Wellbutrin: An Off-Label Alternative for ADHD?
Medically reviewed by Mary Choy, PharmD
Wellbutrin (bupropion) is a common antidepressant used to treat major depressive disorder (MDD). However, it has also been prescribed off-label for other uses, including attention deficit hyperactivity disorder (ADHD).
Off-label medications refer to drugs that are prescribed for a health condition or at a dosage level not approved for by the Food and Drug Administration (FDA). Despite not having approval, when used off-label, these medications have shown promising benefits for treating that condition.
Bupropion is not typically the initial medication choice for ADHD. However, your healthcare provider may prescribe it if your current medication is not working for you. Most non-FDA-approved uses are still experimental and only used with the approval or supervision of a healthcare provider.
This article will discuss the off-label use of Wellbutrin for ADHD, including how well it works, side effects, safety information, and more.
Wellbutrin for ADHD
Wellbutrin is not typically the initial medication option for ADHD. People with ADHD often undergo supportive therapy (nondrug forms of treatment) in addition to taking more standard ADHD medications, such as:
Ritalin, Concerta (methylphenidate)
Adderall (amphetamine and dextroamphetamine)
These medications are commonly prescribed to control hyperactivity and impulsive behavior and increase attention span.
Although stimulants have a high success rate in ADHD, they also have an extensive side effect profile and a high chance of addiction and abuse. When people do not respond well to stimulant therapy, other medications may be used, such as Wellbutrin.
According to a large, reliable study, Wellbutrin was shown to be just as effective as a common drug called methylphenidate in clinical trials. People who took Wellbutrin tended to have fewer headaches as a side effect than those who took methylphenidate for ADHD.
Related: Comparing Ritalin vs. Adderall Effects
Is It Effective?
There have been limited studies of Wellbutrin’s use for ADHD in the past decade. However, some studies have suggested positive results in comparison to common ADHD medications and a placebo (substance without the medication).
In three head-to-head (comparative) studies, bupropion worked as well as methylphenidate in resolving ADHD behaviors in children.
Another review of trials found low-quality evidence that bupropion helped control ADHD behaviors compared with a placebo in adults.
More studies are needed for further confirmation, but many healthcare providers are confident enough to use bupropion if other stimulants or traditional ADHD medications fail at first.
Side Effects of Wellbutrin
Like most medications, Wellbutrin can cause side effects with use.
It contains a boxed warning from the FDA due to a potential increased risk of suicidal thinking and behavior. Anyone treated with this drug should be monitored for suicidal thoughts, behavior, and attempted suicide.
Some of the more commonly reported side effects of Wellbutrin include:
Agitation
Although rare, the following are more severe side effects associated with the use of Wellbutrin. They may occur due to a person’s mental status before starting the medication or if they are already on medication for depression or seizures.
Always speak with your healthcare provider before starting Wellbutrin. Give them your most updated list of medications to review before starting treatment. Wellbutrin can cause behavioral changes in some people, as well as other potentially severe side effects, such as:
Safety Warnings and Interactions
Taking Wellbutrin with other medications may be an impossible task to avoid if you have other health conditions. Wellbutrin can interact with the following:
Antivirals, such as Norvir (ritonavir) or antiepileptic drugs, such as Tegretol (carbamazepine) or Dilantin (phenytoin): These medications could lower the effects of your bupropion, and you may need to increase the dose if necessary (only to a maximum dose of 150 milligrams three times a day).
Antidepressants, such as Prozac (fluoxetine), and certain medications used for heart-related conditions (e.g., beta-blockers and antiarrhythmics): Wellbutrin can increase the concentration of many of these medications.
Monoamine oxidase inhibitors (MAOIs): Do not take an MAOI within two weeks of stopping Wellbutrin, and do not take Wellbutrin within two weeks of stopping an MAOI.
Another important warning while taking Wellbutrin is to make sure you are not taking any medications that can lower your seizure threshold (increase the possibility of causing seizures). These can include antidepressants, other bupropion products, and systemic corticosteroids.
Wellbutrin could trigger seizures if you:
Take medications that can lower your seizure threshold
Are going through alcohol withdrawals
Have a history of seizures
It is always best to make sure your healthcare provider is aware of all your medications before starting Wellbutrin.
How to Take Wellbutrin for ADHD
Wellbutrin and most other antidepressants are usually prescribed by a psychiatrist or someone who specializes in neurodevelopmental needs. You may not be prescribed this medication first for ADHD; it is usually recommended to start stimulants or other non-stimulants, such as Straterra (atomoxetine) as the initial therapy for ADHD.
Forms of Wellbutrin include:
Immediate release (IR), Wellbutrin
Sustained release (SR), Wellbutrin SR
Extended release (XL), Wellbutrin XL
Wellbutrin comes in tablets and can be taken with or without food.
Wellbutrin vs. Other ADHD Medications
Many prescribers start their patients with other stimulant (e.g., Adderall) or non-stimulant (e.g., Straterra) ADHD medications first before considering Wellbutrin. Current literature supports the use of methylphenidate in children and adolescents and amphetamines in adults as the preferred first-line short-term medications for ADHD.
These medications may be effective in helping with the behaviors associated with ADHD and improving mental alertness. However, they can come with potentially severe side effects, such as:
Increased heart rate
Insomnia (or lack of sleep)
Mood disturbances
Loss of appetite (with stimulants)
Atomoxetine is a non-stimulant ADHD medication that alters the brain's chemistry over a short period (about four weeks), which is similar to most antidepressants. With the help of bupropion, these two medications together could be a better combination of medications for people who are unable to tolerate stimulants.
Wellbutrin is not a cheap medication, but the generic version (bupropion) is a lot more affordable and could help treat any comorbid depression or post-depression after discontinuing an ADHD stimulant.
Summary
Wellbutrin, and its active ingredient bupropion, are sometimes considered for off-label use in ADHD. Bupropion is an antidepressant that is FDA-approved to treat depression; however, it has shown some benefits for ADHD.
While other ADHD medications are often prescribed first, bupropion may be an appropriate alternative if you are unable to tolerate the side effects of stimulants. Bupropion can also be helpful for treating depression in people with ADHD who also have MDD. Remember to keep an updated list of your medications and review any medication you're prescribed with your healthcare provider and pharmacist.
Frequently Asked Questions
How long does Wellbutrin take to work for ADHD?
There is not enough data to know for sure the amount of time it takes for Wellbutrin to effectively work for people with ADHD. However, a few older studies of adults that took place over six-week periods showed some benefit.
However, these results are dependent on different factors, such as dosage and age.
Is Wellbutrin approved for treating ADHD?
Wellbutrin is not FDA-approved for ADHD, but it's sometimes prescribed by healthcare providers as an off-label use for ADHD.
More studies are needed to explore the use of Wellbutrin for ADHD before the FDA can approve it.
Does Wellbutrin work better than Adderall?
Wellbutrin is not the first or even second recommended medication for ADHD. If you or a loved one has ADHD, FDA-approved medications, such as amphetamines and methylphenidate, are often the first choice.
Bupropion or another non-stimulant medication may be an option if you're unable to tolerate the side effects of stimulants.
The author would like to recognize and thank Jaycob Mathew Peña for contributing to this article.
Read the original article on Verywell Health.
