Bupropion SR in the naturalistic treatment of elderly patients with major depression

Introduction Bupropion immediate release (IR) and bupropion sustained relea se (SR) are frequently used to treat geriatric depression, as they have few cardiovascular, gastrointestinal and sexual adverse effects. We sought to examine the efficacy and dosing patterns of bupropion in a naturalistic coh ort of elderly subjects with major depression (MD). Methods 31 elderly (> 60 years) patients with unipolar MD (DSM-IV) who were enrolled in Duke's Mental Health Clinical Research Center for the Study of Depression in Later Life were prescribed bupropion SR or IR, alone or in c ombination with other antidepressant agents, for 12 weeks. Montgomery-Asber g depression rating scale (MADRS) scores and clinical global impression (CG I) severity scores were used to define response. Results 74% (23/31) of the sample were responders (MADRS < 15) and 53% (16/ 30) achieved a partial (CGI=2) or complete (CGI=1) remission of MD at week 12. Among patients treated with bupropion SR monotherapy, the mean (range) maximal daily dose achieved was 240 mg (150-400 mg). Among those treated wi th bupropion IR, the mean (range) maximum daily dose achieved was 258 mg (1 50-450 mg). In subjects on monotherapy, 67% (10/15) of MD subjects were res ponders (MADRS < 15) and 50% (7/14) achieved full or partial remission. Res ponse rates did not differ statistically among those with high and low medi cal comorbidity. Conclusions In this naturalistic 12-week study, geriatric MD patients with high and low medical comorbidity responded well to bupropion and bupropion SR. In elderly patients, four to eight week acute treatment periods may be insufficient. Our findings suggest that nearly 50% of elderly depressed sub jects at a tertiary center may need combination therapy over the course of their illness. Controlled randomized studies to establish the long-term eff icacy and optimal dose of the newer antidepressants in geriatric depression are urgently needed. Copyright (C) 2001 John Wiley & Sons, Ltd.