Bupropion for Treatment-Resistant Depression
| Autor: | Tran K, McGill SC, Horton J |
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| Jazyk: | angličtina |
| Zdroj: | 2021 Apr. |
| Abstrakt: | Major depressive disorder (MDD) is a common and disabling illness and 1 of the most common mood disorders. It affects the entire body and mind, leading to reductions in quality of life and significant costs to the health care sector and society. 1 MDD is associated with a high risk of mortality with a relative risk of 1.81 compared with persons without depression. 2 According to Statistics Canada’s 2012 Canadian Community Health Survey on Mental Health, it is estimated that 5.4% of the Canadian population aged 15 years and older have reported mood disorders in the previous 12 months, including 4.7% for major depression. 1 A recent survey on COVID-19 and mental health during the last 3 months of 2020 found that 1 in 5 Canadians had a positive screening for at least 1 of the 3 mental disorders: MDD, generalized anxiety disorder, and post-traumatic stress disorder. 3 MDD was the most prevalent mental disorder, with 15% Canadians screening positive with moderate or severe symptoms. 3 A variety of antidepressant agents have been used for the treatment of patients with MDD including selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI), tricyclic antidepressant (TCA), monoamine oxidase inhibitor (MAOI), glutamate antagonist, and atypical antidepressants such as bupropion. 4 Despite advances in understanding the efficacy and safety of those pharmacological agents, 10% to 15% of patients do not respond to their first course of antidepressant pharmacotherapy, and 30% to 40% achieve only partial remission. 5 After proper diagnosis and adequate treatment of MDD with antidepressants, individuals who are still nonresponders or partial responders are considered to have treatment-resistant depression (TRD). Although there is no universally accepted definition of TRD, approximately half of clinical trials required a minimum of 2 treatment failures to be considered TRD. 6 The pharmacological options for treating TRD are not well-established and remain a challenge for physicians. 7 Options for treatment of TRD include augmentation and switching of the initial antidepressant. 7 Bupropion is an atypical antidepressant which inhibits the reuptake of noradrenaline and dopamine and has been used for treatment of MDD. 8 It is generally well-tolerated but can cause weight loss and low rates of sexual dysfunction. 8 However, its clinical effectiveness and cost-effectiveness in the treatment of TRD is less well understood. The current report aims to review the clinical effectiveness and cost-effectiveness of bupropion for the treatment of adults with TRD. (Copyright © 2021 Canadian Agency for Drugs and Technologies in Health.) |
| Databáze: | MEDLINE |
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