Bupropion SR for the Treatment of Substance- Abusing Outpatient Adolescents with Attention- Deficit/Hyperactivity Disorder and Mood Disorders
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.
[Show abstract] [Hide abstract] ABSTRACT: Comorbid ADHD and substance use disorder (SUD) presents frequently in adolescence, a developmental period that may promote the emergence of substance misuse among individuals with ADHD. Comorbid ADHD and SUD in adolescence results in significant and unique treatment challenges, necessitating examination into effective interventions. This systematic review examined existing research into the treatment of comorbid adolescent ADHD and SUD. Findings from a small number of pharmacological intervention studies suggest potential efficacy of extended-release stimulant and nonstimulant medications. Efficacy of psychotherapeutic interventions has not been systematically examined. Current research on treatments for comorbid ADHD and SUD in adolescence is limited. Future placebo-controlled clinical trials using large samples are needed to examine the efficacy of psychotherapeutic interventions, the heightened risk of prescription stimulant misuse, and the long-term maintenance of treatment gains in this population. Clinical guidelines for the treatment of comorbid ADHD and SUD are discussed. © 2015 SAGE Publications.0Comments 0Citations
- "SUD symptoms were not assessed. Solhkhah and colleagues (2005) also examined the impact of bupropion in a small-scale, naturalistic trial using systemic chart review. Fourteen adolescents (64% male) with DSM-IV ADHD (subtype: 71% combined, 29% inattentive ), DSM-IV SUD, and a mood disorder diagnosis (e.g., major depressive disorder, depressive disorder not otherwise specified, bipolar disorder) were treated with bupropion for 6 months. "
[Show abstract] [Hide abstract] ABSTRACT: Currently there is no guideline for the screening, diagnosis and treatment of adult attention deficit/hyperactivity disorder (ADHD) in patients with a substance use disorder (SUD). The aim was to develop such a guideline, starting out from a systematic review and based on the methodology of the Scottish Intercollegiate Guideline Network (SIGN). Due to the lack of scientific evidence on some of the topics, the guideline is a combination of evidence based and practice based recommendations. Given the high prevalence of ADHD in treatment seeking SUD patients and the availability of valid screening instruments, all treatment seeking SUD patients should be screened for ADHD. Diagnosis of ADHD should be based on clinical observation and history taking, including informant data. Integrated treatment of ADHD and SUD is recommended, including pharmacotherapy, psycho-education, coaching, and cognitive behavioral therapy (CBT). The lack of scientific data and the overall lack of expertise in the field are significant obstacles to the implementation of the guideline. Intensive training programs in the substance abuse sector need to be organized to implement these guidelines.0Comments 3Citations
- "However, data on adult ADHD in a population of substance users is much more limited. A number of case reports and open-label investigations suggest a positive effect of medication on ADHD symptoms in addicts (Castaneda et al. 2000; Levin et al. 2009; Mann and Bitsios 2009; Riggs et al. 1998; Solhkhah et al. 2005; Somoza et al. 2004; Vaiva et al. 2002; Wilens et al. 2010; Winhusen et al. 2006). 3 However, most double-blind and placebo-controlled studies, albeit with small groups and of short duration (Upadhyaya 2006; Wilens et al. 2008), show little or no improvement in ADHD symptoms. "
[Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to assess the effects of the antidepressant bupropion on anxiety and novelty-seeking in adolescent mice of different ages and adults. Behavioural differences between early adolescent, late adolescent and adult NMRI mice were measured both in the elevated plus-maze and the hole-board tasks following acute administration of bupropion (5, 10, 15, 20mg/kg) or saline. In the plus maze test, early and late adolescent mice treated with bupropion (10, 15mg/kg, respectively) had lower percentages of entries in the open-arms compared to their vehicle controls. Adult mice treated with bupropion did not differ from their vehicle controls. These results suggest that the effect of this drug on anxiety-like behaviour in mice depends on the age, showing adolescents an anxiogenic-like profile. In the hole-board, adolescents showed more elevated levels of novelty-seeking than adults, exhibiting shorter latency to the first head-dip (HD) and a higher number of HD's. Bupropion increases the latency to the first HD and decreases the number of HD's in all age-groups, indicating a decline in exploratory tendency. Findings reveal that the age can modulate the behaviour displayed by mice in both animal models, and that adolescents are more sensitive to bupropion's anxiogenic effects.0Comments 2Citations
- "Clinical studies have suggested that bupropion , an antidepressant used in adults for the treatment of nicotine addiction (Benowitz, 2009; Ray et al., 2009), also provides some aid to nicotine-dependent adolescents (Grimshaw and Stanton, 2006; Best, 2008; Bailey et al., 2012). Furthermore, this drug is used as an antidepressant in adolescents with major depression (Kosten and Kosten, 2004), with Attention Deficit Hyperactivity Disorder (ADHD) (Verbeeck et al., 2009; Wigal, 2009), and with substance use disorders and comorbid mood disorders or ADHD (Solhkhah et al., 2005; Kollins, 2008). This antidepressant could alleviate both depressive and anxiety symptoms in patients with comorbid depression and anxiety disorders (Schoevers et al., 2008). "