A 48-year-old man experiences loss of consciousness followed by muscle rigidity and rhythmic contractions, then returns to a normal state. Approximately 6 hours later, he suffers a second episode. Which medication is he most likely taking?

A 48-year-old man experiences loss of consciousness followed by muscle rigidity and rhythmic contractions, then returns to a normal state. Approximately 6 hours later, he suffers a second episode. Which medication is he most likely taking?

• A. Bupropion
• B. Duloxetine
• C. Fluoxetine
• D. Nortriptyline

Answer: (A)

Seizure risk from certain antidepressants is a key idea here. The described events—a generalized tonic-clonic seizure with a postictal return to baseline, followed by a second similar episode hours later—fit a drug that lowers the seizure threshold in a dose-related way. Among the options, this is most strongly linked to bupropion. Bupropion inhibits reuptake of norepinephrine and dopamine and, unlike the others listed, has a well-known, dose-dependent risk of provoking seizures, especially at higher doses or in patients with predisposing factors. That makes it the best fit for causing recurrent seizures in this patient. The other medications listed can have side effects and, in overdose or certain conditions, may carry some seizure risk, but they are not classically associated with this clear, dose-related proconvulsant effect. So the pattern here points to bupropion as the likely medication. If this were encountered clinically, clinicians would review dosing and risk factors, and consider adjusting or stopping the agent if seizures occur.

Seizure risk from certain antidepressants is a key idea here. The described events—a generalized tonic-clonic seizure with a postictal return to baseline, followed by a second similar episode hours later—fit a drug that lowers the seizure threshold in a dose-related way. Among the options, this is most strongly linked to bupropion. Bupropion inhibits reuptake of norepinephrine and dopamine and, unlike the others listed, has a well-known, dose-dependent risk of provoking seizures, especially at higher doses or in patients with predisposing factors. That makes it the best fit for causing recurrent seizures in this patient.

The other medications listed can have side effects and, in overdose or certain conditions, may carry some seizure risk, but they are not classically associated with this clear, dose-related proconvulsant effect. So the pattern here points to bupropion as the likely medication. If this were encountered clinically, clinicians would review dosing and risk factors, and consider adjusting or stopping the agent if seizures occur.