Which formulation of Wellbutrin (bupropion) is most effective for treating Attention Deficit Hyperactivity Disorder (ADHD)?

From the Guidelines

Wellbutrin XL (extended-release bupropion) is the most effective formulation for treating ADHD, due to its steady medication levels throughout the day and reduced risk of side effects. The typical starting dose is 150 mg once daily in the morning, which may be increased to 300 mg daily after several days if needed and tolerated 1. This formulation is preferred over immediate-release (Wellbutrin IR) or sustained-release (Wellbutrin SR) versions because it eliminates the need for multiple daily doses. Bupropion works for ADHD by increasing the levels of norepinephrine and dopamine in the brain, neurotransmitters that are often deficient in people with ADHD. While not FDA-approved specifically for ADHD, bupropion is sometimes prescribed off-label when stimulants are contraindicated or ineffective, as it has been shown to be a viable alternative in certain cases, such as during pregnancy or breastfeeding 1.

Some key points to consider when prescribing bupropion for ADHD include:

• The medication should be taken in the morning to minimize sleep disturbances
• Patients should be aware that full benefits may take several weeks to develop
• Common side effects include insomnia, dry mouth, and headache
• Bupropion is not as efficacious as stimulants for the treatment of ADHD, but it can be a useful alternative in certain situations 1
• The risks of exposure to medications to treat ADHD in pregnancy should be weighed against the risks of untreated or inadequately treated ADHD in pregnancy 1.

It's essential to weigh the benefits and risks of bupropion treatment for ADHD, particularly in unique circumstances such as pregnancy or breastfeeding, and to consider the individual patient's needs and medical history when making treatment decisions 1.

From the Research

Forms of Wellbutrin for ADHD

• The most effective formulation of Wellbutrin (bupropion) for treating Attention Deficit Hyperactivity Disorder (ADHD) is the extended-release (XL) formulation 2.
• A study published in 2005 found that bupropion XL was effective in reducing ADHD symptoms in adults, with 53% of participants responding to treatment compared to 31% of those receiving placebo 2.
• The extended-release formulation of bupropion appeared to provide sustained benefit throughout the day, with significant improvements in ADHD symptoms in the morning, afternoon, and evening 2.

Comparison to Other Treatments

• While other studies have investigated the use of atomoxetine and stimulant combinations for ADHD treatment, there is limited evidence directly comparing these treatments to bupropion XL 3.
• A 2022 review of extended-release methylphenidate for adult ADHD found that it improved ADHD symptoms, but the certainty of the evidence was rated as very low due to high risk of bias and limitations in study design 4.
• A 2017 review of bupropion for adult ADHD found low-quality evidence that it decreased the severity of ADHD symptoms and increased the proportion of participants achieving clinical improvement 5.

Pharmacological Management of ADHD

• Stimulant medications, such as methylphenidate and amphetamine-based stimulants, are considered the gold standard for treating ADHD, but nonstimulant treatments like bupropion may be an alternative for some patients 6.
• The choice of pharmacological agent for ADHD treatment should be guided by individual patient needs and response to treatment, as well as consideration of potential side effects and interactions 6.