Toxicity of Bupropion Overdose Compared With Selective Serotonin Reuptake Inhibitors

Pediatrics. 2019 Aug;144(2):e20183295. doi: 10.1542/peds.2018-3295. Epub 2019 Jul 5.

Abstract

Objectives: Adolescent depression and attempted and completed suicide are increasing in the United States. Because suicide is often impulsive, the means of self-harm are frequently items of convenience like medication. Authors of a recent study compared tricyclic antidepressant overdose to bupropion overdose. Fluoxetine and escitalopram are the only agents with Food and Drug Administration approval for pediatric depression, but off-label bupropion prescriptions are common. We sought to compare the effects of selective serotonin reuptake inhibitors (SSRIs) and bupropion in overdose.

Methods: This was an analysis of the National Poison Data System from June 2013 through December 2017 for adolescent (ages 10-19) exposures to SSRIs or bupropion coded as "suspected suicide." Demographics, clinical effects, therapies, and medical outcome were analyzed.

Results: There were 30 026 cases during the study period. Sertraline and fluoxetine accounted for nearly 60%, whereas bupropion was reported in 11.7%. Bupropion exposure was significantly associated with death (0.23% vs 0%; P < .001) or serious outcome (58.1% vs 19%; P < .001) as well as the 10 most common clinical effects, including seizures (27.0% vs 8.5%; P < .001) and hallucinations (28.6% vs 4.3%; P < .001). Bupropion exposure was significantly associated with the need for cardiopulmonary resuscitation (0.51% vs 0.01%; P < .001), intubation (4.9% vs 0.3%; P < .001), vasopressors (1.1% vs 0.2%; P < .001), and benzodiazepines (34.2% vs 5.5%; P < .001). There was a significant increase in all exposures and in proportion of serious outcomes over time.

Conclusions: Adolescents who attempt self-harm are at higher risk for serious morbidity and poor outcomes with bupropion than with SSRIs. These risks, and the patient's propensity for self-harm, should be evaluated when therapy with bupropion is considered.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adolescent
  • Antidepressive Agents, Second-Generation / toxicity*
  • Bupropion / toxicity*
  • Child
  • Drug Overdose / diagnosis*
  • Drug Overdose / epidemiology*
  • Drug Overdose / therapy
  • Female
  • Humans
  • Male
  • Poison Control Centers / trends
  • Retrospective Studies
  • Serotonin Uptake Inhibitors / toxicity*
  • Suicide, Attempted* / trends
  • Young Adult

Substances

  • Antidepressive Agents, Second-Generation
  • Serotonin Uptake Inhibitors
  • Bupropion