@article{ref1,
title="Toxicity of bupropion overdose compared with selective serotonin reuptake inhibitors",
journal="Pediatrics",
year="2019",
author="Overberg, Adam and Morton, Shannon and Wagner, Emily and Froberg, Blake",
volume="144",
number="2",
pages="ePub-ePub",
abstract="OBJECTIVES: Adolescent depression and attempted and completed suicide are increasing in the United States. Because suicide is often impulsive, the means of self-harm are frequently items of convenience like medication. Authors of a recent study compared tricyclic antidepressant overdose to bupropion overdose. Fluoxetine and escitalopram are the only agents with Food and Drug Administration approval for pediatric depression, but off-label bupropion prescriptions are common. We sought to compare the effects of selective serotonin reuptake inhibitors (SSRIs) and bupropion in overdose. <br><br>METHODS: This was an analysis of the National Poison Data System from June 2013 through December 2017 for adolescent (ages 10-19) exposures to SSRIs or bupropion coded as &quot;suspected suicide.&quot; Demographics, clinical effects, therapies, and medical outcome were analyzed. <br><br>RESULTS: There were 30 026 cases during the study period. Sertraline and fluoxetine accounted for nearly 60%, whereas bupropion was reported in 11.7%. Bupropion exposure was significantly associated with death (0.23% vs 0%; <i>P</i> <.001) or serious outcome (58.1% vs 19%; <i>P</i> <.001) as well as the 10 most common clinical effects, including seizures (27.0% vs 8.5%; <i>P</i> <.001) and hallucinations (28.6% vs 4.3%; <i>P</i> <.001). Bupropion exposure was significantly associated with the need for cardiopulmonary resuscitation (0.51% vs 0.01%; <i>P</i> <.001), intubation (4.9% vs 0.3%; <i>P</i> <.001), vasopressors (1.1% vs 0.2%; <i>P</i> <.001), and benzodiazepines (34.2% vs 5.5%; <i>P</i> <.001). There was a significant increase in all exposures and in proportion of serious outcomes over time. <br><br>CONCLUSIONS: Adolescents who attempt self-harm are at higher risk for serious morbidity and poor outcomes with bupropion than with SSRIs. These risks, and the patient's propensity for self-harm, should be evaluated when therapy with bupropion is considered.<br><br>Copyright © 2019 by the American Academy of Pediatrics.<p /> <p>Language: en</p>",
language="en",
issn="0031-4005",
doi="10.1542/peds.2018-3295",
url="http://dx.doi.org/10.1542/peds.2018-3295"
}