Description

Advantages
Primarily used as an anti-depressant, but is a non-stimulant that is effective for ADHD. Used uncommonly and primarily when stimulants cause mood, anxiety and obsessive compulsive behaviors. Brand name is expensive but generic is very inexpensive.

Disadvantages
Can take 3-4 days to begin to see benefit and 4-6 weeks before optimal effects achieved. Can cause seizures at high dosage, but not at usual dosage.

Excerpt from the book: ADHD Medications: Does It Work and Is It Save? Available on Amazon

A few years ago, I saw a twelve-year-old boy who had been hav- ing a very difficult time. Since preschool, he had trouble sitting still, attending, and was hyperactive and impulsive. He had been seen by three doctors, all of whom diagnosed ADHD. He had been treated with six different stimulant medications, and all of them caused his ADHD symptoms to improve, but he developed major side effects including depression, anxiety, and severe picking of his skin, causing it to bleed.

Ten Non-Stimulant Medications to Treat ADHD 265

While on Vyvanse, he because so depressed that he told his parents, “I just want to be with Jesus.” His parents said “he has lost his zest for life and learning.” Lexapro, an antidepressant, had been tried with a stimu- lant, but his ADHD symptoms just got worse.

Almost all children who have developed these kinds of side effects to the stimulant medications had some evidence of these symptoms before starting medication. However, the parents were adamant that that was not the case with their son. They said that when he was not on medication he was “sweet, easy-going, and a joy.” I checked with his teachers, and they confirmed this. They said that when he was on his medication, he was angry and defiant. Off medication, he was happy and silly and inattentive and distractable.

What was I to do? It looked like everything I would recom- mend in a case like this had already been tried, without success. After going back to my textbooks and scouring the internet and the National Library of Medicine, I stumbled on bupropion. I found a few studies that suggested that bupropion might be useful in a situa- tion like this. But bupropion was not approved by the FDA for the treatment of ADHD.

So, I explained to the parents that bupropion was a possible solu- tion. I explained that bupropion had been shown to be effective for the treatment of ADHD but was usually less successful than the stimulants. I explained the side effects and risks, and after further discussion and debate, the parents agreed.

After one week on Wellbutrin his teachers reported that he was a model student in the classroom. He was attentive, and his distract- ibility had completely vanished. And at home, the dreaded mood side effects did not emerge. His mother reported that “it has been a lovely weekend.” She reported that this was the best Mother’s Day present she had ever received. She stated that her son was “sponta- neous, fun, and obedient, and even spontaneously said, ‘I love you’ last night.”

Wellbutrin (bupropion) is an older antidepressant medication. It is also sold under the brand name Zyban to help patients stop smoking. In 2018, it was the twenty-seventh most commonly prescribed medica- tion in the United States accounting for more than twenty-four million prescriptions.

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Wellbutrin is not approved by the FDA for the treatment of ADHD. That does not mean that it is ineffective or had too many side effects. It just means that no pharmaceutical company has applied to the FDA for that purpose. Physicians can prescribe medications for purposes other than for what they received approval; this is called “off-label” prescribing.

However, numerous research studies have found Wellbutrin to be effective in treating ADHD.21 Effect size was 0.6, comparable to the other non-stimulants, but less effective than stimulants with an effect size of 0.8 to 1.2.22

The most common side effects to Wellbutrin are similar to the stimulants.23 Wellbutrin can cause difficulty falling asleep, although that difficulty is generally less than with stimulants. Some children have trouble falling asleep because they are anxious. He may be worried about monsters in the closet, or she may be worried about the fight she had with her best friend. Children who have significant anxiety in addition to their ADHD may actually fall asleep easier with bupropion; whereas stimulant medication (methylphenidate and amphetamine) can increase anxiety, bupropion is an excellent treatment for anxiety. Bupropion does not usually cause sedation. If anxiety is causing a child to have trouble falling asleep, then bupropion may actually help that child to fall asleep easier, by treating the anxiety, in addition to treating the ADHD.

Bupropion has been found to be safe with few side effects when used with moderate dosages. However, extremely high single doses (>400 mg) of bupropion may cause seizures even in patients who have never had a seizure before.24 But at recommended doses, bupropion is not known to cause seizures.

Bupropion does not work as quickly as the stimulants. It can take 3–4 days before any benefit is realized and 4–6 weeks before the full effect is achieved.

Since I saw this twelve-year-old boy, I have tried bupropion in 8–10 other patients with a similar presentation of major side effects to stimulants that did not exist prior to starting medication, and I have had the same surprising but highly therapeutic result. This is not a medica- tion I would use often, but in some cases, bupropion can be a lifesaver.