Rosh Psychiatry Board Practice Exam

Which medication is contraindicated in a patient with bulimia nervosa considering depression treatment?

1. Bupropion

2. Fluoxetine

3. Nortriptyline

4. Sertraline

The correct answer is: Bupropion

Bupropion is contraindicated in patients with bulimia nervosa due to its potential to lower the seizure threshold. Bulimia nervosa often involves behaviors that can lead to electrolyte imbalances, such as vomiting and purging, which further increase the risk of seizures. When a patient has a history of eating disorders, particularly with purging behaviors, the use of bupropion can precipitate seizures, making it a dangerous choice for treating depression in these individuals. In contrast, the other medications listed, such as fluoxetine, nortriptyline, and sertraline, are generally considered safer options for managing depression in patients with bulimia nervosa. Fluoxetine has even been shown to be effective in reducing the frequency of binge-eating and purging episodes associated with bulimia, while nortriptyline and sertraline have a more favorable safety profile regarding seizure risk in this population. Thus, the choice of medication is critical, and bupropion's potential adverse effects in this scenario highlight the care that must be taken when treating depressed patients with comorbid eating disorders.