Bupropion Maintenance Treatment in Refractory Bipolar Depression: A Case Report

Julia Dehning1, Heinz Grunze2, *, Armand Hausmann1
1 Department of Medicine, Paracelsus Medical University, Salzburg, Austria
2 Department of Medicine, Medical University - Psychiatry, Innsbruck, Austria

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Creative Commons License
© 2017 Grunze et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Medicine, Paracelsus Medical University, Salzburg, Austria; Tel: +49-7250-60592; Fax: +49-7250-60516; E-mail:



The optimal duration of antidepressant treatment in bipolar depression appears to be controversial due to a lack of quality evidence, and guideline recommendations are either vague or contradictive. This is especially true for second line treatments such as bupropion that had not been subject to rigourous long term studies in Bipolar Disorder.

Case presentation:

We report the case of a 75 year old woman who presented with treatment refractory bipolar depression. Because of insufficient response to previous mood stabilizer treatment and refractory depressive symptoms, bupropion was added to venlafaxine and lamotrigine. From there onwards, the patient improved continuously without experiencing deterioration of depression or a switch into hypomania. Our patient being on antidepressants for allmost four years experienced an obvious benefit from longterm antidepressant administration.


Noradrenergic/dopaminergic mechanisms of action may play a more prominent role in bipolar depression, and may still be underused as a therapeutic strategy in the acute phase as well as in long-term maintenance in at least a subgroup of bipolar patients. There is still a lack of evidence from RCTs, but this case report further supports antidepressant long-term continuation and the usefulness of a noradrenergic/dopaminergic antidepressant in the acute and maintenance treatment of bipolar disorder.

Keywords: Bipolar disorder, Bupropion, Depression, Guidelines, Maintenance treatment, TEAS.