Bupropion Contraindication in Eating Disorders

Mechanism and Risk Factors

• Electrolyte disturbances from purging behaviors lower the seizure threshold, and bupropion further reduces this threshold, creating a dangerous synergistic effect in patients with eating disorders 1, 2
• Malnutrition and metabolic abnormalities common in eating disorders independently increase seizure susceptibility, which is then compounded by bupropion's inherent seizure-lowering properties 1

Clinical Implications and Recommendations

• The American Gastroenterological Association recommends that patients with bulimia or anorexia nervosa should not be treated with bupropion due to increased seizure risk 1
• Screening is mandatory before prescribing bupropion, including obtaining a detailed eating disorder history and asking about purging behaviors, dietary restriction patterns, and compensatory exercise 1, 3
• The American Journal of Psychiatry suggests documenting weight control behaviors and any history of significant weight fluctuations before prescribing bupropion 3

Alternative Treatment Options

• SSRIs, particularly fluoxetine 60 mg daily, are recommended for bulimia nervosa and are safe in this population 3