Use of Bupropion for Attention-Deficit/Hyperactivity Disorder and Depression in Children and Adolescents

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders and frequently continues through adolescence and adulthood. Medication is the single most effective treatment for reducing ADHD symptoms and its use is recommended in children with 6 years and older. Nearly two-thirds of children and adolescents with ADHD also have another mental, emotional, or behavioral disorder, including depression disorders. Bupropion is an antidepressant with a mechanism of action potentially relevant to the treatment of ADHD, used in adults for both depression and smoking cessation and eventually as a third line treatment for ADHD. Objective: This review aims to explore the effectiveness, safety and tolerability of bupropion in children and adolescents with ADHD and depression. Method: A scientific review was conducted on a careful analysis of the scientific evidence available on the electronic databases: MEDLINE, Embase and the Cochrane Library. Results: There is little empirical evidence to guide the pharmacological treatment for comorbid ADHD and depression as most treatment studies tend to exclude patients with comorbid disorders. The majority of trials demonstrated bupropion’s efficacy in improving ADHD symptoms in children and adolescents, with effects being superior than placebo and most frequently comparable to methylphenidate. Bupropion also appears to be effective in alleviating depressive symptoms in this population, whether with or without ADHD comorbidity. Side effects did not differ significantly in comparison with stimulants and discontinued medication due to adverse reactions was rare. Conclusions: Current findings have to be interpreted with caution because of the very limited database and frequent use of small sample sizes. Bupropion seems effective and well-tolerated in children and adolescents with ADHD and ADHD-depression comorbidity. It should be considered for treatment of this population, but more randomized controlled trials with larger sample sizes are necessary.