Six month, open-trial of bupropion SR in comparison to methylphenidate in the treatment of adults with ADHD

ABSTRACT Objective: ADHD has become increasingly diagnosed and treated in adults. Treatment modalities have grown to include several antidepressants as well as stimulant medications. This study was designed to evaluate the effectiveness of bupropion SR compared to methylphenidate in an extended open-label study following a previously reported six-week, double-blind placebo-controlled trial of bupropion SR (1). Methods: Sixty subjects were selected using the Utah Criteria and DSM-IV for ADHD. Sixty percent were assigned to bupropion SR and 40% to placebo in a double-blind manner. Nonresponders to bupropion (n=22) were treated with methylphenidate in an open manner. Patients treated with placebo were treated with bupropion SR. Results: Response rate to bupropion SR in patients (n=38) treated in either the double-blind study or the open study was 43% as defined by a 40% improvement in the Wender Reimherr Adult Attention Deficit Disorder Scale (WRAADDS). In nonresponders subsequently treated with methylphenidate (n=16) the response measured in the same manner was 63% (p<ns). Conversely, in patients who continued in treatment for an extended 4-6 month time period, WRAADDS scores improved 65% over baseline with bupropion SR (n=10) and 59% with methylphenidate (n=8) Discussion: We found a lower frequency of response in adult ADHD with bupropion SR as opposed to methylphenidate. However, treatment with either medication produced equivalent levels of improvement at the 4 to 6 month evaluation in the subpopulation continuing on medication. Despite the increasing recognition of adult ADHD, there is a paucity of data on its treatment. Information on long-term outcome in adults is even more limited. Although the stimulants have been shown to be effective in adult ADHD, the multiple dosing, scheduled prescribing restrictions, anxiogenic properties, and abuse potential limit their usefulness in subgroups of adults. Despite the emergence of bupropion as a second-line agent for pediatric ADHD, data in ADHD adults are limited. There is a perception that stimulants produce a greater degree of improvement in the symptoms of ADHD than non-stimulants such as bupropion. We now report findings on an open-label, extended study of bupropion SR in comparison with methylphenidate.