BUPROPION VERSUS METHYLPHENIDATE IN THE TREATMENT OF ATTENTION-DEFICIT HYPERACTIVITY DISORDER

Objective: In the treatment of attention-deficit hyperactivity disorde r (ADHD), the efficacy of the tricyclic antidepressants and monoamine oxidase inhibitor antidepressants has been compared with that of both placebo and the stimulants (methylphenidate and/or dextroamphetamine). However, the effectiveness of bupropion has been contrasted only with placebo. The primary aim of this study was to contrast the efficacy o f bupropion with that of methylphenidate in the treatment of ADHD. Met hod: A double-blind, crossover design was used in this study. After a 14-day medication washout period, 15 ADHD subjects (7 to 17 years old) were randomized to either methylphenidate or bupropion for 6 weeks, w ashed out for an additional 2 weeks, and then ''crossed over'' to the other drug. Methylphenidate was titrated to the maximum effective dose of 0.4 to 1.3 mg/kg per day (mean 0.7 mg/kg per day) and bupropion wa s titrated to an effective dose ranging from 1.4 to 5.7 mg/kg per day (mean 3.3 mg/kg per day). Results: Both methylphenidate and bupropion produced significantly greater (p<.001) and equivalent improvement on the Iowa-Conners Teacher's Rating Scale according to both the subjects ' parents and teachers. The same pattern of improvement was also noted for improvement on the Clinical Global Impression Scale, Kagan's Matc hing Familiar Figures Test, Continuous Performance Test, Children's De pression Inventory, Children's Manifest Anxiety Scale, and Rey Auditor y-Verbal Learning Test. Conclusions: In this double-blind, crossover t rial, bupropion and methylphenidate were both effective and did not di ffer in their overall efficacy as treatments for ADHD.