Higher Bupropion Dose Linked to Increased Fall Risk in Older Adults With Depression, finds study
A secondary analysis of the OPTIMUM randomized clinical trial published in the Journal of General Internal Medicine found that older adults with major depressive disorder (MDD) receiving antidepressant augmentation had a higher risk of falls with higher doses of bupropion and a prior history of falls. The findings highlight the importance of careful fall-risk assessment when using bupropion augmentation in elderly patients with MDD. The study was conducted by David A. and colleagues.
This investigation was based on a randomized controlled trial of older adults with major depressive disorder. A total of 194 participants were included from the bupropion augmentation group, which was found to have a higher rate of falls compared to other treatment groups. Participants were monitored for about 10 weeks, during which time the number of falls was monitored at each bi-weekly visit. The study aimed to determine the predictors of increased risk of falls.
Key findings:
This study showed that fall risk in older adults on bupropion augmentation therapy is multifactorial and dose-related.
A strong correlation was found between falls in the past and study period falls (r = 0.42). Physical illness burden (r = 0.26), physical function (r = −0.23), and depression severity (r = 0.16) were also significantly correlated with falls (all p < 0.05).
The dose level of bupropion significantly predicted fall risk (p = 0.04), and prior falls had a strong independent effect on fall risk (p < 0.001).
The annualized fall rates were 1.39 falls/year for low-risk patients and 12.32 falls/year for high-risk groups defined by prior falls and high-dose bupropion.
This study proves that fall risk in bupropion augmentation therapy is based on fall history and medication dose, and this is a personal approach in managing older adults with MDD. Patient selection and optimization of dose, as well as fall prevention strategies, can minimize adverse outcomes and maintain antidepressant activity.
Reference:
Bender, D.A., Mulsant, B.H., Lavretsky, H. et al. Risk Factors for Falls in Older Depressed Adults Treated with Bupropion: An Analysis of the OPTIMUM Randomized Clinical Trial. J GEN INTERN MED (2026). https://doi.org/10.1007/s11606-026-10181-4
