An Open Trial of Sustained Release Bupropion for Attention-Deficit/Hyperactivity Disorder in Adults with ADHD Plus Substance Use Disorders

Overview

Journal J ADHD Relat Disord

Date 2012 Apr 14

PMID 22500195

Citations 6

Authors

Timothy E Wilens

Jefferson B Prince

James Waxmonsky

Robert Doyle

Thomas Spencer

MaryKate Martelon

Maggie Evans

Affiliations

Soon will be listed here.

Abstract

OBJECTIVE: To evaluate the effectiveness and tolerability of bupropion in adults with Attention-Deficit/Hyperactivity Disorder (ADHD) and comorbid active Substance Use Disorders (SUD). METHODS: This was a six-week open trial of sustained-release (SR) bupropion in adults aged 18 to 55 years diagnosed with both ADHD and SUD. Bupropion-SR was initiated at 100 mg SR and increased weekly to a target dose of 200 mg SR twice daily. Subjects were assessed on multiple outcomes including ADHD, SUD, and adverse effects. All analyses were intent to treat, with last observation carried forward. RESULTS: Thirty-two subjects were treated with bupropion, with nineteen subjects completing the entire protocol (59%). At end point there were clinically significant reductions in the ADHD RS (34.1±8.2 to 19.4±11.4, -43%, t=6.49, p<0.0001) and the Clinical Global Impression (CGI) of ADHD severity (baseline=5.0, endpoint=3.8, -24%, t=6.16, p<0.0001). In contrast, there were clinically negligible effects on the self-report of substance use (p's >0.05) and on the overall CGI of SUD severity (-23%, t=4.95, p<0.0001). CONCLUSIONS: Results from this open trial suggest that in adults with ADHD and SUD, treatment with bupropion-SR is associated with clinically significant reductions in ADHD, but not SUD.

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References

Beck A, Ward C, Mendelson M, Mock J, ERBAUGH J . An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561-71. DOI: 10.1001/archpsyc.1961.01710120031004. View

Levin F, Evans S, McDowell D, Brooks D, Nunes E . Bupropion treatment for cocaine abuse and adult attention-deficit/hyperactivity disorder. J Addict Dis. 2002; 21(2):1-16. DOI: 10.1300/J069v21n02_01. View

Ambrosini P . Historical development and present status of the schedule for affective disorders and schizophrenia for school-age children (K-SADS). J Am Acad Child Adolesc Psychiatry. 2000; 39(1):49-58. DOI: 10.1097/00004583-200001000-00016. View

Carpentier P, de Jong C, Dijkstra B, Verbrugge C, Krabbe P . A controlled trial of methylphenidate in adults with attention deficit/hyperactivity disorder and substance use disorders. Addiction. 2005; 100(12):1868-74. DOI: 10.1111/j.1360-0443.2005.01272.x. View

Wender P, Reimherr F . Bupropion treatment of attention-deficit hyperactivity disorder in adults. Am J Psychiatry. 1990; 147(8):1018-20. DOI: 10.1176/ajp.147.8.1018. View

Wilens T, Adler L, Weiss M, Michelson D, Ramsey J, Moore R . Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders. Drug Alcohol Depend. 2008; 96(1-2):145-54. DOI: 10.1016/j.drugalcdep.2008.02.009. View

Riggs P . Clinical approach to treatment of ADHD in adolescents with substance use disorders and conduct disorder. J Am Acad Child Adolesc Psychiatry. 1998; 37(3):331-2. DOI: 10.1097/00004583-199803000-00019. View

Wilens T, Prince J, Spencer T, Van Patten S, Doyle R, Girard K . An open trial of bupropion for the treatment of adults with attention-deficit/hyperactivity disorder and bipolar disorder. Biol Psychiatry. 2003; 54(1):9-16. DOI: 10.1016/s0006-3223(02)01664-5. View

Carroll K, Rounsaville B . History and significance of childhood attention deficit disorder in treatment-seeking cocaine abusers. Compr Psychiatry. 1993; 34(2):75-82. DOI: 10.1016/0010-440x(93)90050-e. View

10.

Hamilton M . A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23:56-62. PMC: 495331. DOI: 10.1136/jnnp.23.1.56. View

11.

Wilens T, Haight B, Horrigan J, Hudziak J, Rosenthal N, Connor D . Bupropion XL in adults with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled study. Biol Psychiatry. 2005; 57(7):793-801. DOI: 10.1016/j.biopsych.2005.01.027. View

12.

Hamilton M . The assessment of anxiety states by rating. Br J Med Psychol. 1959; 32(1):50-5. DOI: 10.1111/j.2044-8341.1959.tb00467.x. View

13.

Elkins I, McGue M, Iacono W . Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry. 2007; 64(10):1145-52. DOI: 10.1001/archpsyc.64.10.1145. View

14.

Mannuzza S, Klein R, Bonagura N, Malloy P, Giampino T, Addalli K . Hyperactive boys almost grown up. V. Replication of psychiatric status. Arch Gen Psychiatry. 1991; 48(1):77-83. DOI: 10.1001/archpsyc.1991.01810250079012. View

15.

Levin F, Evans S, Brooks D, Kalbag A, Garawi F, Nunes E . Treatment of methadone-maintained patients with adult ADHD: double-blind comparison of methylphenidate, bupropion and placebo. Drug Alcohol Depend. 2005; 81(2):137-48. DOI: 10.1016/j.drugalcdep.2005.06.012. View

16.

Riggs P, Hall S, Mikulich-Gilbertson S, Lohman M, Kayser A . A randomized controlled trial of pemoline for attention-deficit/hyperactivity disorder in substance-abusing adolescents. J Am Acad Child Adolesc Psychiatry. 2004; 43(4):420-9. DOI: 10.1097/00004583-200404000-00008. View

17.

Wise B, Cuffe S, Fischer T . Dual diagnosis and successful participation of adolescents in substance abuse treatment. J Subst Abuse Treat. 2001; 21(3):161-5. DOI: 10.1016/s0740-5472(01)00193-3. View

18.

Wilens T, Monuteaux M, Snyder L, Moore H, Whitley J, Gignac M . The clinical dilemma of using medications in substance-abusing adolescents and adults with attention-deficit/hyperactivity disorder: what does the literature tell us?. J Child Adolesc Psychopharmacol. 2005; 15(5):787-98. DOI: 10.1089/cap.2005.15.787. View

19.

Mariani J, Levin F . Treatment strategies for co-occurring ADHD and substance use disorders. Am J Addict. 2007; 16 Suppl 1:45-54. PMC: 2676785. DOI: 10.1080/10550490601082783. View

20.

Levin F, Evans S, KLEBER H . Prevalence of adult attention-deficit hyperactivity disorder among cocaine abusers seeking treatment. Drug Alcohol Depend. 1998; 52(1):15-25. DOI: 10.1016/s0376-8716(98)00049-0. View