Efficacy of bupropion in tricyclic-resistant or intolerant patients

Available evidence is reviewed concerning the antidepressant efficacy of bupropion in patients who had failed to respond to or been unable to tolerate tricyclic antidepressants (TCAs) during prior episodes of depression. Inpatients classified as TCA nonresponders were randomly assigned to double-blind treatment with bupropion (N = 19) or placebo (N = 11). Patients receiving bupropion showed an excellent antidepressant response, whereas those receiving placebo showed minimal improvement (p less than .001). Inpatients who were classified as TCA responders responded well to double-blind treatment with bupropion, but also had a substantial, although significantly smaller (p less than .05), response to placebo. Outpatients (N = 33) with a history of nonresponse or nonresponse plus intolerance to TCAs showed marked improvement during open treatment with bupropion. The results from both double-blind and open treatment with bupropion demonstrate that this drug offers a promising alternative therapy for patients with a history of poor response to TCAs.