ADHD is a common mental disorder commonly treated with a host of different medications. Clinicians rarely recommend bupropion as a first choice because of its side effects, many of which are similar to those of the stimulant class of medication. Still, bupropion’s unique properties may benefit patients at risk for addiction (such as teenagers or people with a history of addiction) or people with other problems such as nicotine dependence, depression, or oppositional defiant disorder.
Although bupropion has been studied heavily for other conditions such as depression, there have not been very many studies studying its effectiveness in ADHD. Overall, clinicians feel that methylphenidate is more effective, although some studies have shown no major differences.
One of the main uses of bupropion is for treating ADHD with hyperfocus on unproductive behaviors, like video games. It may also be helpful as an add-on for aggression. It is not addictive and is also an effective antidepressant. Although there are case reports of bupropion making tics worse in patients with Tourette’s syndrome, most studies do not mention tics as a major side effect of bupropion. It works best if taken daily, and like other nonstimulants, it works through the entire day.
Serious (but uncommon) side effects of bupropion include seizures (especially in people who already have a seizure disorder or who have had a head injury, or in people taking higher doses). Common side effects include insomnia (in up to 40%) and appetite suppression. Anxiety and nervousness are also more common in people taking bupropion than placebo.
The bupropion package insert also carries warnings about suicidality. This is a standard warning for all antidepressants and is based on the observation that depressed patients tend to briefly become more suicidal when they first enter treatment. No one knows if this type of danger exists for patients who are not depressed, but who are taking bupropion for ADHD alone.
Pregnancy and Breastfeeding
Bupropion is pregnancy category C, meaning the risk to a pregnancy is unknown. One small study showed no effect on children born to mothers taking bupropion during their pregnancy, but it has not been repeated. Usually bupropion would not be recommended unless the mother’s need for bupropion was due to symptoms directly affecting the pregnancy, such as depression or distractability leading to inadequate weight gain or inability to remember important medications.
Bupropion passes into breastmilk in very low quantities. There is a case report of one child having seizures while breastfeeding from a mother who was taking bupropion. This mother was also taking other medications.
Insurance coverage for bupropion is difficult to predict. Some insurances cover it, but since it is a second line medication for depression and also used to treat addiction to nicotine, it is sometimes covered at a higher copay or not at all. It is available as a generic, but without insurance, the generic can still be pricey compared to clonidine and guanfacine (other generic nonstimulants used for ADHD).
There is no ideal medication for ADHD. Nonstimulants have the important advantage of not being addictive, while having similar effectiveness to stimulants. However, bupropion has its own side effects, many of which are similar to stimulants, making it the medication of choice for only a minority of patients. Still, if ADHD is negatively affecting you or your child’s life, it’s best to do what you can to get effective treatment.
Barrickman, Les L., Paul J. Perry, A. J. Allen, Samuel Kuperman, Stephan V. Arndt, Kenneth J. Herrmann, and Elizabeth Schumacher. “Bupropion versus Methylphenidate in the Treatment of Attention-Deficit Hyperactivity Disorder.” Journal of the American Academy of Child & Adolescent Psychiatry 34.5 (1995): 649-57. Print.
Conners, C. Keith, Charles D. Casat, C. Thomas Gualtieri, Elizabeth Weller, Mark Reader, Allan Reiss, Ronald A. Weller, Moise Khayrallah, and John Ascher. “Bupropion Hydrochloride in Attention Deficit Disorder with Hyperactivity.” Journal of the American Academy of Child & Adolescent Psychiatry 35.10 (1996): 1314-321. Print.
Kuperman, Samuel, Paul Perry, Gary Gaffney, Brian Lund, Kristine Bever-Stille, Stephan Arndt, Timothy Holman, David Moser, and Jane Paulsen. “Bupropion SR vs. Methylphenidate vs. Placebo for Attention Deficit Hyperactivity Disorder in Adults.”Annals of Clinical Psychiatry 13.3 (2001): 129-34. Print.
Moses, Scott. “Family Practice Notebook.” ADHD Medication. N.p., 9 Mar. 2013. Web. 10 July 2013.
Wellbutrin [package insert]. GlaxoSmithKline, Research Triangle Park, NC; March 2013. http://us.gsk.com/products/assets/us_wellbutrin_tablets.pdf. Accessed May 28, 2013.
Wilens, T. E., T. J. Spencer, J. Beiderman, K. Girard, R. Doyle, J. Prince, D. Polisner, R. Solhkhah, S. Comeau, M. C. Monuteaux, and A. Parekh. “A Controlled Clinical Trial of Bupropion for Attention Deficit Hyperactivity Disorder in Adults.” Journal of the American Academy of Child and Adolescent Psychiatry 158.2 (2001): 282-88. Print.