Bupropion Modestly Effective for Amphetamine-type Stimulant Use Disorder

Amphetamine-type stimulant use disorder (ATSUD) is a growing problem with limited effective treatment options. The antidepressant medication bupropion has some stimulant-like effects that may be useful for the treatment of ATSUD. This systematic review and meta-analysis included randomized placebo-controlled trials of bupropion for ATSUD.

• The meta-analysis included eight trials with 1239 participants.
• The number of ATS-positive urine drug tests was significantly lower among patients receiving bupropion (relative risk [RR], 0.90); the effect was larger among patients who remained in treatment for 12 weeks (RR, 0.85).
• End-of-treatment ATS craving was significantly lower among patients receiving bupropion.
• Receipt of bupropion was not associated with improved treatment retention or adherence, or decreased symptom severity for substance use disorder or depression.

Comments: This study shows that bupropion has a modest effect on unhealthy amphetamine use and craving, suggesting its utility in a multimodal treatment approach for individuals with ATSUD. Of note, these studies excluded individuals with severe depression; bupropion may be a reasonable choice for people with co-occurring major depression and ATSUD.

Darius A. Rastegar, MD

Reference: Bakouni H, Sharafi H, Bahremand A, et al. Bupropion for the treatment of amphetamine-type stimulant use disorder: a systematic review of placebo-controlled randomized clinical trials. Drug Alcohol Depend. 2023;253:111018.