Bupropion is widely used for treating
bipolar disorder (BD), and especially those with depressive mood, based on its good treatment effect, safety profile, and lower risk of phase shifting. However, increasing evidence indicates that the safety of
bupropion in BD patients may not be as good as previously thought. The aim of this study was to summarize data on the treatment effect and safety profile of
bupropion in the treatment of BD via a meta-analysis. Electronic search through PubMed and ClinicalTrials.gov was performed. The inclusion criteria were: (i) studies comparing changes in disease severity before and after
bupropion treatment or articles comparing the treatment effect of
bupropion in BD patients with those receiving other standard treatments; (ii) articles on clinical trials in humans. The exclusion criteria were (i) case reports/series, and (ii) nonclinical trials. All effect sizes from 10 clinical trials were pooled using a random effects model. We examined the possible confounding variables using meta-regression and subgroup analysis.
Bupropion significantly improved the severity of disease in BD patients (P < 0.001), and the treatment effect was similar to other
antidepressants/standard treatments (P = 0.220). There were no significant differences in the dropout rate (P = 0.285) and rate of phase shifting (P = 0.952) between BD patients who received
bupropion and those who received other
antidepressants. We could not perform a detailed meta-analysis of every category of
antidepressant, nor could we rule out the possible confounding effect of concurrent psychotropics or include all
drug side effects. Furthermore, the number of studies recruited in the meta-analysis was relatively small. Our findings reconfirm the benefits of
bupropion for the treatment of
bipolar depression, which are similar to those of other
antidepressants. However, the rate of phase shifting with
bupropion usage was not as low compared to other
antidepressants as previously thought, which should serve to remind clinicians of the risk of phase shifting when prescribing
bupropion to BD patients regardless of the suggestions of current clinical practice guidelines.