Cochrane for Clinicians

Putting Evidence into Practice

Extended-Release Bupropion for Preventing Seasonal Affective Disorder in Adults

 

Am Fam Physician. 2017 Jan 1;95(1):10-11.

Author disclosure: No relevant financial affiliations.

Clinical Question

Is extended-release bupropion (Wellbutrin XL) more effective than placebo for preventing symptoms of seasonal affective disorder (SAD) in adults?

Evidence-Based Answer

When started in the fall, extended-release bupropion, 300 mg once daily, is effective in preventing recurrent symptoms in high-risk adults with a history of SAD (number needed to treat [NNT] = 5), as well as those at lower risk (NNT = 8). Headaches, nausea, and insomnia may limit adherence to treatment.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

SAD is a recurrent depressive disorder that occurs only during a particular season, typically the winter months.2 SAD is more common at northern latitudes; the prevalence is estimated at 9% in the northern United States,3 and two-thirds of patients experience the symptoms every year.4 Preventive measures are of particular interest for this group of patients.

The authors of this Cochrane review sought studies that compared any second-generation antidepressant with placebo, other medications, or other therapies for the prevention of episodes of SAD.1 They found only three randomized trials, each comparing extended-release bupropion with placebo. The studies enrolled a total of 1,100 patients with a history of SAD at 151 sites in Canada and the northern United States. Patients were excluded if they had medical problems or any other psychiatric illnesses, including major depression. Treatment began between the months of September and November with extended-release bupropion, 150 mg daily, titrated to 300 mg daily for those who were able to tolerate it. In all three studies, the dosage was weaned to 150 mg per day in the first week of spring and then subsequently stopped.

Participants with confirmed SAD were asymptomatic at the start of all three studies. The primary outcome in two studies was the time to onset of depressive symptoms. In the third study, the primary end point was

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. Gartlehner G, Nussbaumer B, Gaynes BN, et al. Second-generation antidepressants for preventing seasonal affective disorder in adults. Cochrane Database Syst Rev. 2015;(11):CD011268....

2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

3. Rosen LN, Targum SD, Terman M, et al. Prevalence of seasonal affective disorder at four latitudes. Psychiatry Res. 1990;31(2):131–144.

4. Rodin I, Thompson C. Seasonal affective disorder. Adv Psychiatr Treat. 1997;3:352–359.

5. Lam RW, Levitt AJ, eds. Canadian Consensus Guidelines for the Treatment of Seasonal Affective Disorder. Vancouver, British Columbia, Canada: Clinical and Academic Publishing; 1999.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.

 

 

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