Table of Contents

Facebook ShareShare

twitter shareTweet This

envelope iconEmail a link

Related ►

Related Articles

[X]

<p class="frontmatter-fieldnotes disclaimernew" style="margin-bottom:15px;">This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s <a href="/pages/termsofuse.aspx" target="_blank">Terms & Conditions</a>.</p> <div id="_idContainer000">
  <p class="ltrs-br-ltr-br-title"><span class="bold"><a id="_idTextAnchor000"></a>Bupropion-Induced Dyskinesia in a Young Adult Patient With Bipolar Disorder</span></p>
  <p class="ltrs-br-ltr-br-body-text"><span class="semibold">To the Editor:</span> Bupropion is an antidepressant that has been reported to induce various extrapyramidal tract symptoms in patients with mood disorders.<span class="htm-cite"><a href="#ref1">1–6</a></span> Previous reports<span class="htm-cite"><a href="#ref1">1–6</a></span> typically involved older patients or those with concurrent physical illness. In contrast, the association between bupropion and dyskinesia has yet to be reported in younger patients with no major physical comorbidities. Here, we present the case of a young adult who developed dose-dependent dyskinesia while taking bupropion for treatment of bipolar depression.</p>
  <p class="ltrs-br-ltr-br-body-text">&nbsp;</p>
  <p class="ltrs-br-ltr-br-body-text"><span class="semibold-ital">Case report.</span> Ms A is a 30-year-old woman who received a diagnosis of bipolar II disorder at the age of 23 years. She reported no past history of major medical disease or substance abuse behavior. She had no family history of neurologic diseases.</p>
  <p class="ltrs-br-ltr-br-body-text">Ms A had received regular treatment in the clinic of a university hospital since the age of 27 years. She experienced a depressive episode at the age of 29 years, which was not fully remitted even after several psychotropic regimens, including the combined therapy of lithium 600 mg/d, escitalopram 20 mg/d, and aripiprazole 15 mg/d. Therefore, bupropion 150 mg/d was started in June 2016 to replace escitalopram for the treatment of bipolar depression. Meanwhile, aripiprazole was discontinued. After 2 weeks, the bupropion dosage was increased to 300 mg/d. Because the depressive symptoms were gradually alleviated, treatment with bupropion 300 mg/d and lithium 600 mg/d was continued. After 3 months of treatment with bupropion 300 mg/d, Ms A began to develop involuntary movements, including intermittent chewing, lip pouting, tongue writhing, eye blinking, neck twisting, and pelvic gyrations. These dyskinetic movements increased with anxiety, decreased with relaxation, and disappeared during sleep. Her total score on the Abnormal Involuntary Movement Scale<span class="htm-cite"><a href="#ref7">7</a></span> was 26. Ms A was referred to a neurologist’s clinic in the same hospital for management of the dyskinesia. Results of brain MRI and blood tests, including a biochemistry screen for Wilson disease, were unremarkable. Therefore, bupropion-induced dyskinesia was clinically suspected. After the bupropion dosage was reduced from 300 mg/d to 150 mg/d for 2 months, Ms A’s AIMS score decreased to 5.</p>
  <p class="ltrs-br-ltr-br-body-text">&nbsp;</p>
  <p class="ltrs-br-ltr-br-body-text">To the best of our knowledge, this report is the first to demonstrate the temporal relationship between dyskinesia and bupropion use in a young adult with no concurrent physical illness. Currently, the mechanisms for the association between dyskinesia and bupropion use are not fully elucidated. Studies have suggested that bupropion is an antidepressant that acts as a dopamine reuptake inhibitor.<span class="htm-cite"><a href="#ref8">8</a></span> Elevated synaptic dopamine levels in the basal ganglia may lead to dyskinesia that resembles prodopaminergic agent–induced dyskinesia.<span class="htm-cite"><a href="#ref9">9</a></span> However, tools such as positron emission tomography were not used in this case to confirm our hypothesis. In addition, our observations of the association between dyskinesia and bupropion use in this case cannot be reexamined because of ethical considerations. Consequently, additional case studies applying imaging tools for exploring the changes of occupancy in dopamine receptor or transporter are warranted to validate our observations.</p>
  <p class="ltrs-br-ltr-br-body-text">In this case, the total score on the Naranjo Adverse Drug Reaction Probability Scale<span class="htm-cite"><a href="#ref10">10</a></span> was 3 (ie, the possible category). Therefore, diagnoses other than bupropion-induced dyskinesia should be differentiated. Meige syndrome is a kind of cranial dystonia that can be associated with different types of involuntary movements including facial dyskinesia. Although the pathogenesis of most cases is unknown, Meige syndrome was found to be related to the use of antidepressants in some patients.<span class="htm-cite"><a href="#ref11">11</a></span> Considering that approximately half of patients with Meige syndrome have progressive symptoms spreading to cervical and limb muscles within 5 years of illness onset,<span class="htm-cite"><a href="#ref11">11</a></span> we should therefore carefully follow up the clinical course of the present case, particularly after the reduction of bupropion dosage.</p>
  <p class="ltrs-br-ltr-br-body-text">Despite its limitations, this case is informative because the dyskinetic movements emerged after the bupropion dosage was increased from 150 to 300 mg/d and were subsequently alleviated after the bupropion dosage was reduced to 150 mg/d. These observations suggest that bupropion-induced dyskinesia is very likely to be dose dependent. Furthermore, an early reduction of bupropion dosage may possibly reverse the dyskinesia. Given that early diagnosis and intervention are important, this case reminds clinicians to be aware of this adverse effect among patients, even those with younger age and generally good physical health.</p>
  <p class="references_references-heading"><span class="smallcaps">References</span></p>
  <p class="references-references-text-1-9"><a name="ref1"></a><span class="htm-ref"> 1.&#9;</span>Szuba MP, Leuchter AF. Falling backward in two elderly patients taking bupropion. <span class="italic">J&#160;Clin Psychiatry</span>. 1992;53(5):157–159. <a href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=1592841&amp;dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a></p>
  <p class="references-references-text-1-9"><a name="ref2"></a><span class="htm-ref"> 2.&#9;</span>Strouse TB, Salehmoghaddam S, Spar JE. Acute delirium and parkinsonism in a bupropion-treated liver transplant recipient. <span class="italic">J&#160;Clin Psychiatry</span>. 1993;54(12):489–490. <a href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=8276742&amp;dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a></p>
  <p class="references-references-text-1-9"><a name="ref3"></a><span class="htm-ref"> 3.&#9;</span>Gardos G. Reversible dyskinesia during bupropion therapy. <span class="italic">J&#160;Clin Psychiatry</span>. 1997;58(5):218. <a href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=9184616&amp;dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.4088/JCP.v58n0507a"><span class="pubmed-crossref">CrossRef</span></a></p>
  <p class="references-references-text-1-9"><a name="ref4"></a><span class="htm-ref"> 4.&#9;</span>de Graaf L, Admiraal P, van Puijenbroek EP. Ballism associated with bupropion use. <span class="italic">Ann Pharmacother</span>. 2003;37(2):302–303. <a href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=12549967&amp;dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1177/106002800303700227"><span class="pubmed-crossref">CrossRef</span></a></p>
  <p class="references-references-text-1-9"><a name="ref5"></a><span class="htm-ref"> 5.&#9;</span>Cheng WC, Liu CM, Hsieh MH, et al. Bupropion-related parkinsonism and dystonia. <span class="italic">J&#160;Clin Psychopharmacol</span>. 2009;29(6):616–618. <a href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=19910737&amp;dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1097/JCP.0b013e3181c07a3f"><span class="pubmed-crossref">CrossRef</span></a></p>
  <p class="references-references-text-1-9"><a name="ref6"></a><span class="htm-ref"> 6.&#9;</span>Kayhan F, Uguz F, Kayhan A, et al. Bupropion XL-induced motor and vocal tics. <span class="italic">Clin Neuropharmacol</span>. 2014;37(6):192–193. <a href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=25384079&amp;dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1097/WNF.0000000000000056"><span class="pubmed-crossref">CrossRef</span></a></p>
  <p class="references-references-text-1-9"><span class="htm-ref"> </span>7.&#9;<span class="citation">Guy E. </span><span class="italic">Abnormal Involuntary Movement Scale. </span><span class="citation">National Institute of Mental Health, Assessment Manual for Psychopharmacology. Rockville, MD: US Department of Health and Human Services; 1976.</span> </p>
  <p class="references-references-text-1-9"><a name="ref8"></a><span class="htm-ref"> 8.&#9;</span>Ascher JA, Cole JO, Colin JN, et al. Bupropion: a review of its mechanism of antidepressant activity. <span class="italic">J&#160;Clin Psychiatry</span>. 1995;56(9):395–401. <a href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=7665537&amp;dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a></p>
  <p class="references-references-text-1-9"><a name="ref9"></a><span class="htm-ref"> 9.&#9;</span>Damier P. Drug-induced dyskinesias. <span class="italic">Curr Opin Neurol</span>. 2009;22(4):394–399. <a href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=19491677&amp;dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1097/WCO.0b013e32832d9dc4"><span class="pubmed-crossref">CrossRef</span></a></p>
  <p class="references-references-text-10-99"><a name="ref10"></a>10.&#9;Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. <span class="italic">Clin Pharmacol Ther</span>. 1981;30(2):239–245. <a href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=7249508&amp;dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1038/clpt.1981.154"><span class="pubmed-crossref">CrossRef</span></a></p>
  <p class="references-references-text-10-99"><a name="ref11"></a>11.&#9;Pandey S, Sharma S. Meige’s syndrome: history, epidemiology, clinical features, pathogenesis and treatment. <span class="italic">J&#160;Neurol Sci</span>. 2017;372:162–170. <a href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=28017205&amp;dopt=Abstract"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1016/j.jns.2016.11.053"><span class="pubmed-crossref">CrossRef</span></a></p>
  <p class="ltrs-br-ltr-br-author"><span class="bold">Pao-Huan Chen, MD</span><span class="superscript">a,b</span></p>
  <p class="ltrs-br-ltr-br-author"><span class="bold">Kuo-Hsuan Chung, MD</span><span class="superscript">a,b</span></p>
  <p class="ltrs-br-ltr-br-author"><a href="mailto:ch2006ung@tmu.edu.tw">ch2006ung@tmu.edu.tw</a></p>
  <p class="end-matter"><span class="superscript">a</span>Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan</p>
  <p class="end-matter"><span class="superscript">b</span>Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan</p>
  <p class="end-matter"><span class="bold-italic">Potential conflicts of interest:</span> None.</p>
  <p class="end-matter"><span class="bold-italic">Funding/support:</span> None.</p>
  <p class="end-matter"><span class="bold-italic">Additional information:</span> Information has been de-identified to protect patient anonymity.</p>
  <p class="end-matter"><span class="bold-italic">Published online:</span> November 16, 2017.</p>
  <p class="end-matter"><span class="italic">Prim Care Companion CNS Disord 2017;19(6):17l02128</span></p>
  <p class="doi-line"><span class="italic">https://doi.org/</span><span class="doi">10.4088/PCC.17l02128</span></p>
  <p class="end-matter"><span class="italic">© Copyright 2017 Physicians Postgraduate Press, Inc.</span></p>
</div>
Manage Subscriptions
/_layouts/images/ReportServer/Manage_Subscription.gif
/PCC/article/_layouts/ReportServer/ManageSubscriptions.aspx?list={ListId}&ID={ItemId}
0x80
0x0
FileType
rdl
350
Manage Data Sources
/PCC/article/_layouts/ReportServer/DataSourceList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
rdl
351
Manage Shared Datasets
/PCC/article/_layouts/ReportServer/DatasetList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
rdl
352
Manage Parameters
/PCC/article/_layouts/ReportServer/ParameterList.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rdl
353
Manage Processing Options
/PCC/article/_layouts/ReportServer/ReportExecution.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rdl
354
Manage Cache Refresh Plans
/PCC/article/_layouts/ReportServer/CacheRefreshPlanList.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rdl
355
View Report History
/PCC/article/_layouts/ReportServer/ReportHistory.aspx?list={ListId}&ID={ItemId}
0x0
0x40
FileType
rdl
356
View Dependent Items
/PCC/article/_layouts/ReportServer/DependentItems.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsds
350
Edit Data Source Definition
/PCC/article/_layouts/ReportServer/SharedDataSource.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsds
351
View Dependent Items
/PCC/article/_layouts/ReportServer/DependentItems.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
smdl
350
Manage Clickthrough Reports
/PCC/article/_layouts/ReportServer/ModelClickThrough.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
smdl
352
Manage Model Item Security
/PCC/article/_layouts/ReportServer/ModelItemSecurity.aspx?list={ListId}&ID={ItemId}
0x0
0x2000000
FileType
smdl
353
Regenerate Model
/PCC/article/_layouts/ReportServer/GenerateModel.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
smdl
354
Manage Data Sources
/PCC/article/_layouts/ReportServer/DataSourceList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
smdl
351
Load in Report Builder
/PCC/article/_layouts/ReportServer/RSAction.aspx?RSAction=ReportBuilderModelContext&list={ListId}&ID={ItemId}
0x0
0x2
FileType
smdl
250
Edit in Report Builder
/_layouts/images/ReportServer/EditReport.gif
/PCC/article/_layouts/ReportServer/RSAction.aspx?RSAction=ReportBuilderReportContext&list={ListId}&ID={ItemId}
0x0
0x4
FileType
rdl
250
Edit in Report Builder
/PCC/article/_layouts/ReportServer/RSAction.aspx?RSAction=ReportBuilderDatasetContext&list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsd
250
Manage Caching Options
/PCC/article/_layouts/ReportServer/DatasetCachingOptions.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsd
350
Manage Cache Refresh Plans
/PCC/article/_layouts/ReportServer/CacheRefreshPlanList.aspx?list={ListId}&ID={ItemId}&IsDataset=true
0x0
0x4
FileType
rsd
351
Manage Data Sources
/PCC/article/_layouts/ReportServer/DataSourceList.aspx?list={ListId}&ID={ItemId}
0x0
0x20
FileType
rsd
352
View Dependent Items
/PCC/article/_layouts/ReportServer/DependentItems.aspx?list={ListId}&ID={ItemId}
0x0
0x4
FileType
rsd
353
Compliance Details
javascript:commonShowModalDialog('{SiteUrl}/_layouts/itemexpiration.aspx?ID={ItemId}&List={ListId}', 'center:1;dialogHeight:500px;dialogWidth:500px;resizable:yes;status:no;location:no;menubar:no;help:no', function GotoPageAfterClose(pageid){if(pageid == 'hold') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+'/_layouts/hold.aspx?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'audit') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+'/_layouts/Reporting.aspx?Category=Auditing&backtype=item&ID={ItemId}&List={ListId}'); return false;} if(pageid == 'config') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+'/_layouts/expirationconfig.aspx?ID={ItemId}&List={ListId}'); return false;}}, null); return false;
0x0
0x1
ContentType
0x01
898
Document Set Version History
javascript:SP.UI.ModalDialog.ShowPopupDialog('{SiteUrl}/_layouts/DocSetVersions.aspx?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
330
Send To other location
javascript:GoToPage('{SiteUrl}/_layouts/docsetsend.aspx?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
350

Information Links

Terms of Use | Privacy Policy | Information for Authors (JCP) | Information for Authors (PCC) | Reprints and Permissions | CNS Job Market | Information for Advertisers | Media Relations | PPP COVID-19 Statement

Help

Contact us | Unsubscribe from Elerts | Customer Service | FAQ | About JCP | About PCC | About Psychiatrist.com

Our Family of Sites

Psychiatrist.com | The Journal of Clinical Psychiatry | The Primary Care Companion | The CME Institute | Strong Veterans
Anonymous