A controlled clinical trial of bupropion for attention deficit hyperactivity disorder in adults

Objective: Despite the increasing recognition of attention deficit hyperact ivity disorder (ADHD) in adults, there is a paucity of controlled pharmacol ogical trials demonstrating the effectiveness of compounds used in treatmen t, particularly nonstimulants. The authors report results from a controlled investigation to determine the anti-ADHD efficacy of bupropion in adult pa tients with DSM-IV ADHD. Method: This was a double-blind, placebo-controlled, randomized, parallel, 6-week trial comparing patients receiving sustained-release bupropion (up t o 200 mg b.i.d.) (N=21) to patients receiving placebo (N=19). The authors u sed standardized structured psychiatric instruments for diagnosis of ADHD. To measure improvement, they used separate assessments of ADHD, depression, and anxiety symptoms at baseline and each weekly visit. Results: Of the 40 subjects (55% male) enrolled in the study, 38 completed the study. Bupropion treatment was associated with a significant change in ADHD symptoms at the week-6 endpoint (42% reduction), which exceeded the ef fects of placebo (24% reduction). In analyses using a cutoff of 30% or bett er reduction to denote response, 76% of the subjects receiving bupropion im proved, compared to 37% of the subjects receiving placebo. Similarly, in an alyses using Clinical Global Impression scale scores, 52% of the subjects r eceiving bupropion reported being "much improved" to "very improved," compa red to 11% of the subjects receiving placebo. Conclusions: These results indicate a clinically and statistically signific ant effect of bupropion in improving ADHD in adults. The results suggest a therapeutic role for bupropion in the armamentarium of agents for ADHD in a dults, while further validating the continuity of pharmacological responsiv ity of ADHD across the lifespan.