SYMPOSIA

Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Poster Presentations
[PP-001] Ref. No: 133
Visual hallucinations induced by bupropion: A case report
Sevda Korkmaz 1 , Murat Kuloglu 2 , Sadullah Saglam 3 , Murad Atmaca 2
1 Department of Psychiatry, 3 Department of Neurology, Psychiatric Hospital
2 Department of Psychiatry Firat University School of Medicine, Elazig-Turkey
E-mail: skorkmaz23@hotmail.com
Bupropion is an antidepressant, which inhibits reuptake of norepinephrine and dopamine. It is a relatively reliable antidepressant in terms
of side effects and also is used in the treatment of nicotine deprivation (1, 2). Most frequent side effects are insomnia, dry mouth, and
headache (3). Here we present a case who developed visual hallucinations during bupropion treatment.
Case: F.Y: A 51 year old woman was admitted to the outpatient clinic with complaints of hump, horror, and seeing spider images. Visual
hallucinations, anxiety, irritability, insomnia, and anhedonia were noted on psychiatric examination. Except for the visual hallucinations,
there was no other perception abnormality nor other psychotic symptoms. History: she reported to a psychiatrist with complaints
of joylessness, weakness, fatigue, and anhedonia. She was diagnosed with major depressive disorder and subsequently was put on
bupropion 150mg/day. After a week, the dosage of bupropion was increased to 300mg/day. On the first day of the bupropion dose
increase to 300 mg/day, spider images developed in both of her eyes and in the following days these images increasingly continued. The
images lasted for days and scared the patient, ruined her sleep pattern, and increased her anxiety. The patient saw an ophthalmologist
with these complaints and at the medical examination there was no evidence of an organic or pathological disorder. Her blood pressure
was under control with treatment. The patient had been treated with escitalopram and duloxetine 6 years ago with a diagnosis of
depressive disorder, but the patient specified that she had not had any visual complaints. There were not any relevant symptoms at
that time and patient was not describing any clear stress factors. The family history was unremarkable. The patient did not have such
complaints as dizziness, tinnitus, or paraesthesia and there was not any pathological finding at the neurological examination. Also there
were no abnormal findings in the blood tests, urinalysis, and MR imaging. The Beck depression, Beck anxiety, and SCL-90 scales showed
high levels of anxiety and moderate depression. After the assessment of all these data, suspicion was focused on the bupropion as the
main cause of the spider images (visual hallucinations). The patient did not accept hospitalization, thus she was followed up periodically.
First the dosage of bupropion was decreased to 150 mg and bupropion treatment was stopped completely in a few days. Alprazolam 0.5
mg/day treatment was started to decrease the patient’s anxiety. Paroxetine 10 mg/ day was started and increased to 30 mg/day in two
weeks. Following the discontinuation of the bupropion, the visual hallucinations disappeared in a few days. The patient came for controls
monthly and at the end of the 6th month the symptoms of depression and anxiety had decreased considerably.
Comment: Bupropion has become a popular antidepressant in the treatment of depressive disorders in Turkey and is preferred frequently
because of its relatively low incidence of side effects. Nevertheless every kind of side effects including psychotic symptoms that appear
during treatment should be assessed carefully.
Key words: Bupropion, hallucination, antidepressant
References:
1. Ascher JA, Cle JO, Colin JN, et al. Bupropion: A review of its mechanism of antideressant activity. J Clin Psychiatry 1995;56:395-401.
2. Englisch S, Inta D, Eer A, Zink M (2010) Bupropion for depression in schizophrenia. Clin Neuropharmacol; 33(5): 257-259.
3. Hurt RD, Sachs DPL, Glover ED, Offord KP, Johnston JA, Dale LC, et al. A comparison of sustained release bupropion and placebo. N Engl J Med 1997;337:1195-1202.
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S121
[PP-002] Ref. No: 139
Clinical features of patients with panic disorder in outpatient clinics of a psychiatric
training and research hospital
Ramazan Konkan 1 , Erkan Aydın 1 , Oya Güçlü 1 , Ömer Şenormancı 1 , Mehmet Z. Sungur 2
1 MD, Psychiatrist in Deparment of Psychiatry in Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul Turkey
2 MD, Proffessor in Deparment of Psychiatry, Marmara University School of Medicine, Istanbul Turkey
E-mail: ramazankonkan@gmail.com
Objective: Panic disorder is a disorder characterized by recurrent unexpected panic attacks where the patient may exhibit avoidance
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