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safer-jug-omens asked:

A while ago, it was decided that anticholinergic drugs increase the already-pretty-high risk of developing dementia. When I go on the internet and try to figure out if bupropion is an anticholinergic drug, I get very conflicting results. It didn't seem to be doing much for me so I stopped taking it as a precaution, but is bupropion "really anticholinergic"?

Yes, there’s a lot of conflicting stuff on this.

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As you can see here, bupropion has the (5) mark representing anticholinergic activity almost all the way to the right, which means it has very little of it - less, in fact, than most other antidepressants. The Beers Criteria List for anticholinergic drugs to avoid in the elderly doesn’t list bupropion

However, the Anticholinergic Burden Scale gives it a score of +1, for “possible anticholinergic”.

Two things seem to be creating this confusion. First, bupropion is a “pseudoanticholinergic”, which means that it increases dopamine, which has some downstream effect on the acetylcholine system I don’t really understand that causes it to be less active. So it’s downregulating the cholinergic system (SLIGHTLY) without actually blocking any receptors. Second, most drug effects on the cholinergic system are via muscarinic receptors and these are the ones we usually mean when we say “anticholinergic”, and bupropion doesn’t touch these, but it does affect a different kind of receptor called nicotinic receptors which are also cholinergic.

(by the way, all of the news articles that list bupropion as an anticholinergic drug that should be avoided if you want to avoid dementia are just getting their information by going to the Wikipedia article on “Anticholinergic Drugs,” listing the best-known ones on that page, and assuming the study’s conclusion applies to them - I know this because they all use about the same language, and one of them admitted that was what they were doing. But that doesn’t necessarily mean they’re wrong.)

Do antinicotinic drugs contribute to dementia in the same way as antimuscarinic drugs? God only knows. The studies that have shown a link don’t include any antinicotinic drugs, and certainly not bupropion, but there does seem to be some nicotinic reception dysregulation in Alzheimers, and smoking (which obviously agonizes nicotinic receptors) does have some evidence for preventing Alzheimers (true story!) so based on total conjecture about the mechanisms involved it seems vaguely possible, maybe, although without any direct evidential support.

A more interesting question might be - do you, as a person presumably below 65 years old, need to worry about this? I can’t answer that question. All the studies showing a link between AC drugs and dementia have been on people taking the drugs in their 50s, 60s, and 70s. Whether an AC drug taken in your 20s will come back to bite you later is a totally different question. My guess is no, but I have no evidence for this.

None of this matters for you, because you said bupropion didn’t work for you anyway. If you’re depressed and bupropion doesn’t work for you, just switch to an SSRI or something. And good news! SSRIs probably decrease your risk of Alzheimers!

psychiatry