In Reply: Drs Dervaux and Laqueille provide a reminder that bupropion treatment for patients with bipolar disorder carries a risk of switching into mania. The patient in question was already prescribed bupropion at the time of the Clinical Crossroads conference and was presumably stable and being monitored for a recurrence of mania. For the reasons Dervaux and Laqueille discuss, bupropion should not be a first-line smoking cessation treatment for patients with bipolar disorder. Because the benefits of stopping smoking are so great, however, there may be circumstances—such as failure to quit with other standard pharmacotherapies plus counseling—in which a trial of bupropion is indicated. In those situations, appropriate monitoring is certainly indicated.
Schroeder SA. Antidepressant Treatment and Smoking Cessation in Bipolar Disorder—Reply. JAMA. 2009;301(20):2093. doi:10.1001/jama.2009.706