What medication should be avoided or used cautiously due to its potential to lower the seizure threshold?

Bupropion is the correct choice to consider with caution regarding its potential to lower the seizure threshold. This medication is an atypical antidepressant that is known to carry a higher risk of seizures, particularly at higher doses or in individuals with a predisposition to seizures. Unlike some other antidepressants, which do not have this same risk profile, bupropion can lead to increased neuronal excitability, which is critical to be aware of in clinical practice.

For individuals who have a history of seizures, eating disorders, or are withdrawing from alcohol or sedatives, the use of bupropion is particularly risky and should be avoided or closely monitored.

Other medications listed, such as paroxetine, venlafaxine, and mirtazapine, do not significantly impact seizure thresholds in the same way and are generally considered safer options in patients at risk for seizures. Understanding the unique side effect profile of bupropion is essential for prescribing safely, especially in patients with pre-existing conditions that may predispose them to seizures.