Bupropion SR for the treatment of substance-abusing outpatient adolescents with attention-deficit/hyperactivity disorder and mood disorders.
ABSTRACT Few studies exist on pharmacological interventions for adolescents with substance use disorders (SUD). To this end, we evaluated the response of bupropion hydrochloride sustained release (SR) in SUD adolescents with comorbid psychopathology (both attention-deficit/ hyperactivity disorder (ADHD) and a mood disorder). Methods: Fourteen adolescent outpatients were treated naturalistically and followed openly for 6 months. Adolescents were rated using the Drug Use Screening Inventory--Revised (DUSI-R), ADHD Symptom Checklist, and the Hamilton Rating Scale for Depression (HAM-D). Clinical Global Impression (CGI) Scale scores were obtained for Substance Abuse, ADHD, Anxiety, and Depression. The ratings were completed at baseline, at month 3, and at the 6-month endpoint. Bupropion SR was initiated at 100 mg once-daily and titrated naturalistically to a maximum dose of 400 mg/day.
Of the 14 subjects followed, 13 subjects completed 6 months of treatment. At the 6- month endpoint compared to baseline, treatment with bupropion was associated with clinical and significant reductions in DUSI scores (-39%; p < 0.05), ADHD symptom checklist (-43%; p < 0.001), HAM-D (-76%; p < or = 0.001); and reductions in the CGIs for ADHD (p < or = 0.001), depression (p < or = 0.001), and substance abuse (p < 0.05). The mean daily dose of bupropion SR was 315 mg (in divided doses). No significant adverse events were noted during the follow-up period.
These naturalistic data suggest that bupropion is well tolerated and may be an effective medication for the treatment of substance abusing adolescents with comorbid mood disorders and ADHD.
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ABSTRACT: Introduction The prevalence of the attention deficit hyperactivity disorder (ADHD) in childhood is 3% to 5%; apparently, its expression during adolescence is not lower. Around 65% of the children diagnosed with ADHD continue meeting criteria for the diagnosis through adolescence and the rest appear to maintain some symptoms that cause dysfunction in at least two areas of their life. Many factors may play a role in adolescents who met ADHD criteria in the past and continue to manifest dysfunction, although they do not meet diagnostic criteria. At this age group, one factor may be the decrease in sensibility in different diagnostic approaches. When the diagnosis of ADHD is established during childhood, the task of the mental health professional is to continue with the treatment as much as it is needed. However, some adolescents who attend first time evaluation do not have a previous diagnosis and ADHD symptoms may be subtler during puberty. In sharp contrast with ADHD diagnosed during childhood, when it is diagnosed in adolescence, often times it presents itself with more complications due to the deterioration it generates in the individual's psychosocial development, especially when it has not been adequately treated in the past. In Latin America, studies have been carried out that include adolescent population with ADHD, albeit most of them include children. In Brazil, for example, a study including 1013 students 12 -14 years old was carried out, it showed that the prevalence of ADHD was around 6%, and that it came about with a high comorbidity with behavioral disruptive disorders (48%). In this study, youths with ADHD showed a higher probability of having lower academic performance, (e.g. history of more repetitions of school grade, suspensions and expulsions of schools), in comparison with the group without ADHD. With regards to gender, a meta-analysis including 25 studies between 1996-2006 reported a prevalence of mental illness in adolescent population (n=14,639). The estimated prevalence of ADHD among women was reported to be higher than in men (18% vs. 12%), contrary to what was been reported in childhood. Another complication of ADHD among adolescent population is that there is a higher risk of suffering comorbid psychiatric disorders with ADHD, such as oppositional defiant disorder, conduct disorder, affective disorders, and substances use disorders, which increase the dysfunction and complicate the treatment. It has been reported that adolescents with ADHD and comorbid internalizing disorders (e.g. depression, anxiety) have better compliance and treatment outcomes than those with externalizing disorders. Adolescents with ADHD have a quality of life similar to adolescent patients with a chronic physical illnesses. Hence, it is extremely important to recognize and to give an appropriate treatment that diminishes the impact this disorder has on overall function. With this clinical picture in mind, ADHD has become a problem of public health in Latin American countries, thus the inclusion of medical doctors of first and second level of attention, with regards to education, diagnosis and treatment of this disorder and its possible complications, is of the utmost importance. The practice guidelines for the treatment of mental health problems in children and adolescents integrate the pharmacological treatment with psychosocial (such as psychotherapy, parent management training including psicoeducation). The multicentric randomized studies carried out in the United States have identified specific advantages for the multimodal treatment compared to the medication alone, including improvement not only in symptoms but in family functioning as well. At the moment, there is more evidence showing that the psychopharmacological treatments for adolescents with ADHD, the stimulants mainly and also atomoxetine, are effective and efficient, making them the first line of intervention. Even though pharmacological treatment is the pillar for the treatment of this disorder, the addition of psychosocial interventions at all stages in life, directed to the parents, teachers and the affected individual, is strongly recommended given the need for a multimodal treatment of ADHD and to better assist the way the patient's environment shapesSalud Mental 01/2009; · 0.42 Impact Factor
- International Journal of Mental Health and Addiction 10/2014; · 0.95 Impact Factor
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ABSTRACT: Major Depressive Disorder (MDD) in children and adolescents is a common and impairing condition that is both recurrent and persistent into adulthood. In this article, a review of the literature regarding multimodal treatment is presented. The literature review process for this article included «adolescents», «children», «depression», «treatment», «antidepressants» and «psychotherapy» as key words. The initial Medline search covered a 10 year period dating back to 2001. Double blind randomized and meta-analysis studies were considered as gold standard to be included in the revision, but also experts' consensus were incorporated. Regarding pharmacological treatment, tricyclic-antidepressants did not show better efficacy against placebo in double blind controlled studies; selective serotonin reuptake inhibitors showed better efficacy against placebo in controlled studies, specifically fluoxetine and escitalopram, both approved to be used in pediatric population with MDD. Noradrenalin and serotonin reuptake inhibitors like venlafaxine or mirtazapine had not shown superior response than placebo. Comorbidity needs to be taken into account in the decisions of the pharmacological treatment; attention deficit hyperactivity disorder is the most frequent associated disorder and requires to add specific drug treatment like stimulants; if psychotic symptoms are present, atypical antipsychotics should be added. Regarding psychosocial treatment, psychoeducation is the first step in this treatment approach. Psychotherapy aims include decreasing symptoms severity by improving self esteem, increasing frustration tolerance and autonomy, as well as the ability to enjoy daily life activities, and establishing good relations with peers. Interpersonal and cognitive behavioral therapies are good options as psychotherapy for this age group. It is important to monitor patients to prevent relapses and complications of depression and suicidal behavior.Salud Mental 10/2011; 34(5):403-407. · 0.42 Impact Factor