Hallucinations during bipolar depressive episode treated with bupropion after alcohol withdrawal surgery: a case report

TL;DR

A patient with alcohol use disorder and bipolar depression experienced delirium linked to bupropion, highlighting the need for personalized treatment in complex cases.

Contribution

This case report highlights bupropion's potential to induce delirium in AUD patients post-alcohol withdrawal surgery, a previously under-recognized risk.

Findings

Delirium and behavioral disturbances occurred after bupropion initiation and resolved upon discontinuation.

Symptoms recurred with bupropion reintroduction and ceased again after stopping the medication.

The patient remained symptom-free without bupropion at one-month follow-up.

Abstract

Alcohol Use Disorder (AUD) is a prevalent condition often co-occurring with affective disorders. Bupropion, a medication used to treat affective disorders, acts by inhibiting dopamine (DA) and norepinephrine (NE) reuptake, potentially helping to alleviate emotional dysregulation. However, the risk of delirium in AUD patients at therapeutic doses is poorly understood, despite reports linking bupropion overdose to delirium. We report here a rare case of a 49-year-old Chinese male with AUD who developed mood disturbances and relapsed following alcohol detoxification surgery. He was diagnosed with 1. Bipolar II Disorder, Current Depressive Episode, Severe Without Psychotic Features; 2. Harmful Pattern of Alcohol Use. During inpatient treatment, the patient received a combination of medications, including bupropion. Delirium and behavioral disturbances appeared after bupropion initiation but resolved upon its discontinuation. These symptoms recurred when bupropion was reintroduced and resolved again after stopping the medication. After discharge, no further bupropion was used, and the patient remained symptom-free at a one-month follow-up. This case suggests that bupropion may trigger delirium in AUD patients with a history of alcohol withdrawal surgery, underscoring the importance of careful medication selection and personalized treatment in complex cases.