Bupropion is typically not used for ADHD because there are
many stimulants that are more effective and have a similar side effect
profile. However, it is preferred in
certain situations, when the patient is struggling with hyperfocus on
nonproductive activities (like screen time), addiction, binge eating, or
depression, or if the patient hasn’t responded to other medications.
How well does it
work?
Bupropion has been studied in a few smaller clinical studies. A 2015 metanalysis
concluded that while bupropion appeared to be modestly effective, further study
was warranted. In this same metanalysis,
stimulants and atomoxetine were both found to be more effective than bupropion
for ADHD. Like most nonstimulants,
bupropion does work all day once it starts to work, but it is usually several
weeks after starting.
What are the side
effects?
Bupropion has a well established track record in treating
depression and nicotine dependence. It
has also been recently approved for treatment of binge eating disorder in
combination with naltrexone. Since it
has been widely used for some time, the side effects and long term effects are
relatively well known.
One downside to bupropion is that its side effects are
similar to the stimulants. Anxiety,
appetite problems, and insomnia (in about 40%) are common. There are some case reports of tics being
worsened by bupropion, but generally tics have not been reported as a common
side effect. However, bupropion is not
habit forming.
The package label carries a black-box warning about possible
increase in suicidal thinking. This can
be seen with antidepressant usage in depressed patients. It is not seen in nondepressed patients who
take bupropion to quit smoking. No study
has examined this issue in patients taking bupropion only for ADHD, as such, it
is important to be aware of the possibility.
Pregnancy and
Breastfeeding
Until recently, bupropion was considered pregnancy class B,
safe in pregnancy. However, newer rat
studies suggested that birth defects could be possible, so it was changed to
pregnancy category C, pregnancy risk unknown.
Typically drugs in category C are used only if the benefits outweigh the
risks and there are no good alternatives.
For example, if you have ADHD that is severe enough to make you unable
to function at work or at home, and you have a history of addiction to speed
(i.e. you can’t take stimulants), bupropion may be the best choice for your
ADHD, but you wouldn’t want to switch from Adderall (if it worked well and you
were otherwise healthy) to bupropion with the thought that it might be safer.
Bupropion does enter the breastmilk in small quantities that
would not be expected to cause problems for a nursing infant. However, two case studies have reported
seizures in infants of mothers taking bupropion and it is possible that the
bupropion was responsible. Currently,
nursing mothers who are taking bupropion are counseled not to stop breastfeeding,
but to inform their health provider if their child has unusual symptoms.
Cost
Unfortunately because it is used in treating nicotine
addiction, it is often not covered by lower end insurance companies who don’t
want to pay for something more expensive than nicotine patches for people
trying to quit smoking. It’s best to
check with your insurance company and perhaps get your doctor to help with
getting coverage if you need this medication.
Bottom line
Bupropion is a third line drug for ADHD for a good
reason. It isn’t as effective as the
stimulants and has a similar side effect profile. However, it is nonaddictive and does work for
some people. Additionally, it works all
day and has antidepressant properties.
So it could be a good fit for a select group of patients who have failed
treatment with stimulants, or who are unable to take them.
This article is part of a series on nonstimulants, including atomoxetine ( Strattera), clonidine (Kapvay), and guanfacine (Tenex, Intuniv).
This article is part of a series on nonstimulants, including atomoxetine ( Strattera), clonidine (Kapvay), and guanfacine (Tenex, Intuniv).
References:
"Bupropion." LACTMED. US National Library of Medicine, 6 Nov. 2015. Web. 19 Aug.
2016.
Moses, Scott. "Family Practice
Notebook." ADHD Medication. N.p., 9 Mar. 2013. Web. 10 July
2013.
Wellbutrin [package
insert]. GlaxoSmithKline, Research
Triangle Park NC
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