Why and How Wellbutrin May Be an Effective Treatment for ADHD
Wellbutrin is an anti-depressant medication prescribed to help manage ADHD symptoms in adults who don’t benefit from more mainstream stimulant medications for attention deficit. Here, learn about the benefits and risks associated with this Norepinephrine Dopamine Reuptake Inhibitor.
Stimulant medications — methylphenidates and amphetamines — are the first-line ADHD treatment prescribed by the vast majority of clinicians. Why? Because they work for 70 to 80 percent of patients with attention deficit disorder (ADHD or ADD).
But what about those who have a less-than-optimal response to stimulant medications? What about the ADHD patients with other co-existing conditions, such as depression, anxiety, or other medical conditions? What about those who hesitate to try a stimulant? An alternative medication option considered and prescribed for a growing number of adults with ADHD is Wellbutrin, the trade name for the anti-depressant drug Bupropion.
About Wellbutrin: Off-Label ADHD Treatment
Wellbutrin was first approved for use as an anti-depressant by the Federal Drug Administration (FDA) in 1985. Since then, it has been used to treat seasonal affective disorder (SAD) and help minimize nicotine cravings when stopping smoking. Although it is classified as an anti-depressant, Wellbutrin enhances actions that impact dopamine and norepinephrine in the brain, so today it is also commonly prescribed as an “off-label” treatment for ADHD.
Prescribing “off-label” is legal and common. A medication can be prescribed “off-label” when research has shown that it might help with a condition (like ADHD), even though it is not currently approved by the FDA for that specific condition. In this case, Wellbutrin has been approved to treat depression, and scientific studies 1, 2, 3 have shown that it might help improve concentration, focus, and other symptoms of ADHD for patients aged 18 and older.
How Wellbutrin Works: Off-Label ADHD Treatment
Wellbutrin, like other medications used to treat ADHD, affects neurotransmitter function in the brain. Specifically, it blocks the reuptake (reabsorption) of dopamine and norepinephrine by the presynaptic neuron after those chemicals have been released from the nerve cell. Medications that act in this way are called NDRIs (Norepinephrine Dopamine Reuptake Inhibitors).
Reuptake is a normal way the body controls how long a nerve signal lasts. Blocking the reuptake increases the concentration of dopamine and norepinephrine active in the brain. When more of these neurotransmitters stay active, they are available to send messages to other nerves. In this case, more is better.
Why Use Wellbutrin for ADHD Symptoms?
If stimulants are the most effective treatment for ADHD, why would someone be prescribed Wellbutrin? There are several reasons:
- Not everyone taking stimulant medication experiences a significant reduction of his or her ADHD symptoms. In these cases, adding Wellbutrin, which enhances the action of dopamine and norepinephrine in the brain, might help.
- Patients taking stimulant medications sometimes experience negative side effects. The action of Wellbutrin is different than that of stimulant medications, so some patients may experience fewer negative side effects on Wellbutrin.
- The majority of ADHD patients also have at least one comorbid condition. Co-existing conditions, such as depression and anxiety, are more than common — they are the norm for patients with ADHD. Adding an antidepressant, such as Wellbutrin, can sometimes help in treating and minimizing these symptoms.
- An underlying medical or psychiatric condition may make the prescription of a stimulant medication less than ideal. For example, a heart condition, sleep disorders, tic disorder, a history of addiction, and some other psychiatric conditions such as bipolar disorder may preclude a patient from safely taking a stimulant medication.
Dose and Forms of Wellbutrin for ADHD Treatment
Wellbutrin comes in three forms:
- Wellbutrin SR (sustained-release): Lasts 12 hours and is taken twice a day
- Wellbutrin XL (extended release): Lasts 24 hours and is taken once a day
For ADHD, Wellbutrin is usually prescribed in the extended release (XL) form and can be taken with or without food. It is often safely combined with another ADHD medication. The starting dose for adults is typically 150mg, and that can be gradually increased up to 450 mg daily. It’s common for the dosages to be divided into morning and nighttime. The specific dose for an individual differs depending on the effectiveness of the medication.
According to the existing research, Wellbutrin hasn’t been shown to be safe and effective for use in people younger than 18 years old.
Common Side Effects of Wellbutrin
- low appetite
- blurry vision
- agitation, increased anxiety
- difficulty sleeping
- dry mouth
- nausea or vomiting
- muscle twitching, restlessness
Important Information About Taking Wellbutrin for ADHD
- It can take some time to realize the full benefit of Wellbutrin. In contrast to the quick onset of stimulant medication, it may take patients approximately 3 to 7 days to notice any benefits of Wellbutrin. It may also take several weeks for a prescriber and patient to find the most effective therapeutic dose. Once the dose has been adjusted, it can take an additional 4-6 weeks for a patient to experience the full benefit of Wellbutrin. While the dosage is being determined, signs that the medication is working are an improved mood, increased appetite, and better sleep.
- Wellbutrin should not be discontinued without a physician’s assistance. Patients who want to stop taking Wellbutrin should discuss this with their physician. Patients may experience irritability when stopping Wellbutrin abruptly.
- Wellbutrin is not considered safe to take during pregnancy or while breastfeeding.
Patients who are pregnant or planning to become pregnant should discuss medications with their clinician.
- Wellbutrin’s black box warning is important. The FDA puts a warning on certain prescription medications that may have serious or life-threatening risks. Wellbutrin has a black box warning about the possibility of suicidal thoughts or action in children, teens, and young adults. Wellbutrin hasn’t been shown to be safe and effective for use in people younger than 18 years old. There’s no FDA-approved dosage for children. Knowing this risk helps parents, caregivers, and partners watch for any changes in their loved one such as suicidal thoughts, behavior, or attempted suicide.
For all of these reasons, it is important for prescribers and patients to discuss the benefits versus the risks of Wellbutrin, to stay in close contact, and to schedule regular follow-up appointments while taking this medication.
Though Wellbutrin is not a first-line medication treatment for ADHD, it can be helpful in treating ADHD symptoms for some people. Patients interested in adding Wellbutrin as part of an ADHD treatment plan should discuss the options with their prescribing clinician.
Laurie Dupar, PMHNP, RN, PCC, is a member of the ADDitude ADHD Specialist Panel.
1 Barrickman LL, Perry PJ, and Allen AJ. et al. Bupropion versus methylphenidate in the treatment of attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1995 34:649–657.
2 Hudziak JJ, Wilens TE, and Rosenthal NE. et al. The efficacy of extended-release bupropion in adult ADHD [poster]. Presented at the 42nd annual meeting of the American College of Neuropsychopharmacology. 7–11December 2003 San Juan, Puerto Rico.
3 Conners CK, Casat CD, and Gualtieri CT. et al. Bupropion hydrochloride in attention deficit disorder with hyperactivity. J Am Acad Child Adolesc Psychiatry. 1996 34:1314–1321.