title: An open trial of bupropion for the treatment of adults with attention-deficit/hyperactivity disorder and bipolar disorder.
abstract: BACKGROUND
  Despite the increasing recognition of comorbid attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BPD) in adults, there are no prospective trials of pharmacological agents to treat ADHD in these patients. Given the efficacy of bupropion for ADHD in adults, as well as its use in the management of bipolar depression, we studied the tolerability and efficacy of sustained-release (SR) bupropion in adults with ADHD plus BPD.
  
  
  METHODS
  This was an open, prospective, 6-week trial of bupropion SR (up to 200 mg b.i.d.) in adults with DSM-IV ADHD plus historical bipolar I disorder (BPD I) (10%) or bipolar II disorder (BPD II) (90%). Adults receiving adjunct antimanic agents (mood stabilizers and antipsychotics) at baseline were included in the study. We used standardized psychiatric instruments for diagnosis and outcome. Efficacy was based primarily on the Clinical Global Impression Scale (CGI) for ADHD and the ADHD symptom checklist.
  
  
  RESULTS
  Of 36 patients entered (75% male, mean age 34 years), 30 patients (83%) completed the protocol. At end point (last observation carried forward [LOCF]) compared to baseline, treatment with bupropion SR resulted in significant reductions in the ADHD symptom checklist (-55%, z = 5.63, p <.001) and CGI severity of ADHD (-40%, z = 6.285, p <.001). Bupropion was associated with reductions in ratings of mania and depression.
  
  
  CONCLUSIONS
  The results from this open study of adults with ADHD plus BPD suggest that sustained-release bupropion may be effective in treating ADHD in the context of a lifetime diagnosis of BPD, without significant activation of mania. Further controlled trials are warranted.
authors.affiliation: Clinical Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Wilens
authors.forename: Jefferson B
authors.initials: JB
authors.lastname: Prince
authors.forename: Thomas
authors.initials: T
authors.lastname: Spencer
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Van Patten
authors.forename: Robert
authors.initials: R
authors.lastname: Doyle
authors.forename: Kristine
authors.initials: K
authors.lastname: Girard
authors.forename: Paul
authors.initials: P
authors.lastname: Hammerness
authors.forename: Sarah
authors.initials: S
authors.lastname: Goldman
authors.forename: Sarah
authors.initials: S
authors.lastname: Brown
authors.forename: Joseph
authors.initials: J
authors.lastname: Biederman
mesh_terms: D000328:Adult; D000339:Affect / Q000187:drug effects; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D001714:Bipolar Disorder / Q000188:drug therapy*; D016642:Bupropion / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D003692:Delayed-Action Preparations; D018765:Dopamine Uptake Inhibitors; D016642:Bupropion