Cullum, J. L., Wojciechowski, A. E., Pelletier, G., & Simpson, J. S. (2004). Bupropion sustained release treatment reduces fatigue in cancer patients. Canadian Journal of Psychiatry, 49, 139–144.

Bupropion sustained release was initiated at 100 or 150 mg daily, and the dose was adjusted according to the patient’s response. The final bupropion dose ranged from 100 to 300 mg daily. The modal bupropion dose was 150 mg, and patients were treated and observed for as long as two years.

• The study included 15 patients consecutively referred for assessment due to the presence of fatigue or depression with marked fatigue.
• Age ranged from 37 to 87 years.
• Diagnoses included breast cancer, primary brain tumor, prostate cancer, and lymphoma.
• Patients were excluded if they were receiving erythropoietin treatment, were anemic, had a history of diabetes mellitus, or had an active rheumatologic condition.

• Single site
• Comprehensive cancer center

The study was a single-arm, open-label, case series.

Fatigue was evaluated on the Clinical Global Improvement (CGI) Scale by a clinician not directly involved in the trial.

• The degree of fatigue was rated as very much improved (n = 6), much improved (n = 2), and minimally improved (n = 5).
• One patient showed no change, and another was much worse with respect to fatigue symptoms following bupropion treatment.
• Most patients (n = 13) reported some of the most common bupropion side effects, such as increased anxiety, dry mouth, nausea, insomnia, tremor, and tinnitus. These were rated as mostly mild to moderate.
• Thirteen patients were reported as improved, and eight were rated as much improved or better.
• In all patients, improvement occurred in two to four weeks.

• The study had a single arm, and no random assignment or comparison group was included.
• The trial used an open-label design.
• Clinician-evaluated measures of fatigue may be less sensitive to a change in rating of a subjective symptom, such as fatigue.
• Bupropion should be used with caution in patients at risk for seizure and those receiving concurrent therapies that lower the seizure threshold.

Cost is incurred to acquire the drug.