Understanding De Novo Bupropion-Induced Psychosis and Its Management Strategies: A Case Report and Literature Review

Psychotic manifestations of iatrogenic origin are common in clinical practice, and it is essential to rule out organic and iatrogenic causes before attributing symptoms to psychiatric disorders. Bupropion, an atypical antidepressant used for treating depression and aiding smoking cessation, has been linked to rare instances of psychosis, especially in patients with risk factors like substance use, older age, or history of head trauma. This report describes the case of a 52-year-old man with recurrent depression who developed a bupropion-induced psychotic episode following an increase in dose to 300 mg/day. He presented with persecutory delusions, although he had no history of psychosis or contributing factors. With the withdrawal of bupropion and the addition of risperidone, the patient's psychotic symptoms resolved within a week. The report takes a look at the recent literature since 2010 and the role of bupropion's dopaminergic effects, its ability to lead to psychosis, and the risk factors associated with this problem. Although there are no guidelines, in some cases antipsychotics such as risperidone have been helpful in reversing bupropion-induced psychosis after discontinuation of the drug.