Bupropion for Adult Attention Deficit Disorder
conference coverage
Synopsis: Bupropion is superior to placebo in attenuating ADHD symptoms in adults.
Source: Wilens TE, et al. New Clinical Drug Evaluation Unit Program, 39th Annual Meeting, June 1-4, 1999, Boca Raton, FL.
Attention deficit hyperactivity disorder (ADHD) commonly persists into adulthood. Given the understandable reticence to use lifelong stimulant medication, and the dilemma of giving stimulants to patients with comorbid substance abuse, alternate medications are needed. The current study is a double-blind, placebo-controlled, randomized, six-week trial comparing bupropion SR (Wellbutrin SR) (up to 200 mg bid) to placebo in adults with DSM-IV diagnosed ADHD. Subjects consisted of 38 adults who completed the six-week trial. Subjects were excluded if they had diagnoses of an eating disorder, seizure disorder, bipolar disorder, or substance abuse. Bupropion SR was initiated at 100 mg per day and titrated in weekly intervals to a target dose of 400 mg per day. Subjects’ mean age was 38.3 ± 11 years. Using a predetermined cutoff of 30% or more reduction in ADHD symptoms to denote response, 75% improved on bupropion SR, compared to 37% on placebo (P = 0.012). Similarly, using the Clinical Global Impression (GCI) scores of much to very much improved, 62% met response criteria on bupropion SR, compared to 11% on placebo (P = 0.005). The bulk of improvement in ADHD symptoms occurred after week four. There was no significant effect on anxiety or depression. Average daily dose at week six was 362 mg of bupropion SR. The most common adverse effect reported in those receiving bupropion SR was insomnia (38%). However, this did not result in withdrawal from the study. The delay in full therapeutic effect may represent a combination of time to titration and possibly a delayed onset of action.
Comment by Lauren B. Marangell, MD
Bupropion (Wellbutrin) is currently marketed in the United States for the treatment of depression, and under the trade name Zyban for smoking cessation. As opposed to most other antidepressants, bupropion inhibits the reuptake of norepinephrine, and to a lesser degree, dopamine. Therefore, there is a similarity in neurotransmitter targets between bupropion and the more commonly used psychostimulants. Although the current study has methodological limitations, including a small sample size, the fact that this was a randomized placebo-controlled trial is noteworthy. Bupropion may be a first-choice medication for patients who have both depression and ADHD, when the physician wants to avoid the use of a controlled substance. As in the treatment of depression, bupropion should be avoided in patients who are at increased risk of seizures or have an active eating disorder. Patients who fail to respond to bupropion may have an improved response with subsequent treatment with psychostimulants. (This study was supported by Glaxo-Wellcome, the manufacturer of bupropion.)
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