However, not everyone can tolerate these stimulant medications. Nonstimulant treatments, such as Wellbutrin, are common alternatives that doctors can prescribe to people with ADHD. Wellbutrin is an antidepressant that researchers have tested for the treatment of ADHD in adults. In this article, we discuss the effectiveness, side effects, warnings, and doses of Wellbutrin for treating ADHD in adults.
Wellbutrin is one brand of the generic drug bupropion. People use bupropion for treating depression and seasonal affective disorder , and as an aid for quitting smoking.
Some doctors also prescribe Wellbutrin for antidepressant-induced sexual dysfunction, obesity , attention deficit hyperactivity disorder ADHD , and depressive episodes in people with bipolar disorder. Wellbutrin acts on norepinephrine and dopamine in the brain, which are two chemicals associated with mood.
Extended release formulations release the medication throughout a hour or hour period. People may experience side effects when taking Wellbutrin. Researchers estimate that side effects may occur in at least 1 in 10 people taking the drug. ADHD is a psychological condition that affects both children and adults. People with ADHD may find it difficult to concentrate or pay attention. Other symptoms include impulsivity and hyperactivity. Doctors often prescribe stimulant medications and recommend therapy for people living with ADHD.
However, not everyone responds well or tolerates stimulant medications. Stimulant medications are controlled substances with a potential for abuse, so they may not be suitable for some people. As an alternative to stimulants, doctors can prescribe Wellbutrin to treat symptoms of ADHD in adults. Doctors do not know the safety and efficacy of Wellbutrin in children. In , researchers reviewed six clinical studies that evaluated the effects and side effects of Wellbutrin compared with a placebo in adults with ADHD.
Each study used a long-acting formulation of Wellbutrin and doses ranging from mg to mg per day. The results of this study showed a possible benefit of using Wellbutrin to treat symptoms of ADHD in adults. The low-quality evidence indicates uncertainty with respect to the pooled effect estimates. Further research is very likely to change these estimates. More research is needed to reach more definite conclusions as well as clarifying the optimal target population for this medicine.
Treatment response remains to be reported in a DSM5-diagnosed population. There is also a lack of knowledge on long-term outcomes. The syndrome is commonly accompanied by psychiatric comorbidities and is associated with educational and occupational underachievement. Although psychostimulant medications are the mainstay of treatment for ADHD, not all adults respond optimally to, or can tolerate, these medicines. Thus, alternative non-stimulant treatment approaches for ADHD have been explored.
One of these alternatives is bupropion, an aminoketone antidepressant and non-competitive antagonism of nicotinic acetylcholine receptors. Bupropion is registered for the treatment of depression and smoking cessation, but is also used off-label to treat ADHD. We also searched three trials registers and three online theses portals. In addition, we checked references of included studies and contacted study authors to identify potentially relevant studies that were missed by our search.
We included all randomised controlled trials RCTs that evaluated the effects including adverse effects of bupropion compared to placebo in adults with ADHD. Two review authors WV, GB independently screened records and extracted data using a data extraction sheet that we tested in a pilot study. We extracted all relevant data on study characteristics and results. We assessed risks of bias using the Cochrane 'Risk of bias' tool, and assessed the overall quality of evidence using the GRADE approach.
We used a fixed-effect model to pool the results across studies. We included six studies with a total of participants. Five studies were conducted in the USA, and one in Iran. All studies evaluated a long-acting version of bupropion, with the dosage ranging from mg up to mg daily. Study intervention length varied from six to 10 weeks. Four studies explicitly excluded participants with psychiatric comorbidity and one study included only participants with opioid dependency.
Four studies were funded by industry, but the impact of this on study results is unknown. Two studies were publicly funded and in one of these studies, the lead author was a consultant for several pharmaceutical companies and also received investigator-driven funding from two companies, however none of these companies manufacture bupropion.
The WSAS is a clinician-administered scale addressing overall social adjustment as well as five specific components: work, social leisure, extended family, marriage, and parental functioning Weissman An attempt was made to increase the dose of bupropion over the first 3 weeks to the maximum tolerated dose or until a significant response was produced as assessed by the CGI-I scale.
Dosing was flexible and could be either once or twice daily, depending upon response, adverse effects, and patient preference. However, if the total daily dose exceeded mg, it was divided between two daily doses.
Clinic visits were done at days 0, 7, 14, 21, 35, and After the conclusion of the study, patients were allowed to enter a 6-month open-label study. At the conclusion of either portion of the overall study, patients were followed until stable and then treated as private clinic patients or referred to an outside clinic. To compare study groups on continuous variables a repeated measures ANOVA using the screening visit and the last double-blind visit was performed.
For comparison of groups on continuous variables at specific time intervals, the Mann-Whitney Wilcoxon test was used. All patients with at least one outcome measure during the double-blind period were included using a last-visit-carried-forward design.
Statistical tests were performed using the SPSS Fifty-nine patients 43 male, 16 female signed informed consent for entry into the study. All but two patients were assessed as having substantial symptoms in both attentional and hyperactive areas.
These two patients had primarily attentional symptoms. The patients assigned to two treatment groups placebo or bupropion SR did not differ in demographic or pretreatment measures Table 1. There were mild elevations in anxiety and depression as indicated by average HAM-D scores of Seventy-nine percent of patients were experiencing at least moderate problems in their overall social adjustment, a non-surprising number given that one requirement for admission was at least moderate impairment in one area of social adjustment.
Work and marriage were the most common problem areas. Pretreatment demographic and clinical characteristics of all adults enrolled in the study. Of the 59 patients who entered the study, 47 provided outcome data during the double-blind period. Patients dropping out either did not complete the single-blind evaluation or did not furnish outcome data during the double-blind period following randomization. There were no significant pretreatment differences between these patients and those continuing in the study.
Furthermore, there was no evidence of adverse effects leading to study withdrawal. Data were collected on vital signs and side effects at each visit. There were no significant adverse effects and the medication was well tolerated. Table 2 shows the outcome measures for the 47 patients who completed the double-blind period.
However, both patients on placebo and those on bupropion SR demonstrated this improvement, and the difference between the two groups was not significant on this measure. This graph does not carry forward data on patients who dropped out. Thereafter, the placebo patients showed no more change, while the bupropion SR patients improved an additional 3.
The subjects in the active treatment arm averaged The placebo subjects averaged Although bupropion SR produced more improvement than placebo in reducing ADHD symptoms in this short-term, double-blind study, statistical analysis indicated that these were nonsignificant numerical trends favoring bupropion SR.
No statistically significant differences were found between bupropion and placebo a priori. This limited statistical significance stands in contrast to the more positive studies of bupropion found in the literature. Most studies that employ a single-blind placebo phase use the results at the end of the single-blind period to measure change over the course of the study.
This is done partly to give researchers an extended opportunity to remove inappropriate patients. Additionally, it is generally believed that the single-blind phase may increase the power of the study. We had initially examined this data set employing the scores at the end of the single-blind phase to measure change over the course of the study.
However, after producing a graph of the WRAADDS for the study visits, and noting the changes during the single-blind week on placebo, we decided to measure improvement from both the beginning and the end of the single-blind placebo period. In contrast to expectations, the single-blind data actually reduced the differences found in the study.
This limited statistical significance contrasts with previously reported studies evaluating bupropion in ADHD. Five factors may account for why these results differ from those of previous studies. If equal numbers of patients had been placed in both treatment groups, and if the same response rates were observed, the results on the CGI-I would have achieved statistical significance.
Second, the small sample size limited the overall power of the study to detect a difference. Third, it is possible that a higher dose would have produced greater differences.
The current study had four placebo responders. Three of these were followed for 4—6 months, and all three continued to do well without medication. Finally, and perhaps most significantly, there was a very important difference between the design of this study and that of Wilens et al that might render a direct comparison misleading.
All patients with current major depression, dysthymia, or symptoms of depression as measured by the HAM-D were excluded from our study. The only depressive diagnosis allowed was a single past episode of major depression that was clearly related to environmental stresses.
Consequently, the samples of patients in these two studies may be quite different. An important question in the use of bupropion in ADHD regards the appropriate duration of a trial in evaluating whether a patient will respond to the medication.
There was little additional recruitment of bupropion responders after week 4. Conversely, in the Wilens report there were patients who seemed to become responders between weeks 4 and 6.
Despite the fact that no additional responders were identified between week 4 and week 6, we would still recommend 6 weeks as the appropriate duration for short-term double-blind studies with bupropion. There is a significant question regarding the level of improvement in ADHD symptoms required to produce clinically meaningful improvement in psychiatric adjustment.
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