Bupropion doesn't prevent smoking in ADHD patients

NEW YORK (Reuters Health) - The high risk of smoking among young people with attention-deficit/hyperactivity disorder (ADHD) is not reduced by treatment with the antidepressant bupropion, according to a report in the Journal of Clinical Psychiatry. However, stimulants do seem to cut the likelihood of smoking.
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Bupropion is sold under the trade name Zyban when it's prescribed to help people stop smoking, and under the name Wellbutrin when it's prescribed to treat depression or seasonal affective disorder.

"Given that children with ADHD are at very high risk for the development of nicotine dependence, the development of successful smoking prevention programs in this population will address a serious public health issue," Dr. Michael C. Monuteaux told Reuters Health.

Monuteaux from Massachusetts General Hospital and Harvard Medical School, Boston, and associates evaluated the effects of bupropion on smoking prevention in a study of 57 ADHD patients of both sexes ages 9 to 18 years. They were randomly assigned to daily bupropion or placebo and were followed for an average of 1 year.

The rate of any positive test results for cotinine, a chemical marker that appears in the urine after smoking, was lower in the placebo group (28 percent) than in the bupropion group (46 percent), the investigators report.

Patients treated with bupropion were 2.3 times more likely than placebo-treated patients to start smoking over the course of follow-up. However, these differences were not statistically significant.

"We were somewhat surprised given the evidence for (bupropion's) efficacy in smoking cessation trials in adults," Monuteaux said. However, these previous studies contained adult smokers, not adolescents with ADHD. However, adolescents who received "treatment with stimulants serendipitously appeared to have a lesser risk for smoking."

Specifically, patients who were treated concurrently with stimulants were 73.6-percent less likely to start smoking over the course of follow-up compared with those who were not treated with stimulants, the report indicates. Patients treated with stimulants were also 69.5 percent less likely to continue smoking over the course of the follow-up period.

Based on these findings, "our research group is currently conducting a clinical trial examining the potential prophylactic effects of a long-acting stimulant treatment in adolescents with ADHD to test its efficacy as an agent against smoking initiation," Monuteaux said.

SOURCE: Journal of Clinical Psychiatry, July 2007

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