A trial of bupropion sustained release (SR) was conducted in 24 adolescents (ages 11-16 years) with ADHD and either major depressive disorder or dysthymic disorder at the Department of Psychiatry, Dartmouth Medical School, Hanover, NH. The mean final titrated doses were 2.2 mg/kg qam and 1.7 mg/kg qpm, with a maximum of 3 mg/kg bid. Outcomes were rated by the clinician, parent, child, and teachers. Fourteen (58%) showed a global improvement in both ADHD and depression on clinician ratings; the response was in depression only in 29%. and in ADHD only in 4%. Parents’ and childrens’ ratings of depression after bupropion improved significantly, when compared to prior placebo ratings. Parents’ ratings of ADHD improved while teachers’ ratings did not. Final parents’ ratings of functional impairment showed significant improvements. All subjects completed the 2-week single-blind placebo lead-in and the 8 week bupropion trial. Comparing bupropion versus placebo periods, rash occurred in 13% vs 8%; irritability in 8% vs 4%;. tremor in 4% vs 0%; and motor tics in 4% vs 0%. No patient discontinued medication completely because of side effects. [1]

COMMENT. Bupropion SR may be effective in adolescents with depression and ADHD and further controlled studies are indicated. The teachers’ failure to observe improvement in ADHD symptomatology is disappointing, and the occurrence of rash, irritability, tremor, and tics is noteworthy. The lack of seizures as a side effect in this study is encouraging, though the drug should be avoided or used with caution in patients with a predisposition to seizures.