Bupropion (Wellbutrin, Zyban) is not a first-line ADHD medication, but there’s decent evidence that it can help with inattentiveness in some patients. Here’s a summary:
1. Evidence Base
- Clinical trials: Several randomized controlled trials (e.g., Wilens 2001; Daviss 2001; Patel 2017) have found that bupropion reduces ADHD symptoms, including inattentiveness, compared with placebo.
- Meta-analyses:
- A 2017 systematic review in Cochrane Database (López-Muñoz et al.) concluded that bupropion is more effective than placebo for adult ADHD, but with a smaller effect size than stimulants.
- Effect sizes typically fall in the small-to-moderate range (Cohen’s d ≈ 0.3–0.5).
- Guidelines:
- The Canadian ADHD Practice Guidelines and some APA/US practice parameters list bupropion as a second-line option for adults, especially if stimulants are contraindicated (e.g., due to anxiety, substance use, tics).
2. How Effective Compared to Stimulants
- Stimulants (methylphenidate, amphetamines): Response rates ≈ 70–80%, with large effect sizes (d ≈ 0.8–1.0).
- Bupropion: Response rates ≈ 40–50%, with more modest symptom reduction.
- It is generally less potent than stimulants but can still provide meaningful benefit, particularly for inattentive symptoms and in those with comorbid depression.
3. Clinical Use
- Dosing: usually 150–300 mg/day (SR or XL formulations).
- Onset: therapeutic effects for ADHD often take several weeks (slower than stimulants).
- Advantages:
- Non-stimulant (no abuse potential).
- May help with comorbid depression and smoking cessation.
- Limitations:
- Less robust effect on hyperactivity/impulsivity compared to stimulants.
- Contraindicated in seizure disorders, eating disorders.
Bottom Line
Yes—bupropion can be effective for inattentiveness, but less so than stimulants.
- Expect modest improvements (≈40–50% response rate, small-to-moderate effect size).
- Best considered when stimulants or atomoxetine are unsuitable, or when depression is also present.
Would you like me to also compare bupropion vs. atomoxetine for inattentive ADHD specifically, since both are non-stimulant options? That might give a clearer clinical picture of “how effective” it really is in practice.
