Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
Possible manic switch induced by combination of bupropion and electroconvulsive therapy in recurrent unipolar depression: a case series
1 Department of Clinical Research, Emergency Management and Research Institute, Hyderabad-500014, India
2 RINPAS, Psychiatry, Kanke Road, Kanke, Ranchi, 834006, India
3 Central Institute of Psychiatry, Kanke Road, Kanke, Ranchi, 834006, India
Correspondence to:
saddichha{at}gmail.com
Although there is sufficient evidence of manic switch induced by bupropion or electroconvulsive therapy (ECT) in bipolar depression, the evidence is not robust for unipolar recurrent depression. We present two patients with unipolar recurrent depression, with no family history of bipolarity or relevant personal medical history, who switched states while on a possible combination of bupropion and ECT. We believe that a hypersensitive state caused by ECT may have been aggravated by the dopamine synergistic action of bupropion, causing the switch. As current guidelines (American Psychiatric Association versus the National Institute for Health and Clinical Excellence) give contradictory advice regarding the treatment of patients with severe depression especially about combining pharmacotherapy and ECT, such patients need to be carefully evaluated before being treated with ECT.
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Unwanted effects / adverse reactions
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Drugs: psychiatry
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Mood disorders (including depression)
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Depressive disorder
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