Can Adderall (amphetamine and dextroamphetamine) be used to treat Attention Deficit Hyperactivity Disorder (ADHD) in individuals who experience high anxiety while taking Wellbutrin (bupropion)?

Adderall Can Be Used for ADHD When Wellbutrin Causes Anxiety

Yes, Adderall (amphetamine and dextroamphetamine) can be an appropriate treatment option for ADHD in patients who experience high anxiety with Wellbutrin (bupropion). 1

Understanding the Relationship Between Medications and Anxiety

• Bupropion (Wellbutrin) is considered a second-line agent for ADHD treatment and can cause anxiety as a side effect in some patients, particularly those with pre-existing anxiety disorders 1
• Stimulants like Adderall remain first-line treatments for ADHD and can be effective even in patients with comorbid anxiety 1

Treatment Algorithm for ADHD When Bupropion Causes Anxiety

Step 1: Evaluate the anxiety symptoms

• Determine if anxiety is directly related to bupropion use rather than underlying anxiety disorder 1
• Assess severity of both ADHD symptoms and anxiety symptoms to guide treatment decisions 1

Step 2: Consider stimulant trial

• Stimulants like Adderall have shown robust efficacy in treating ADHD symptoms, with response rates of up to 78% in adults 1
• Despite common misconceptions, stimulants often do not worsen anxiety and may actually improve anxiety symptoms by better controlling ADHD 1
• Start with a low dose of Adderall (5-10 mg twice daily) and titrate gradually based on response 2

Step 3: Monitor for effectiveness and side effects

• Evaluate both ADHD symptom improvement and anxiety levels 1
• Watch for potential stimulant side effects including insomnia, decreased appetite, and cardiovascular effects 1

Evidence Supporting Stimulant Use in Patients with Anxiety

• The MTA study found that ADHD patients with comorbid anxiety actually showed greater improvement with stimulant medication compared to those without anxiety 1
• Low-dose amphetamine salts (Adderall) at mean doses of 10.77 mg/day have shown effectiveness in adults with ADHD 2
• Clinical guidelines support stimulant use as first-line treatment even when anxiety is present 1

Important Considerations and Precautions

• Stimulants may occasionally exacerbate anxiety in vulnerable individuals, particularly at higher doses 2
• Start with lower doses (5 mg twice daily) and titrate slowly to minimize risk of anxiety exacerbation 2
• Long-acting formulations may provide more consistent symptom control with less "peak and trough" effects that could trigger anxiety 1
• For patients with severe anxiety disorders, consider treating the anxiety disorder first or concurrently with ADHD treatment 1

Alternative Options if Adderall is Not Effective or Tolerated

• Other stimulant formulations (methylphenidate, lisdexamfetamine) may have different side effect profiles 1
• Non-stimulant alternatives such as atomoxetine can be considered, though they are generally less effective than stimulants 3
• Alpha-2 agonists (clonidine, guanfacine) may help with both ADHD and anxiety symptoms 1

Conclusion for Clinical Practice

When Wellbutrin causes significant anxiety in ADHD patients, switching to a stimulant like Adderall is a reasonable and evidence-based approach. Starting with lower doses and careful monitoring can help optimize treatment outcomes while minimizing side effects 1, 2.