Alternative to stimulant drugs are needed to expand treatment options for clinicians and patients.
One problem with the stimulants is the potential for misuse and diversion of prescription drugs to illicit drug use.
One non-stimulant FDA approved drug (atomoxetine/Strattera) is available in the U.S.
An additional drug of interest for treatment of ADHD is the antidepressant drug bupropion (Wellbutrin). Bupropion is not a selective serotonin reuptake inhibitor like the most commonly prescribed antidepressants. It appears to target other neurotransmitters like dopamine that may be more relevant in the pathophysiology of ADHD.
Bupropion has not received full clinical trial attention and is not an FDA approved drug in the U.S. Nevertheless, there is some research suggesting it may be useful in ADHD.
A recent study from Iran summarized the results of a randomized, double-blind trial of bupropion in 42 adults with ADHD.
This study found the following results:
- A statistically superior reduction in ADHD symptoms for bupropion vs controls (-43% v -18%)
- The most common side effects with bupropion were agitation, fatigue, somnolence and anxiety
- Side effect frequency in the bupropion group was not statistically different than in the control group although small sample size may have contributed to reduced power to find a difference (type II error)
The authors note that the maximum dose of bupropion in their study was only 150 mg per day. Doses as high as 300 mg per day are common for the treatment of depression. If tolerated, higher doses may be able to further reduce symptoms of ADHD.
A recent meta-analysis examined the efficacy and acceptability of four drugs including bupropion for ADHD in children and adolescents.
This study found bupropion to have lower efficacy compared to the standard stimulant drugs in ADHD.
Nevertheless, bupropion may have some clinical utility for ADHD in adults. Bupropion is approved for smoking cessation and major depression. Adult smokers with ADHD or depressed adults with ADHD may benefit from a drug trial of bupropion.
As noted, bupropion has not been approved by the FDA for ADHD. Any use of this drug for ADHD is off-label. Drug selection and treatment for ADHD requires assessment by a qualified medical professional along with clinical monitoring for safety and efficacy.
Readers with more interest in the two studies discussed in this post can find access to the abstracts by clicking on the PMID links in the citations below.
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Hamedi M, Mohammdi M, Ghaleiha A, Keshavarzi Z, Jafarnia M, Keramatfar R, Alikhani R, Ehyaii A, & Akhondzadeh S (2014). Bupropion in adults with Attention-Deficit/Hyperactivity Disorder: a randomized, double-blind study. Acta medica Iranica, 52 (9), 675-80 PMID: 25325205
Stuhec M, Munda B, Svab V, & Locatelli I (2015). Comparative efficacy and acceptability of atomoxetine, lisdexamfetamine, bupropion and methylphenidate in treatment of attention deficit hyperactivity disorder in children and adolescents: A meta-analysis with focus on bupropion. Journal of affective disorders, 178, 149-159 PMID: 25813457
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