Long term effects of bupropion

Bupropion (Wellbutrin) | NAMI: National Alliance on Mental Illness

Brand names:

Wellbutrin SR®
- Tablets: 100 mg, 150 mg, 200 mg
Wellbutrin XL®
- Tablets: 150 mg, 300 mg
Zyban®
- Tablets: 150 mg
Forfivo XL®
- Tablets: 450 mg
Aplenzin®
- Tablets: 174 mg, 348 mg, 522 mg
Bupropion hydrochloride
- Immediate release tablets: 75mg, 100 mg
- Sustained release tablets: 100 mg, 150 mg, 200 mg
- Extended release tablets: 150 mg, 300 mg
Bupropion hydrobromide
- Extended release tablets: 174 mg, 348 mg, 522 mg

Generic name: bupropion (byoo PRO pee on)

All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.

What Is Bupropion And What Does It Treat?

Bupropion is an antidepressant medication that works in the brain. It is approved for the treatment of major depressive disorder (MDD), seasonal affective disorder (SAD), and to help people quit smoking (smoking cessation).

Symptoms of depression include:

Depressed mood - feeling sad, empty, or tearful
Feeling worthless, guilty, hopeless, and helpless
Loss of interest or pleasure in your usual activities
Sleep and eat more or less than usual (for most people it is less)
Low energy, trouble concentrating, or thoughts of death (suicidal thinking)
Psychomotor agitation (‘nervous energy’)
Psychomotor retardation (feeling like you are moving and thinking in slow motion)
Suicidal thoughts or behaviors

SAD is a type of depression that occurs mainly during the autumn-winter season. Although the common term SAD is now referred to as Major Depression with Seasonal Pattern, this fact sheet will continue to use SAD as it is more commonly known.

Bupropion may also be helpful when prescribed “off-label” for bipolar disorder, attention deficit hyperactivity disorder (ADHD, and sexual dysfunction due to SSRI antidepressants. “Off-label” means that it hasn’t been approved by the Food and Drug Administration for this condition. Your mental health provider should justify his or her thinking in recommending an “off-label” treatment. They should be clear about the limits of the research around that medication and if there are any other options.

What Is The Most Important Information I Should Know About Bupropion?

After starting bupropion, symptoms gradually decrease over a period of weeks. In MDD and SAD, sleep and other physical symptoms may improve before there is noticeable improvement in mood or interest in activities. Once symptoms are under control, MDD usually requires long-term treatment to help prevent the return of depressive symptoms. If you are using bupropion for SAD or smoking cessation, the length of your treatment may be shorter. With input from you, your health care provider will assess how long you will need to take the medicine.

Do not stop taking bupropion or change your dose without talking with your health care provider first.

Depression is also a part of bipolar illness. People with bipolar disorder who take antidepressants may be at risk for "switching" from depression into mania. Symptoms of mania include "high" or irritable mood, very high self-esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).

Are There Specific Concerns About Bupropion And Pregnancy?

If you are planning on becoming pregnant, notify your health care provider to best manage your medications. People living with MDD who wish to become pregnant face important decisions, each with risks and benefits as they relate to how the illness, medications, and risks to the fetus may interact. Untreated MDD has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.

Bupropion has also been evaluated for smoking cessation during pregnancy and is recommended only after other therapies have failed.

Caution is advised with breastfeeding since bupropion does pass into breast milk.

What Should I Discuss With My Health Care Provider Before Taking Bupropion?

Symptoms of your condition that bother you most
If you have thoughts of suicide or harming yourself
Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require an adjustment in the medication.
Any other psychiatric or medical problems you have, including a history of bipolar disorder
All other medications you are currently taking and any medication allergies you have. This will help your prescriber assess for potential drug interactions.
Other non-medication treatment you are receiving (such as psychotherapy (i.e., talk therapy) or substance abuse treatment). Your provider can explain how these different treatments work with the medication.
If you are pregnant, plan to become pregnant, or are breastfeeding
If you drink alcohol or use drugs

How Should I Take Bupropion?

Bupropion hydrochloride is available in 3 different forms: immediate release (IR), sustained release (SR), and extended release (XL).

Bupropion IR is usually taken 2 or 3 times per day with 4-6 hours between doses. The dose usually ranges from 100 mg twice daily to 150 mg three times daily, with the last dose taken mid-afternoon.

Bupropion SR is usually taken twice daily in the morning and mid-afternoon. The dose usually ranges from 100 mg twice daily up to 200 mg twice daily.

Bupropion XL is usually taken once daily in the morning. The dose ranges from 150 mg to 450 mg.

Bupropion hydrobromide (Aplenzin®) is usually taken once daily in the morning. The dose ranges from 174 mg to 522 mg.

While there are dose ranges for each form, your health care provider will determine the form and dose that is right for you based on your response.

The dose for SAD is bupropion XL 150 mg once daily in the morning. The dose may be increased to 300 mg once daily.

The dose for smoking cessation is bupropion SR 150 mg once daily for 3 days and then twice daily for 7 to 12 weeks.

You should not take more than one product that contains bupropion, including the products that are used to quit smoking. Do not take more than your prescribed dose since higher doses may increase your risk of having a seizure. Since quickly increasing the dose of bupropion can cause seizures in some people, your doctor will slowly increase your dose.

You can take bupropion on an empty stomach or with food. The SR and XL forms should be swallowed whole — not chewed, crushed, or broken — so that the medication can work correctly in your body and to reduce the risk of serious side effects. The tablet shell from the SR and XL forms may appear in your feces.

Consider using a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member or friend to remind you or check in with you to be sure you are taking your medication.

What Happens If I Miss A Dose Of Bupropion?

For bupropion IR or SR, if you miss a dose, take it as soon as you remember. Take the remaining doses for the day at evenly spaced times at least 4 hours apart. DO NOT take 2 doses at once. You should not take more than your prescribed dose and doing so may increase your risk of having a seizure.

For bupropion XL, do not take an extra tablet to make up for the dose you forgot. Wait and take your next dose at your regular time the next day.

What Should I Avoid While Taking Bupropion?

Avoid drinking alcohol or using illegal drugs while you are taking bupropion because the beneficial effects of the medication may be decreased and the risk of seizures may be increased. If you are dependent on drugs or alcohol and would like to stop, consult your healthcare provider for help. Abruptly stopping these substances can result in a seizure, especially when taking bupropion.

What Happens If I Overdose With Bupropion?

If an overdose occurs, call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

What Are The Possible Side Effects Of Bupropion?

Common side effects

Headache, weight loss, dry mouth, trouble sleeping (insomnia), nausea, dizziness, constipation, fast heartbeat, and sore throat. These will often improve over the first week or two as you continue to take the medication.

Rare/serious side effects

Less than 10% of patients will experience skin rash, sweating, ringing in the ears, shakiness, stomach pain, muscle pain, thought disturbances, anxiety or angle closure glaucoma (symptoms of angle closure glaucoma may include eye pain, changes in vision, swelling or redness in or around eye).

Unlike many antidepressants, bupropion does not commonly cause sexual side effects and may be selected as an alternative treatment when antidepressant-induced sexual side effects are problematic. Sexual side effects include such problems as difficulty achieving orgasm or ejaculatory delay.

In general the risk of seizures due to bupropion is low. The risk of having a seizure increases with higher than recommended doses of bupropion, a history of seizures or head injury, tumor in the brain, severe liver disease, an eating disorder, alcohol or drug dependence, or taking other drugs that can also increase your risk of having a seizure.

There is a low risk of cardiovascular adverse events associated with stimulating agents, including bupropion. This risk increases if you have heart disease, high blood pressure, previous heart attack, or irregular heartbeat, or when used with transdermal nicotine replacement products. In these cases, a thorough cardiovascular evaluation is recommended before starting this medicine.

Are There Any Risks For Taking Bupropion For Long Periods Of Time?

To date, there are no known problems associated with long term use of bupropion. It is a safe and effective medication when used as directed.

What Other Medications May Interact With Bupropion?

Bupropion should not be taken with or within two weeks of taking monoamine oxidase inhibitors (MAOIs). These include phenelzine (Nardil®), tranycypromine (Parnate®), isocarboxazid (Marplan®), and selegiline (Emsam®).

There are several products with the active ingredient bupropion. Do not take more than one product that contains bupropion since this may increase your risk of having a seizure.

Certain medications may increase your risk of having a seizure when combined with bupropion. These include other antidepressants, antipsychotics, theophylline, isoniazid, tramadol, stimulants, steroids, hypoglycemic agents (including insulin), certain antibiotics (e.g., Cipro®), and abrupt discontinuation of benzodiazepines (e.g., Ativan®).

Notify your doctor and pharmacist if you are taking any of the following medications: phenytoin (Dilantin®), carbamazepine (Tegretol®, Equetro®), phenobarbital, cimetidine (Tagamet®), ritonavir (Norvir®), lopinavir (Kaletra™), nelfinavir (Viracept®), or efavirenz (Sustiva®). These medications can change the way your body reacts to bupropion.

Notify your doctor and pharmacist if you are taking any of the following medications: atomoxetine (Stratterra®), codeine, tamoxifen, tetrabenazine, thioridazine (Mellaril®), tramadol (Ultram®), or a tricyclic antidepressant. Bupropion can change the way your body reacts to these medications.

How Long Does It Take For Bupropion To Work?

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.

Summary of FDA Black Box Warnings

Suicidal thoughts or actions in children and adults

Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications. This risk may persist until significant remission occurs.

In short-term studies, antidepressants increased the risk of suicidality in children, adolescents and young adults when compared to placebo. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24. Adults ages 65 and older taking antidepressants have a decreased risk of suicidality. Patients, their families and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or healthcare professional. All patients being treated with antidepressants for any indication should watch for and notify their healthcare provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.

Provided by

(December 2020)

©2020 The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). CPNP and NAMI make this document available under the Creative Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.

This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein.

Wellbutrin side effects and how to avoid them

Wellbutrin treats major depressive disorder (MDD), seasonal affective disorder (SAD), and assists with smoking cessation

Wellbutrin (bupropion hydrochloride) is a brand-name prescription drug used for the treatment of major depressive disorder (MDD), the prevention of seasonal affective disorder (SAD), and smoking cessation, in addition to several off-label uses. As an antidepressant medication, Wellbutrin works by increasing the amount of norepinephrine and dopamine in the brain. These substances are neurotransmitters that are involved with regulating mood, emotions, memory, and motivation, and by increasing the levels of these neurotransmitters, Wellbutrin can help manage mental health conditions.

Brand-name Wellbutrin is available as a sustained-release (Wellbutrin SR) or extended-release (Wellbutrin XL) tablet, and generic Wellbutrin is available as an immediate-release tablet in addition to a sustained- or extended-release tablet. Bupropion might also be sold under other brand names including Forfivo XL and Aplenzin (bupropion hydrobromide), as well as Zyban, which has recently been discontinued. Although Wellbutrin works differently than other antidepressants, it does have side effects and may not be suitable for some people with pre-existing medical conditions.

RELATED: What is Wellbutrin?

Common side effects of Wellbutrin

The most common side effects of Wellbutrin are:

Trouble sleeping
Headache
Agitation
Dry mouth
Constipation
Weight loss or weight gain
Migraine
Nausea
Vomiting
Excessive sweating
Tremor
Dizziness
Blurred vision
Fast heartbeat
Joint aches
Sore throat

Serious side effects of Wellbutrin

Possible side effects of Wellbutrin that can be serious or even life-threatening include:

Worsened depression
Suicidal thoughts and behaviors
Homicidal thoughts
Neuropsychiatric events (psychosis, mania, hallucinations, and panic attacks)
Seizures
Severe high blood pressure (hypertension)
Heart problems, including irregular heartbeat
Angle-closure glaucoma
Liver problems
Visual problems, such as changes in vision
Severe allergic reactions

Wellbutrin and suicide

Wellbutrin has a black box warning that highlights a risk of worsening depression and suicidal thoughts or behaviors in children, teens, and young adults. The incidence of these adverse effects is between 0.1% and 1%, although older adults are at a lower risk of this effect. Patients and caregivers should watch behavior and mood closely and call a healthcare provider at any signs of suicidality, such as:

Talks of suicide or dying
Suicide attempts
New or worsened depression, anxiety, or irritability
Agitation and restlessness
Extreme dietary changes
Irritability
Trouble sleeping
Increased use of illicit substances or alcohol
Unusual, aggressive, or violent behaviors
Isolation from friends and family

Wellbutrin and angle-closure glaucoma

Angle-closure glaucoma is a medical emergency that comes on suddenly when the opening, or angle, between the iris and the cornea is blocked, causing fluid pressure to build up rapidly in the eye. This opening allows fluid to drain from the eye, but people with uncorrected “narrow angles” between the iris and the cornea are particularly vulnerable to closure. Because angle-closure glaucoma can rapidly develop into permanent vision loss, you should immediately stop taking Wellbutrin and go to an emergency room at any sign of angle-closure glaucoma, such as:

Eye pain
Changes in vision
Swelling or redness in or around the eye

Wellbutrin and neuropsychiatric events

When taken for smoking cessation, Wellbutrin has been reported to cause neuropsychiatric events, such as depression, anxiety, panic attacks, hostility, and even psychosis or hallucinations. The risk of experiencing these events can vary, but people with a history of mental health problems may be at a high risk of experiencing these events. Patients and caregivers should monitor behaviors and mood closely and call a healthcare provider at any sign of psychiatric problems.

Wellbutrin and weight loss

Weight loss is a common side effect of Wellbutrin, affecting 14% to 23% of people who take the medication. Anorexia—loss of appetite—is also commonly experienced, with an incidence between 1% and 18%. For this reason, some healthcare professionals may prescribe bupropion off-label for weight loss or weight loss maintenance, while others consider it the antidepressant of choice for patients diagnosed with both depression and obesity. The U.S. Food and Drug Administration (FDA) has approved at least one bupropion drug for weight loss: Contrave, a combination of bupropion and naltrexone, a drug normally used to treat opioid or alcohol abuse.

How long do side effects last?

With a half-life of 14 hours when taken as a single dose and 21 hours when taken on a consistent basis, bupropion and its active metabolites can remain in the body for three or four days. However, side effects are usually mild and temporary. Side effects of bupropion can last a couple of days or weeks as the body gets used to the drug. Consult a healthcare provider if side effects last longer than two to three weeks, or if side effects are particularly bothersome or severe.

Some side effects may take longer to resolve or require medical attention. Serious adverse effects, such as severe allergic reactions, angle-closure glaucoma, irregular heartbeat, heart attack, seizures, severe high blood pressure, and severely low blood sodium levels will require medical attention. Some of these side effects, such as angle-closure glaucoma or heart attack, may have lifelong complications.

Suicidality, worsening of depression, mood changes, mania, hostility, and other neuropsychiatric events can occur with the use of bupropion. In many cases, Wellbutrin will be discontinued. However, these symptoms may be due to pre-existing mental health problems, so long-term psychiatric treatment for other mental health problems may be recommended.

Wellbutrin contraindications & warnings

Wellbutrin affects the brain and body in different ways, and it can cause problems in people with a variety of pre-existing conditions.

Abuse and dependence

The U.S. Food and Drug Administration (FDA) does not consider Wellbutrin a drug that can cause physical dependence, abuse, or tolerance. However, Wellbutrin can produce a mild amphetamine-like reaction. For this reason, Wellbutrin is commonly abused as a street drug and sometimes referred to as “the poor man’s cocaine.” This medication also carries a risk for psychological dependence, but the most serious problems are side effects, particularly seizures, when people abuse bupropion by snorting the drug, injecting the drug, or taking it in large doses.

Overdose

A Wellbutrin overdose is potentially serious and will often require medical attention. The most common side effect of a Wellbutrin overdose is seizures, but other symptoms include:

Hallucinations
Loss of consciousness
Fast heartbeat
Irregular heartbeat
Overactive reflexes
Convulsions

When taken in excessive amounts in combination with other drugs, Wellbutrin may also cause fever, muscle rigidity, low blood pressure, stupor, coma, and respiratory failure.

Restrictions

Some medical conditions make taking Wellbutrin too hazardous:

Anyone with allergies to bupropion will not be prescribed Wellbutrin.
Because of an increased risk of seizures, Wellbutrin is never given to people with a history of seizures, a prior diagnosis of an eating disorder, such as anorexia or bulimia, or anyone undergoing abrupt withdrawal from alcohol, barbiturates, benzodiazepines, or antiepileptic medications.

Other pre-existing conditions may cause problems, so healthcare providers will prescribe Wellbutrin cautiously and watch carefully for side effects.

Because of the increased risk of suicidal thoughts and behaviors, people younger than the age of 25 should be carefully watched for signs of worsening depression, unusual behaviors, or thoughts about suicide or dying. Any mood changes, depression, or suicidality need to be reported to the prescribing healthcare professional as soon as they’re noticed.
Because of an increased risk for seizures, people with risk factors for seizures may need to be carefully monitored. These risk factors include head injury, CNS infection, severe stroke, arteriovenous malformation, and drug or alcohol abuse.
People with a history of mental health problems will be monitored for neuropsychiatric side effects, particularly when taking Wellbutrin for smoking cessation.
All antidepressants can provoke mania or hypomania in people with bipolar disorder, so people with bipolar disorder should be closely monitored for behavioral changes.
People with high blood pressure or a recent heart attack may require close monitoring of blood pressure.
People who have uncorrected narrow angles are at a higher risk of narrow-angle glaucoma when taking Wellbutrin, so they should watch for and report any eye problems.
People with Tourette’s syndrome or with a tic disorder may be at risk for new or worsening tics when taking Wellbutrin.
Wellbutrin may require dose modifications and monitoring in people with liver or kidney problems.

Pregnancy and nursing

There is no evidence that bupropion increases the risk of birth defects, miscarriage, or other problems when taken during pregnancy. Because untreated depression does have pregnancy risks, women should get medical advice from a healthcare professional about the safety and benefits of taking Wellbutrin during pregnancy.

Nursing mothers are advised to be cautious about taking Wellbutrin. Bupropion and its active metabolites are present in breast milk, but healthcare providers are uncertain about its effects on the baby. Before taking Wellbutrin, women who are breastfeeding should talk to a healthcare professional about its benefits and risks.

Children

The Food and Drug Administration (FDA) has not approved bupropion for anyone younger than the age of 18. Some healthcare providers, however, may prescribe Wellbutrin off-label to children as young as 11 years of age, but these children are at an increased risk of worsening depression, suicidal thoughts, and suicidal behaviors.

Seniors

People older than 65 can take Wellbutrin in the same doses as younger adults, but doses may be modified in some older adults if the person has liver or kidney problems.

Wellbutrin interactions

Most Wellbutrin drug interactions are minor, but some are serious enough to require monitoring, dosing changes, or avoiding the drug combination altogether.

Wellbutrin is never combined with some drugs because of the potential hazards. These include:

MAO inhibitors: Because of the risk for high blood pressure or seizures, Wellbutrin is never taken with monoamine oxidase inhibitors (MAOIs), a small family of drugs that includes the antidepressants isocarboxazid, phenelzine, tranylcypromine, and selegiline. Other examples of MAOIs include the cancer drug procarbazine, the antibiotic linezolid, and methylene blue injections.
Anti-seizure medications, barbiturates, and benzodiazepines: Because of an increased risk of seizures, treatment with Wellbutrin is not started if these medications have been used excessively or discontinued suddenly.
Other precautions: Because of the increased risk of serious heart rhythm problems, Wellbutrin is not recommended to be taken with the antipsychotic drugs pimozide or thioridazine.

Some drugs that lower the seizure threshold may need to be avoided. These include:

Antipsychotics
Tricyclic antidepressants
Appetite suppressants
Certain opioids
Systemic corticosteroids
Theophylline
Stimulants

Bupropion raises dopamine levels in the brain. When combined with similar drugs (dopaminergic drugs), dopamine can rise to toxic levels. So both levodopa and amantadine should be used cautiously with bupropion.

Bupropion can block the body’s metabolism of other drugs. As a result, the concentration of other drugs in the body can increase, raising the risk of side effects. Either these drugs must be stopped or the doses must be changed. These include:

Tricyclic antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
Antipsychotics
Beta blockers
Certain types of heart rhythm medications

Finally, alcohol mixed with bupropion can provoke neuropsychiatric events. The use of alcohol should be avoided or minimized when taking Wellbutrin.

How to avoid Wellbutrin side effects

1. Take Wellbutrin as directed

Take Wellbutrin as instructed. The typical dose is 300 mg a day. Don’t skip a dose, but if you do, don’t make up that dose. Wait until the next scheduled dose and take that dose as planned.

2. Tell the healthcare provider about all medical conditions

To avoid potentially serious side effects, tell the prescribing healthcare professional about all medical conditions, especially if you’ve had a history of:

Eating disorders
Suicide attempts
Depression or other mental health problems, such as mania, hypomania, or bipolar disorder
Heart disease, high blood pressure, or recent heart attack
Liver problems
Kidney problems
Head injuries
Seizures
Brain or spinal tumors
Diabetes
Alcohol or illicit drug use
Pregnancy or pregnancy plans
Breastfeeding or plans to breastfeed

3. Tell the healthcare provider about all medications

Drug interactions can also cause side effects, so tell your healthcare provider about all prescription and over-the-counter medications you take, especially:

MAO inhibitors
Anti-seizure medications
Sedatives
Benzodiazepines
Opioids

4.

Do not drink alcohol

Drinking alcohol when being treated with Wellbutrin can cause neuropsychiatric side effects. Avoid alcohol entirely or drink in moderation according to your doctor’s instructions.

5. Be careful about driving and other risky activities at first

Avoid driving cars or operating machinery for a few days until you’re familiar with Wellbutrin and how it affects your body.

6. Eat a healthy diet

To avoid weight loss or weight gain, eat a healthy diet and carefully monitor weight while taking Wellbutrin. A dietitian or nutritionist may be able to help if appetite and weight changes become a problem while taking this medication.

7. Talk to a healthcare provider before discontinuing Wellbutrin

The sudden discontinuation of Wellbutrin can cause unpleasant withdrawal effects. Seek medical advice if Wellbutrin does not seem to be working or the side effects become hard to manage. Upon discontinuing Wellbutrin, a healthcare provider may recommend tapering, or gradually lowering, the dose to help prevent problems when stopping Wellbutrin.

Related resources for Wellbutrin side effects:

15 years of clinical experience with bupropion HCl: from bupropion to bupropion SR to bupropion XL, Primary Care Companion to The Journal of Clinical Psychiatry
Bupropion compound summary, U.S. National Library of Medicine
Bupropion drug summary, Prescriber’s Digital Reference
“Narrow angles” a tip-off to eyesight risk, Harvard Health Publishing
One antidepressant shown to control weight during a 2-year study, Science Daily
Wellbutrin SR, Epocrates
Wellbutrin SR prescribing information, U.S. National Library of Medicine
What is naltrexone?, UAMS Psychiatric Research Center

Bupropion for attention deficit hyperactivity disorder (ADHD) in adults

Review question

We reviewed the evidence regarding the effects of bupropion in adults with ADHD. We also looked at adverse effects (side effects resulting from taking this medication).

Relevance

ADHD is a brain disorder characterized by inattention, impulsivity and/or overactivity that interferes with normal functioning or development. Some people with ADHD have problems with only one aspect of their behavior, while others have problems in combination. Bupropion is a medication used to treat depression and quit smoking, but it is also used to treat ADHD. People with ADHD are commonly prescribed stimulant medications such as methylphenidate and amphetamines. However, not everyone responds well to these medications. Some people cannot tolerate stimulants due to side effects. Others may have medical reasons for taking stimulants, such as psychiatric or tic disorders. Other people may not want to use stimulants because they are controlled substances. Therefore, non-stimulant agents such as bupropion are sometimes used instead. Its efficacy in the treatment of ADHD remains unclear.

Search date

Evidence is current to February 2017.

Study profile

We included six randomized controlled trials (RCTs), studies in which participants are randomly assigned to one of two or more treatment groups. Five studies were conducted in the US and the sixth in Iran. The studies involved 438 people with ADHD. All studies evaluated long-acting bupropion, a slow-absorbing formulation that can be taken as little as once a day. This simple dosage is suitable for people with ADHD, as the illness can cause them to forget to take their medications.

The duration of the studies varied from six to 10 weeks. The participants were all diagnosed with ADHD and often had other mental health issues. In one study, all participants had ADHD and were dependent on opioids (pain relievers).

Research funding sources

Four studies were funded by industry and the other two by public funds. In one of the publicly funded studies, the lead author was paid by the industry (not by the buproprion manufacturers) for research activities.

Main results

Bupropion may lead to mild improvement in ADHD and may also reduce symptoms associated with ADHD. There were no more adverse effects with this medication than with placebo. Bupropion may be an alternative treatment for those adults with ADHD who cannot or will not take stimulants.

Quality of evidence

The quality of the evidence in this review was low due to the small number of studies; five of the six studies were small and all were poorly conducted. The effect of bupropion on various aspects of daily functioning has not been studied. In addition, no studies have evaluated the long-term effects of this medication. Further research is needed to evaluate whether bupropion is effective in certain subgroups of ADHD or in people with additional disorders/disorders.

Translation notes:

Translation: Marina Tkalich. Editing: Kukushkin Mikhail Evgenievich, Yudina Ekaterina Viktorovna. Project coordination for translation into Russian: Cochrane Russia - Cochrane Russia (branch of the Northern Cochrane Center on the basis of Kazan Federal University). For questions related to this translation, please contact us at: [email protected]; [email protected]

Hyperactivity and attention deficits: new treatment recommendations

A new clinical study comparing the efficacy and safety of 7 drugs for the treatment of attention deficit hyperactivity disorder (ADHD). The results are published in The Lancet Psychiatry. Today, methylphenidate is considered the most effective and safe drug for the treatment of ADHD in children. For adults, amphetamines (including lisdexamfetamine) are preferred.

The study looks at the efficacy and side effects of drugs such as lisdexamfetamine, atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil. Medicines were compared with each other and with placebo.

Antipsychotics and antidepressants were not included in the study because they do not treat ADHD symptoms. Psychological treatments for ADHD have also not been included, but experts recommend their use, especially for children and adolescents.

“The study lasted for 12 weeks. However, we do know that ADHD medications can take significantly longer. More research is needed to include the long-term effects of these drugs. Of course, non-drug treatments for ADHD should be preferred, but for children who need medication, methylphenidate should be the drug of first choice, according to our research. For adults, amphetamines are recommended,” said Dr. Andrea Cipriani from the University of Oxford, UK.

According to statistics, ADHD occurs in 5% of school-age children and 2.5% of adults worldwide. The disorder is characterized by scattered attention, hyperactivity, impulsivity.

For ADHD, medications are not required on a regular basis, but they can help patients focus better, be less impulsive, feel calmer, learn, and work.

The UK National Institute for Health and Care Excellence (NICE) currently recommends methylphenidate as a first-line drug therapy for children and adolescents. For the second line, it is suggested to use lisdexamfetamine, for the third - atomoxetine or guanfacine.

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