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Thursday, April 24, 2014
Attention Deficit Hyperactivity Disorder
Wellbutrin Treatment for ADHD
My son, age 11, has been on Wellbutrin, 100 mg at bed time for 18 months. His doctor feels he needs to continue on this medication. Initially it was to combat insomnia and mild depression. I question if this is a standard dose and what effects we may see if he is taken off the drug. Also, can it be stopped abruptly or should it be weaned off? At present we are continuing to give it. He is also on ritalin.
Wellbutrin is an excellent medication for depression. It is also useful in treating ADHD. In terms of treating insomnia, Wellbutrin can actually cause insomnia as one of its side effects. However, since insomnia can be the result of depression and/or ADHD, and Wellbutrin treats both of these conditions, it is reasonable to presume that it will be effective for the insomnia, especially if it is due to one of these two conditions. Because ADHD is a chronic condition, medications may need to be taken for an extended period to alleviate symptoms. If the Wellbutrin has seemed to help any of your son's ADHD symptoms, then it is reasonable to keep him on this medicine. Because the depression was mild and a first time occurrence, it may be reasonable to discontinue the Wellbutrin if his depression seems to be resolved, especially if this medicine is not helping the ADHD. If you and your doctor believe that your son's ADHD and depressive symptoms are well controlled you might consider weaning the Wellbutrin. If he has recurrence of any of his depressive symptoms or insomnia or worsening of his ADHD, then he should resume taking the Wellbutrin. Because of the small risk of seizures in patients taking Wellbutrin, it would be best to wean this medicine, rather than stopping it abruptly. Regarding dosing of Wellbutrin, in children this is weight-dependent. The starting dose is usually between 3 to 6 mg/kg/day. The total dose is best split up into two or three doses per day; however, Wellbutrin is now available as a once daily dose given in a sustained-release form. To calculate the amount of medicine your son should be taking, you need to divide his weight in pounds by 2.2 to get the number of kilograms (kg) that he weighs. The starting dose mentioned here is not an absolute. Some people require more medicine, while others require less.
Margaret C Sweeney, MD
Formerly, Associate Professor of Clinical Family Medicine
College of Medicine
University of Cincinnati