Attention-deficit/hyperactivity disorder bupropion

Dopamine-Stimulating Medications. A variety of drugs that increase the availability of dopamine have been studied in cocaine addicts including L-DOPA, bupropion, amantadine, and methylphenidate. In small uncontrolled trials, these have shown some benefit, but definitive studies have yet to be performed. In addition, some dopamine-stimulating medications (in particular, the stimulants like methylphenidate or the amphetamines) are themselves subject to abuse, though, of note, this is typically not a problem when they are prescribed to patients who do not have a history of substance abuse such as, for example, in the treatment of attention deficit-hyperactivity disorder. 

Barrickman, L.L., Perry, P.J., Allen, A.J., Kuperman, S., Arndt, S.V., Herrmann, K.J., and Schumacher, E. (1995) Bupropion versus methylphenidate in the treatment of attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 34 649-657. 

Wender, P.H. and Reimherr, EW. (1990) Bupropion treatment of attention-deficit hyperactivity disorder in adults. Am J Psychiatty... 

Wilens, T.E., Spencer, T.J., Biederman J., Girard, K., Doyle, R., Prince, J., Polisner, D., Solhkhah, R., Comeau, S., Monuteaux M.C., and Parekh, A. (2001) A controlled clinical trial of bupropion for attention deficit hyperactivity disorder in adults. Am J Psychiatty 158 282-288. 

Connors, C.K., Cast, C.D., Guiltieri, C.T., Welder, E., Mark, R., Reissue, A., Khayrallah, M., and Ascher, J. (1996) Bupropion hydrochloride in attention deficit hyperactivity disorder. / Am Acad Child Adolesc Psychiatry 35 1314—1321. 

Spencer, T., Biederman,/., Steingard, R., and Wilens, T. (1993a) Bupropion exacerbates tics in children with attention-deficit hyperactivity disorder and Tourette s syndrome. / Am Acad Child Adolesc Psychiatry 32 211-214. 

Daviss WB, Bentivoglio P, Racusn R, et al. Bupropion sustained release in adolescents with comorbid attention-deficit/hyperactivity disorder and depression. J Am Acad Child Adolesc Psychiatry 2001 40 307-314. 

OTHER THERAPEUTIC USES OE THESE DRUGS The various antidepressant agents have found broad utility in other disorders that may not be related psychobiologicaUy to the mood disorders. Current applications include rapid but temporary suppression of enuresis with low (e.g., 25 mg) pre-bedtime doses of tricyclic antidepressants, including imipramine and nortriptyline, by uncertain mechanisms in children and in geriatric patients, as well as a beneficial effect of duloxetine on urinary stress incontinence. Antidepressants have a growing role in attention-deficit/hyperactivity disorder in children and adults, for which imipramine, desipramine, and nortriptyline appear to be effective, even in patients responding poorly to or who are intolerant of the stimulants (e.g., methylphenidate). Newer NE selective reuptake inhibitors also may be useful in this disorder atomoxetine is approved for this application. Utility of SSRIs in this syndrome is not established, and bupropion, despite its similarity to stimulants, appears to have limited efficacy. 

Jafarinia M, Mohammadi MR, Modabbemia A, Ashrafi M, Khajavi D, Tabriz M, et al. Bupropion versus methylphenidate in the treatment of children with attention-deficit/hyperactivity disorder randomized double-blind study. Hum Psychopharmacol Clin Exp 2012 27 411-8. Rosenberg PB, Lanctot KL, Drye LT, Hermann N, Scherer RW, Bachmann DL, ADMET Investigators, et al. Safety and efficacy of methylphenidate for apathy in Alzheimer s disease a randomized, placebo-controUed trial. J Clin Psychiatry 2013 74 810-6. 

A 19-year-old white male with a history of multiple drug abuse, psychosis, depression and attention-deficit hyperactivity disorder used an unknown quantity of MXE IV for abuse shortly before he was discharged from an inpatient detoxification facility. He was on bupropion, aripiprazole and chlorprothixene. About 30 min after the injection, he presented to the ER of the hospital with extreme agitation, ataxia and semistuporous state. 

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