Discontinuation of Bupropion Due to Suicidality

Introduction to Discontinuation Guidelines

The FDA requires monitoring for development or worsening of serious neuropsychiatric issues, including those without a previous history, and discontinuation if these signs occur, particularly in patients with emergent suicidality or symptoms that might be precursors to worsening depression or suicidality 1

Consider switching to an SSRI rather than another activating antidepressant, as SSRIs are the preferred psychopharmacological treatment for childhood and adolescent depression, with caution that suicidal youth on SSRIs must be watched for any increase in agitation or suicidality, and this principle extends to adults with treatment-emergent suicidality 2
Preferred agents for older patients with depression include citalopram, escitalopram, sertraline, mirtazapine, venlafaxine, but given the patient's adverse response to bupropion, select from the other options 3

Begin monitoring within 1-2 weeks of initiation of any new antidepressant, as the risk for suicide attempts is greatest during the first 1-2 months of treatment, and any patient who develops suicidal ideation with one antidepressant warrants closer follow-up during the next-step treatment 4