Abstract
Background
Despite the increasing recognition of comorbid attention-deficit/hyperactivity disorder
(ADHD) and bipolar disorder (BPD) in adults, there are no prospective trials of pharmacological
agents to treat ADHD in these patients. Given the efficacy of bupropion for ADHD in
adults, as well as its use in the management of bipolar depression, we studied the
tolerability and efficacy of sustained-release (SR) bupropion in adults with ADHD
plus BPD.
Methods
This was an open, prospective, 6-week trial of bupropion SR (up to 200 mg b.i.d.)
in adults with DSM-IV ADHD plus historical bipolar I disorder (BPD I) (10%) or bipolar
II disorder (BPD II) (90%). Adults receiving adjunct antimanic agents (mood stabilizers
and antipsychotics) at baseline were included in the study. We used standardized psychiatric
instruments for diagnosis and outcome. Efficacy was based primarily on the Clinical
Global Impression Scale (CGI) for ADHD and the ADHD symptom checklist.
Results
Of 36 patients entered (75% male, mean age 34 years), 30 patients (83%) completed
the protocol. At end point (last observation carried forward [LOCF]) compared to baseline,
treatment with bupropion SR resulted in significant reductions in the ADHD symptom
checklist (−55%, z = 5.63, p < .001) and CGI severity of ADHD (−40%, z = 6.285, p < .001). Bupropion was associated with reductions in ratings of mania and depression.
Conclusions
The results from this open study of adults with ADHD plus BPD suggest that sustained-release
bupropion may be effective in treating ADHD in the context of a lifetime diagnosis
of BPD, without significant activation of mania. Further controlled trials are warranted.
Keywords
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Article info
Publication history
Accepted:
August 26,
2002
Received in revised form:
August 9,
2002
Received:
May 22,
2002
Identification
Copyright
© 2003 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
