Delirium Precipitated by Bupropion in a Vulnerable Depressed Patient

Abstract

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.