Is Wellbutrin (bupropion) effective for treating Attention Deficit Hyperactivity Disorder (ADHD) and anxiety?

Wellbutrin (Bupropion) for ADHD and Anxiety

Bupropion (Wellbutrin) is effective for treating ADHD symptoms but is not recommended for anxiety and may potentially worsen anxiety symptoms in some patients. 1, 2

Efficacy for ADHD

Bupropion has demonstrated efficacy for ADHD treatment:

• Low-quality evidence shows bupropion decreases ADHD symptom severity and increases the proportion of patients achieving clinical improvement 1
• A randomized, double-blind study found bupropion more effective than placebo in treating adults with ADHD 2
• Bupropion can be considered as an alternative non-stimulant medication for ADHD treatment, particularly when:
  • Stimulants are ineffective or poorly tolerated
  • There are concerns about stimulant misuse or diversion
  • Comorbid conditions exist where stimulants may be contraindicated 1, 3

Concerns with Anxiety

Bupropion is not indicated for anxiety treatment and may potentially exacerbate anxiety symptoms:

• Unlike other antidepressants (SSRIs/SNRIs), bupropion lacks significant serotonergic activity, which is typically beneficial for anxiety disorders
• Bupropion's dopaminergic and noradrenergic effects may increase activation and potentially worsen anxiety in some patients
• For patients with comorbid ADHD and anxiety, atomoxetine may be a better non-stimulant option 4

Dosing Information

For ADHD treatment with bupropion:

• Sustained-release (SR): Start with 100-150 mg daily, maintenance dose 100-150 mg twice daily 5
• Extended-release (XL): Start with 150 mg daily, maintenance dose 150-300 mg daily 5
• Maximum dose: 450 mg per day 5

Special Considerations

Comorbid Conditions

• Bupropion may be particularly beneficial in patients with:
  • ADHD and depression 6
  • ADHD and bipolar disorder (particularly bipolar II) 6
  • ADHD and substance use disorders 3

Safety Profile

• Common side effects include headache, dry mouth, insomnia, nausea, decreased appetite
• Bupropion has a low risk of sexual side effects compared to many antidepressants
• Seizure risk is dose-dependent (higher at doses >450 mg/day)
• Contraindicated in patients with seizure disorders, eating disorders, or those undergoing abrupt discontinuation of alcohol or sedatives 5

Pregnancy and Breastfeeding

• Limited data on bupropion use during pregnancy shows:
  • Possible small increased risk of cardiovascular malformations (left ventricular outflow tract obstruction and ventricular septal defects) 5
  • Possible increased risk for spontaneous abortion 5
  • Caution advised during breastfeeding due to presence in breast milk and rare case reports of seizures in breastfed infants 5

Alternative Non-Stimulant Options

If anxiety is a significant concern, consider:

• Atomoxetine (Strattera): First-line non-stimulant for ADHD with comorbid anxiety 4
  • Target dose: 1.2 mg/kg/day (maximum 1.4 mg/kg/day or 100 mg)
  • Provides all-day symptom control
  • Has negligible abuse potential
  • May be better tolerated in patients with anxiety

Bottom Line

For patients with ADHD and anxiety, bupropion may effectively treat ADHD symptoms but is unlikely to improve and may potentially worsen anxiety. Atomoxetine would be a more appropriate first-line non-stimulant choice for patients with both conditions.