Which medication should be avoided in patients with a history of seizures when considering treatment for depression or smoking cessation?

Bupropion is commonly known to lower the seizure threshold, making it a less suitable option for patients with a history of seizures. Its mechanism of action, primarily as a norepinephrine-dopamine reuptake inhibitor, can provoke seizures in susceptible individuals, especially at higher doses.

In contrast, varenicline, naltrexone, and amphetamines do not share this same risk to the degree that bupropion does. Varenicline is used for smoking cessation and has a different mechanism that doesn't significantly affect seizure thresholds. Naltrexone is primarily used for alcohol and opioid dependence and is not associated with seizure risks in the same way. Amphetamines, while they can have stimulating effects that might complicate certain mental health conditions, do not inherently raise the risk of seizures in the same manner as bupropion.

Thus, in patients with a history of seizures, bupropion poses a significant risk that necessitates avoidance, making it important to select an alternative treatment that does not carry a similar risk profile.