Antidepressants for Major Depression and High Suicide Risk: Paxil vs. Wellbutrin

Major depressive disorder (MDD) is a mental health problem with both psychological and physical effects. Someone diagnosed with depression may have strong feelings of sadness or a loss of interest in normal activities; physical symptoms may include lethargy, body pains, insomnia, and headaches. Despite decades of research and study, fast and effective treatment for depression remains an unfulfilled goal. Currently, the preferred approach for depression treatment begins with cognitive behavioral therapy and may include one or more psychotropic medications. 

Suicide risk is a serious complicating factor in the treatment of major depressive disorder, and choosing the appropriate drug intervention remains a haphazard procedure. Because many antidepressants are potentially linked with a heightened risk of suicidal behavior, doctors must exercise caution. Response to psychotropic drugs, particularly antidepressants, is highly individual. A period of trial and error is often necessary before doctors can identify the optimum drug or drug combination. In cases of possible suicidal thoughts and behavior, the best course of action is often observation, possibly in an inpatient facility.

A recently completed study at the New York State Psychiatric Institute promises to offer some guidance in the selection of treatment for severely depressed individuals with suicidal tendencies. The study consisted of two groups, one receiving Paxil (paroxetine) and the other receiving Wellbutrin (bupropion). The choice of these specific drugs was deliberate: Paxil belongs to the selective serotonin reuptake inhibitors (SSRI) category and is among the most frequently prescribed antidepressants; Wellbutrin is a non-SSRI medication with a different mechanism of action. However, both medications still carry the “black box” warning to notify doctors and pharmacists of potentially dangerous side effects, namely the increased suicide risk. A second aspect of the study included functional MRI scanning of each participant’s brain—once at the beginning of the 8-week trial and once more at the conclusion. Participants were given a cognitive task during the scan to assess how each of them processed sensations of reward.

The initial phase of the study is complete. Data on the 125 participants is currently being compiled and analyzed. Researchers hope that one of the drugs will reveal itself as a more effective remedy for major depression, although they may find that one of the drugs leads to a higher rate of side effects. In any event, the data from this study will help attending physicians and therapists make better choices when treating their most severely depressed patients.

References:

1. Bupropion, t. c. (n.d.). WELLBUTRIN XL® (bupropionhydrochloride extended-release tablets). DailyMed. Retrieved July 18, 2012, from http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=14812
2. Depression (major depression). (n.d.). Mayo Clinic. Retrieved July 18, 2012, from http://www.mayoclinic.com/health/depression/DS00175
3. Paroxetine/Bupropion in Suicide Attempters/Ideators With Major Depression. (n.d.). ClinicalTrials.gov. Retrieved July 18, 2012, from http://clinicaltrials.gov/ct2/show/NCT00429169?recr=Open&intr=%22Bupropion%22&rank=16

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