Englisch Susanne, Morgen Katrin, Meyer-Lindenberg Andreas, Zink Mathias
Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
Clin Neuropharmacol. 2013 Nov-Dec;36(6):203-15. doi: 10.1097/WNF.0b013e3182a8ea04.
Bupropion inhibits the reuptake of norepinephrine and dopamine, which are involved in the pathogenesis of affective, cognitive, and psychomotor impairment in schizophrenia. Because of reports on bupropion-associated psychoses, it is reluctantly used in schizophrenic patients. Risks and benefits, however, have never been comprehensively reviewed.
The objectives of this study were to evaluate the efficacy of bupropion on depression, negative symptoms, cognition, and smoking habits in schizophrenia and to appraise safety aspects.
MEDLINE OVID/PubMed, scholar.google.com and the Cochrane Database were screened for the keywords ("bupropion"/"wellbutrin"/"elontril"/"zyban") and ("psychosis"/"schizophrenia"/"psychotic disorder").
A total of 13 randomized controlled trials (28 publications), 3 open prospective evaluations, 5 multiple case reports, 22 single case reports, and 6 review articles were incorporated in the final analysis.
Information on patient population, age, diagnosis, bupropion dose and formulation, antipsychotic and concomitant medication, adverse events and treatment outcomes regarding psychosis, affective and negative symptoms, cognition, and smoking habits were collected from the published reports.
A total of 30 cases of bupropion-induced psychoses have been published, 17 (57%) of which were associated with the immediate-release drug formulation and 28 (93%) of which occurred without concomitant antipsychotic medication. In comparison, 229 schizophrenic patients on stable antipsychotic regimens were successfully treated with bupropion and experienced marked clinical improvement without developing psychosis. Pharmacokinetic interactions with antipsychotics were rare, whereas electroencephalographic abnormalities occurred frequently.
In schizophrenic patients treated with bupropion in addition to antipsychotics, the risk for bupropion-induced psychoses seems negligible. The efficacy of a combined dopamine and norepinephrine agonist in schizophrenia is biologically plausible. Further trials involving bupropion should integrate neurobiological methods and focus on negative symptoms and cognitive deficits in schizophrenia.
安非他酮可抑制去甲肾上腺素和多巴胺的再摄取，而去甲肾上腺素和多巴胺与精神分裂症的情感、认知及精神运动损害的发病机制有关。鉴于有安非他酮相关精神病的报道，故在精神分裂症患者中使用该药较为谨慎。然而，其风险和益处从未得到全面评估。
本研究旨在评估安非他酮对精神分裂症患者抑郁、阴性症状、认知及吸烟习惯的疗效，并评估其安全性。
在MEDLINE OVID/PubMed、scholar.google.com以及Cochrane数据库中检索关键词（“安非他酮”/“安非他酮缓释片”/“盐酸安非他酮片”/“畅沛”）以及（“精神病”/“精神分裂症”/“精神障碍”）。
最终分析纳入了13项随机对照试验（28篇出版物）、3项开放性前瞻性评估、5项多病例报告、22项单病例报告以及6篇综述文章。
从已发表的报告中收集有关患者人群、年龄、诊断、安非他酮剂量及剂型、抗精神病药物及合并用药、不良事件以及精神病、情感和阴性症状、认知及吸烟习惯等方面的治疗结果的信息。
共发表了30例安非他酮所致精神病的病例，其中17例（57%）与速释剂型有关，28例（93%）发生时未合并使用抗精神病药物。相比之下，229例接受稳定抗精神病治疗方案的精神分裂症患者成功接受了安非他酮治疗，且临床症状显著改善，未发生精神病。与抗精神病药物的药代动力学相互作用罕见，而脑电图异常则较为常见。
对于在使用抗精神病药物的同时加用安非他酮治疗的精神分裂症患者，安非他酮所致精神病的风险似乎可以忽略不计。多巴胺和去甲肾上腺素联合激动剂在精神分裂症中的疗效在生物学上是合理的。进一步涉及安非他酮的试验应整合神经生物学方法，并关注精神分裂症的阴性症状和认知缺陷。
