Which drug for which patient? Is there a fluoxetine responding versus a bupropion responding personality profile?

Abstract

This paper proposes that a certain premorbid personality type - that of hard driving, achievement-oriented, often exercise-oriented individuals - correlates with bupropion response; conversely, patients without these premorbid traits and whose depression is marked by mood swings, irritability and rumination are likely fluoxetine responders. The authors developed the Fluoxetine Bupropion Assessment Scale (FBAS), a 10-question, self-administered rating scale, to assess these traits and hypothesized that its use would improve outcomes. A Marriage and Family Therapist (MFT) and a Registered Nurse/Nurse Practitioner (RN/NP) retrospectively reviewed 72 charts from one psychiatrist's office for two time periods: before and after the psychiatrist utilized the questionnaire to guide antidepressant selection (33 charts before and 39 charts after). Raters were blinded to the theory and to the treatment time period. On the basis of clinical information in the charts, they formulated Clinical Global Impression assessments of treatment response in patients with Beck Depression Inventory scores ≥17 who were not on either drug at the time of intake, and who were prescribed either fluoxetine or bupropion. The data were in the direction of better results in the FBAS-guided group, particularly after adjusting for age, gender and marital status (efficacy p = 0.087). When global improvement data were combined into three groups describing treatment response (improved, minimal to no improvement, and worse) there were statistically significant better results (p = 0.047) in the FBAS-guided treatment group. Revision and validation of the questionnaire and a larger, randomized study seem indicated.

Keywords: Bupropion; depression; exercise; fluoxetine; personality; rating scale; selective serotonin reuptake inhibitor; temperament..