Wellbutrin is a newer anti-depressant that differs chemically from the tricyclics and has a different mechanism of action. It is a better antidepressant for children than tricyclics are, and it has also been proven effective for ADD. Often Wellbutrin helps a child with ADD for whom other medications haven’t worked as well as expected. The reason for this seems to be that Wellbutrin increases the brain activity of Dopamine (DA), while all other ADD drugs increase Norepinephrine (NE). DA and NE are the two brain chemicals (neurotransmitters) known to be “under-active” in people with ADD. Presumably the small number of individuals for whom Wellbutrin works best have a bigger DA deficit, and a smaller NE deficit, than the “typical” case of ADD.
Wellbutrin has very few risks or side effects. In fact, it has really only one of each. The main side effect is appetite suppression. This can be so powerful in some children as to not only cause weight loss, but also actual hypoglycemia (low blood sugar). Therefore we monitor the weight of children on this drug closely, and we recommend they eat mid morning, mid afternoon, and bedtime snacks in addition the usual three daily meals in a manner similar to that of diabetics. The main risk of Wellbutrin is that it increases the likelihood of seizures. While seizures are a rare event even in patients taking this medicine, the rate is roughly doubled in comparison to the general population. Many seizures seen with Wellbutrin are related to hypoglycemia, and so may be prevented by adhering to the diet with snacks described above. Wellbutrin should not be used, however, when there is a past history of seizures or a family history of epilepsy. Wellbutrin won’t exacerbate tics or anxiety the way stimulants do, but unlike tricyclics it won’t help these things either.
We mainly use Wellbutrin in two situations: The first is when other medications just don’t seem to be working as well as we expect, as noted above. The second is when a child has both Depression and ADD, and we are trying to treat both with a single medicine. Wellbutrin only comes in tablet form and needs to be taken twice a day. Wellbutrin has also been proven to assist in smoking cessation, and this can sometimes be a factor in choosing medication for a tobacco using teenager with ADD who wants to quit.