A Pilot Controlled Trial of Bupropion XL vs. Escitalopram in Generalized Anxiety Disorder (GAD)

Alexander Bystritsky, M.D.; Lauren Kerwin, B.A.; Jamie D. Feusner, M.D.; Tanya Vapnik, Ph.D.


Psychopharmacol Bull. 2008;41(1):1-9. 

In This Article

Abstract and Introduction

Objective: To compare the efficacy and safety of bupropion XL (150-300mg/day) with the selective serotonin reuptake inhibitor escitalopram (10-20mg/day) in outpatients diagnosed with generalized anxiety disorder (GAD).
Methods: Twenty-four participants with GAD between the ages 18 and 64 years enrolled in a 12-week, double-blind, randomized, trial. The primary efficacy measures were the Clinical Global Impression of Improvement (CGI-I) and the Hamilton Anxiety Rating Scale (HARS).
Results: Bupropion XL demonstrated comparable anxiolytic efficacy to escitalopram in outpatients with GAD. Both treatments were well-tolerated.
Conclusion: Findings from this pilot project suggest bupropion XL may be useful in treating GAD. These preliminary results warrant further research to explore the use of bupropion XL in the treatment of GAD.

Generalized Anxiety Disorder (GAD) has a lifetime prevalence of 1.1% to 3.6%.1 Both cognitive behavioral therapies and medications have proved to be effective treatments.2 First line medication treatments are the serotonin reuptake inhibitors (SRIs) including escitalopram, which was approved by the FDA for the treatment of GAD in 2005.3 However, better-tolerated compounds are often needed, due to the fact that SRIs can cause problematic side effects such as sexual side effects.4 Support for the role of norepinephrine in the treatment of GAD comes from double-blind, placebo-controlled trials of tricyclic antidepressants (TCAs) that found them to be effective treatments for GAD.5

Bupropion hydrochloride, a norepinephrine and dopamine reuptake inhibitor (NDRI), has proven effective in clinical trials in major depressive disorder and has been an effective treatment for depression for over 20 years. Recent research suggests bupropion hydrochloride reduces anxiety in patients diagnosed with major depression.6, 7 Another study demonstrated that treatment with the sustained release (SR) formulation resulted in comparable anxiolytic efficacy to sertraline in outpatients with major depression.8 Moreover, both agents showed a rapid onset of clinically significant anxiolytic activity. The efficacy of bupropion and bupropion SR has also been demonstrated in patients with panic disorder and social phobia.9, 10

This pilot study explored the efficacy and safety of an extended release formulation of bupropion (bupropion XL) and the SRI escitalopram in outpatients diagnosed with GAD. Our primary hypothesis was that bupropion XL would demonstrate comparable anxiolytic efficacy to escitalopram in outpatients with GAD.


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