34th AM (2023) - Poster Session-Bupropion Treatment for Stimulant Withdrawal in a Patient with Substance Use Disorder and Unspecified Bipolar Disorder

Bupropion Treatment for Stimulant Withdrawal in a Patient with Substance Use Disorder and Unspecified Bipolar Disorder

Pdf Summary

This case presentation discusses the use of bupropion, an antidepressant, for the treatment of stimulant withdrawal in a patient with substance use disorder and bipolar disorder. Limited data and guidelines exist, but some clinical trials have shown the effectiveness of bupropion in reducing cravings for cocaine. The theory behind its use is that bupropion has structural similarities to amphetamines, allowing for cross-reactivity and producing a cocaine-like effect. Clinical trials have shown that bupropion can decrease cocaine usage, cravings, and positive urine samples for cocaine. <br />Stimulant use disorder commonly presents comorbidly with other conditions, and while benzodiazepines are often used for acute intoxication, no single medication has consistently shown positive results in clinical trials. Bupropion, approved by the FDA for major depressive disorder, seasonal affective disorder, and smoking cessation, has been used off-label for other conditions such as ADHD, obesity, and depression associated with bipolar disorder. Its mechanism of action is primarily through the inhibition of neuronal uptake of norepinephrine and dopamine. Recent studies have documented its use in treating withdrawal effects of stimulants like amphetamine and cocaine. Acute stimulant withdrawal can cause symptoms such as severe dysphoria, irritability, anxiety, and paranoia.<br />The case presented involves a young female with a history of substance use disorder who was brought to the emergency department by the police due to bizarre behavior. The patient was agitated and uncooperative, and a urine test confirmed recent cocaine use. The patient exhibited severe mood swings, paranoia, anger, and impulsive behaviors during admission. Olanzapine was initially prescribed, but bupropion was later started due to worsening cravings. After 10 days of bupropion use, the patient reported a dramatic decrease in cravings compared to previous admissions.

Keywords

bupropion

antidepressant

stimulant withdrawal

substance use disorder

bipolar disorder

cocaine cravings

clinical trials

benzodiazepines

comorbidity

off-label use

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