Delirium Precipitated by Bupropion in a Vulnerable Depressed Patient

Bupropion促發憂鬱老人之譫妄

10.29478/TJP.200909.0008

賴怡均(Yi-Chun Lai)；吳思穎(Szu-Ying Wu)；曾美智(Meg Mei-Chih Tseng)；李明濱(Ming-Been Lee)；陳錫中(Hsi-Chung Chen)

bupropion ； 譫妄 ； 中風 ； bupropion ； delirium ； stroke

台灣精神醫學

23卷3期（2009 / 09 / 01）

230 - 235

英文

目的：本文報告一例bupropion相關之譫妄個案，並作文獻回顧。病例報告：案例為一位81歲罹患無精神病症症狀之再發性憂鬱症患者，因服用單線mirtazapine 45 mg/d十個月後憂鬱症狀復發，故另投以每天112.5 mg bupropion雙線治療。一個月後，個案出現定向感缺失、視幻覺及腦波變化之譫妄症狀。於停用bupropion後，其譫妄症狀緩解。結論：bupropion在建議劑量之內也可能產生與其相關之譫妄症狀。臨床上使用bupropion需特別注意之相關因子包括年長，基底核病灶，慢性腎臟疾病，及多種抗憂鬱劑的使用。

Objective: We report a case of bupropion precipitating delirium and review the psychiatric literature of associated topics from 1982 to 2008. Case report: An 81-year-old businessman had major depressive disorder, recurrent without psychotic symptoms. In addition to be on mirtazapine for over 10 months, he received bupropion in recommended dosage level. But within 10 days, he had episodes of mild disorientation and increased impulsivity. A few weeks later, he was disoriented, agitated, restless, and had visual hallucination of seeing stars and gods. He also had electroencephalogram changes. All those symptoms resolved after discontinuation of bupropion. Conclusion: This case and a review of literature reveal that bupropion precipitating delirium happens even in recommended dosage levels. Patients who are elderly, have insults to the basal ganglia, have chronic kidney disease, and having use multiple antidepressants, warrants more attention in using bupropion.

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