Sir: Dr. Johnson's interest in our reported case of bupropion-associated withdrawal symptoms is greatly appreciated. As was pointed out in the case report, the exact mechanism responsible for the somatic and psychological symptoms is not known. It is believed that many neurotransmitters may be involved, including the noradrenergic and dopaminergic sites, which appear to be where bupropion exerts its effects.1
There is no doubt that Glaxo Wellcome Inc. has been extremely vigilant in monitoring thousands of patients for adverse effects associated with bupropion. However, when a patient is reporting a variety of symptoms, an evaluation is warranted. In our case, a physical examination with laboratory tests was performed, the findings of which suggested no obvious cause of symptoms other than an abrupt cessation of bupropion, the patient's only prescription medication. He was empirically treated for a withdrawal syndrome and improved rapidly.
Physicians must remain aware that withdrawal syndromes do exist and educate their patients fully about the possibility. One such strategy to decrease withdrawal symptoms is to taper the agent being discontinued. This will enhance compliance, which ultimately benefits the patient.
The opinions and assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the U.S. Government, the Department of Defense, the U.S. Army, or the Army Medical Command.
Reference
- Golden RN, Dawkins K, Nicholas L, and et al. Trazodone, nefazodone, bupropion, and mirtazapine. In: Schatzberg AF, Nemeroff CB, eds. The American Psychiatric Press Textbook of Psychopharmacology. 2nd ed. Washington, DC: American Psychiatric Press. 1998 258–259. [Google Scholar]