Bupropion decreases resting motor threshold: A case report
Received 17 April 2009; received in revised form 1 July 2009; accepted 14 August 2009. published online 14 September 2009.
Background
Bupropion is associated with a dose-related increased seizure risk. This effect could correlate with a change in motor cortex excitability. Transcranial magnetic stimulation (TMS) can assess changes in motor cortical excitability by measuring resting motor threshold (RMT).
Methods
RMT was determined before and during 2 weeks concomitant administration of bupropion at two different doses (150 mg/d and 300 mg/d) in a 41-year-old woman enrolled in a study of repetitive TMS (rTMS) for the treatment of depression.
Results
RMT was significantly lower when the patient took 300 mg/d of bupropion compared with no bupropion and 150 mg/d of bupropion. When bupropion was reduced to 150 mg, RMT returned to the premedication level.
Conclusions
Bupropion 300 mg/d increased cortical excitability as demonstrated by decreased RMT. This finding emphasizes the importance of assessing RMT regularly during rTMS treatment, especially in the context of new or changed doses of medications.
aDepartment of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
bDepartment of Neurology, Emory University School of Medicine, Atlanta, Georgia
Correspondence: Paul E. Holtzheimer III, MD, 101 Woodruff Circle NE, Suite 4000, Atlanta, GA 30322.
This work was funded through a grant from the National Institute of Mental Health (NIMH) (R01 MH069886).
Dr. Mufti reports no financial relationships or potential conflicts of interest.
Over the past 5 years, Dr. Holtzheimer has received: grant funding from National Alliance for Research on Schizophrenia and Depression (NARSAD), NIMH, and the Greenwall Foundation; consulting fees from Advanced Neuromodulation Systems/St. Jude Medical, AstraZeneca, Shaw Science and Tetragenex; honoraria from CME Outfitters, Inc. (Cyberonics); Cerebrio, Inc. (Boerhinger-Ingelheim); CME LLC, Inc. (Bristol-Myers Squibb); Letters and Sciences (Bristol-Myers Squibb); and Prescott Medical Communications Group (Forest).
Dr. Epstein consults for Neuronetics, Inc. Through Emory University he holds patents for the Neuronetics transcranial magnetic stimulator that is used in the NIMH trial, but has no involvement in the choice of equipment, protocol design, treatment, or data analysis for that trial. He is Principal Investigator on a VA study of depression that uses non-Neuronetics equipment. He receives grant support from GlaxoSmithKline, Inc.
Ms. Quinn and Ms. Vito report no financial relationships or potential conflicts of interest.
Dr. McDonald reports that he serves on the Executive Board of the Georgia Psychiatric Physicians Association and is Director of the Fuqua Center for Late-Life Depression that advocates for geriatric psychiatry. He is also the Chair of the American Psychiatric Association (APA) Committee on Electroconvulsive Therapy and Other Electromagnetic Therapies and a member of the APA Council on Research; and reports Consultant/Speaker Honorarium from Myriad, Bristol-Myers Squibb, and Janssen. He has received grant support from Boehinger Ingelheim and Neuronetics and was an investigator in a trial sponsored by Janssen. He is currently Principal Investigator on an NIMH study that uses Neuronetics' transcranial magnetic stimulators. Dr. McDonald works for Emory University that holds a patent for the transcranial magnetic stimulator that is used in the NIMH trial. He is also in an National Institute of Neurological Disorders and Stroke (NINDS) trial that is evaluating medication donated by Smith Kline (Paxil CR) and Wyeth (Effexor XR).
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