The question bank is the fastest way to start, but PMHNP Helper also includes board-review planning, student resources, and plain-English guidance for psychiatric nurse practitioner students who are still learning the exam landscape.
A 23-year-old female college student presents with a 4-month history of depressed mood, loss of interest, difficulty concentrating, and fatigue. She also discloses that she has been engaging in binge eating followed by self-induced vomiting approximately 4 times per week for the past 2 years. Her BMI is 21. She has no prior psychiatric medication trials and no history of seizures. The PMHNP considers antidepressant options. Which of the following medications is absolutely contraindicated in this patient?
Explanation
Bupropion's contraindication in eating disorders is a fundamental clinical principle. The key facts: bupropion lowers the seizure threshold in a dose-dependent manner, and patients with bulimia or anorexia are already at elevated seizure risk due to electrolyte abnormalities from purging, restriction, and malnutrition. The FDA added this contraindication after an unexpectedly high seizure rate in bulimic patients during premarketing trials. The presence of bulimia or anorexia nervosa immediately rules out bupropion as a treatment option.
Key Takeaway
Bupropion is absolutely contraindicated in patients with current or prior diagnosis of bulimia nervosa or anorexia nervosa due to a significantly elevated risk of seizures.