Bupropion Identification — MRCPsych Paper B MCQ

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ModerateMood DisordersBupropion IdentificationMRCPsych Paper B

A 50-year-old woman with depression who smokes asks about a drug that has a lower propensity for sexual dysfunction than selective serotonin reuptake inhibitors. In the UK, the same drug is licensed as an aid to smoking cessation, although it is licensed for depression in some other countries. It acts mainly by inhibiting neuronal reuptake of noradrenaline and dopamine, with minimal effect on serotonin reuptake. Which drug is being described?

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Correct answer: D — Bupropion

The answer is D, bupropion. The UK Zyban SmPC describes bupropion as a noradrenaline/dopamine reuptake inhibitor and licenses it as an aid to smoking cessation with motivational support. Although pharmacologically classified as an antidepressant and licensed for depression in some countries, its UK Zyban indication is smoking cessation. Bupropion has a lower propensity for sexual dysfunction than SSRIs. Fluoxetine and sertraline are SSRIs, while venlafaxine and duloxetine are SNRIs; these serotonergic drugs are more commonly associated with sexual adverse effects. Mirtazapine may also cause fewer sexual adverse effects, but it is not an NDRI and is not licensed for smoking cessation. Bupropion carries a dose-related seizure risk and is contraindicated in people with seizure disorders or current or previous anorexia nervosa or bulimia.

Reference: Electronic Medicines Compendium. Zyban 150 mg prolonged-release tablets, Summary of Product Characteristics, sections 4.1, 4.3, 4.4 and 5.1. Text revised 29 July 2024. https://www.medicines.org.uk/emc/product/3827/smpc