Bupropion For Reducing High-Risk Behaviors in Depressed Men Who Have Sex With Men (MSM)

Depression in men is often masked by high-risk behaviors such as alcohol and drug abuse.
Common symptoms among depressed men include feelings of hopelessness and helplessness,
irritability, and anger. MSM are among those at highest for HIV acquisition due to high-risk
behaviors, including unprotected sexual intercourse and drug abuse. Bupropion is an
antidepressant medication commonly used to treat depression. The purpose of this study thus
was whether bupropion could help MSM with mild-to-moderate depression reduce their high-risk
behaviors.

Participants in this trial were randomly assigned to receive either bupropion or placebo for
6 months. Study visits lasting approximately 2 hours each occurred at Day 0, and at Months 4,
6, and 9; included in these visits were physical examination, testing for HIV and sexually
transmitted disease (STD), depression screening, and an interview-administered questionnaire
inquiring into sexual activity and drug use. Shorter study visits, lasting 15 - 30 minutes
each occurred at Day 15, and Months 1, 2, 4, 5, and 7, and included depression screening and
physical exam.

Inclusion Criteria:

- Available for at least 9 months, or the duration of the study

- Willing to complete HIV testing and counseling

- History of HIV testing and counseling

- At high risk of HIV infection, indicated by more than one male sexual partner in the 3
months prior to study entry

- Meets criteria for either (a) major depression or dysthymia within a mild-to-moderate
level according to standard criteria DSM-IV, or (b) minor depression as defined by one
or more of the following symptoms at any time and for any duration during the past 12
months: significant weight loss or gain, or significant decrease or increase in
appetite; poor sleep pattern; noticeable irritability or slowness; fatigue or lack of
energy; inappropriate feelings of worthlessness or guilt; inability to concentrate;
indecisiveness; and recurrent thoughts of death or suicide.

Exclusion Criteria:

- HIV infected

- Sexual intercourse in the 3 months prior to study entry with only one partner, and in
a monogamous relationship

- Currently enrolled in another study involving repeated HIV testing and counseling

- Receiving treatment for depression with antidepressant medication for any length of
time within the year prior to study entry

- Currently in psychotherapy, psychoanalysis, or any other form of talk therapy for any
reason

- Severe depression or at suicidal risk

- No evidence or prior history of depression

- Homicidal or other similar problem that, in the opinion of the investigator, may
endanger study staff and participants

- Currently taking monoamine oxidase inhibitors (MAOIs). Participants may be allowed to
enroll 14 days after discontinuing use of a MAOI.

- History of seizures

- History or current symptoms of bipolar disorder