Bupropion and Buspirone Clinical Use

Primary Indications and Mechanisms

Bupropion is approved for treatment of major depressive disorder and is also FDA-approved as a smoking cessation aid, functioning as a norepinephrine and dopamine reuptake inhibitor and acting as an inhibitor of nicotinic acetylcholinergic receptors, according to the National Comprehensive Cancer Network 1, 2
Bupropion was first approved to treat depression, but its efficacy as a smoking cessation aid became apparent later, with the National Comprehensive Cancer Network citing its use in this context 1, 2

Bupropion is effective for major depression with efficacy comparable to standard antidepressants, and is particularly beneficial for smoking cessation with superior abstinence rates compared to placebo, as noted by the National Comprehensive Cancer Network 1, 2
Bupropion may be especially beneficial as a smoking cessation agent for persons with depression, according to the National Comprehensive Cancer Network 1, 2
In major depression, bupropion can be used as an augmentation strategy when initial treatment with SSRIs fails, as recommended by the American College of Physicians, with evidence from the Annals of Internal Medicine 3, 4, 5

Bupropion lowers the seizure threshold (0.1% seizure risk) and should be avoided in patients with seizure risk factors, with common side effects including disturbed sleep, dry mouth, headaches, and nausea, as reported by the National Comprehensive Cancer Network 1, 2
Bupropion has been associated with neuropsychiatric effects, though recent studies show these are rare, according to the National Comprehensive Cancer Network 1, 2

When augmenting citalopram treatment for depression, bupropion decreases depression severity more than buspirone, with discontinuation due to adverse events lower with bupropion than with buspirone when used as augmentation therapy, as found in studies published in the Annals of Internal Medicine 3, 4, 5
For smoking cessation, bupropion has established efficacy while buspirone has inconsistent results, according to the National Comprehensive Cancer Network 1, 2
Neither medication causes significant cardiovascular effects, making them safer options for patients with cardiac concerns, as noted by the National Comprehensive Cancer Network 1, 2

Bupropion should be avoided in patients with brain metastases, history of seizures, or elevated seizure risk, as recommended by the National Comprehensive Cancer Network 1, 2, 6