Microsoft word - bcch bupropion - ov sept 06.doc

Using Bupropion in Children and Adolescents

This information explains how Bupropion can be used as part of a treatment plan with children and
adolescents. You may wish to share this information with your family members to help them to understand your
treatment options. Since every person's needs are different, it is important that you follow the advice provided to
you by your own doctor, nurse and/or pharmacist and speak to them if you have any questions about this
What is Bupropion used for?

Bupropion (Wellbutrin®) belongs to a group of medications called antidepressants. Bupropion can be
Like many medications used to treat childhood disorders, bupropion has not been formally approved by Health Canada for use in children and adolescents. When the benefits (e.g., reducing your symptoms) of using bupropion outweigh the potential risks (e.g., the side effects), many doctors may prescribe it to treat: • Depression. • Depression associated with Bipolar Disorder. • Attention Deficit Hyperactivity Disorder. • Cravings associated with quitting smoking (often prescribed as “Zyban®”). Your doctor may be using this medication for another reason. If you are unclear why bupropion is being prescribed, please ask your doctor. How does Bupropion work?

Bupropion is a selective “Norepinephrine and Dopamine Reuptake Inhibitor (NDRI)”. This
means it increases the amount of certain chemicals in the brain called norepinephrine and
dopamine. It is believed that some brain chemicals, such as norepinephrine and dopamine,
are not working well in people who are depressed. The exact way that bupropion improves the symptoms of depression is still not fully known.
How well does Bupropion work in children and adolescents?

Testing of bupropion in children and adolescent research studies has been limited. In some studies of children and
adolescents with depression, medications like bupropion have been found to help about 5-6 people out of 10.
Some of these studies also found that antidepressants were not better at treating the symptoms of depression
than a placebo (an inactive pill that looks like the medication being tested). In general, depressed youth who take
bupropion for 2-3 months should notice an improvement in their depressive symptoms (such as improved mood,
better sleep, more energy, and improved concentration).
Whenever possible, the addition of talk therapy (such as
Cognitive Behaviour Therapy – “CBT”
) to this medication increases the potential for benefits.

How should Bupropion be taken?

Bupropion is usually taken twice a day with or without food. You should take this medication at the same time each day as directed by your doctor. Try to connect it with something you do each day (like eating breakfast or brushing your teeth) so that you don’t forget. Usually, your doctor will start with a low dose of bupropion. This dose will be slowly increased over several days or weeks based on how you respond to it. You and your doctor can then discuss the best dosage to stay on based on how this medication is tolerated (how well the medication is working and how you are doing with side effects of the medication) and how well it helps decrease your symptoms. Child & Adolescent Mental Health Programs, BC Children’s Hospital, 4480 Oak Street, Vancouver, B.C., Canada V6H 3V4
When will this medication start working?

Bupropion must be taken for 3 - 6 weeks before you begin to feel better. Different symptoms start to improve at
different rates. For example, improvements in sleep, appetite and energy may be seen within the first 2 weeks.
Sometimes, others will notice improvements in you before you do. Full beneficial effects may take 4 to 8 weeks (or
Since this medication takes time to work, do not increase, decrease or stop it without discussing it with your

If you are not feeling better within 6 to 8 weeks, your doctor may recommend you take a different
antidepressant. There is also a small possibility that your depressive symptoms may worsen or that you
may experience some thoughts of self harm during the first couple months of taking this medication (see
section on side effects). If this happens, tell your doctor IMMEDIATELY.
How long do I have to take this medication?
This depends on the symptoms you have, how frequent they occur and how long you have had them. Most people need to take this medication for at least 6 months. This allows time for your symptoms to stabilize and for you to regain functioning. After this time, you and your doctor should discuss the benefits and risks of continuing treatment. Once you have started taking this medication, your doctor and you will need to monitor for both the beneficial and
unwanted effects. Your doctor will likely check your progress and discuss changes in symptoms during the next 3
months to confirm that the medication is working properly and that possible side effects are avoided.
Do not stop taking this medication if you are feeling better without discussing it with your doctor.
If you have had several episodes of severe depression and you tolerate this medication well, you may be asked to take this medication for an indefinite amount of time. By continuing to take this medication, you significantly decrease the chance that you may have another episode of depression. Tip: Use the Antidepressant Monitoring Form to help measure your progress on this medication. Is Bupropion addictive?

No, Bupropion is not addictive. You will not have “cravings” for it like some people do with nicotine or street drugs.
If you and your doctor decide to stop using Bupropion, your doctor can explain how to safely lower the dose so
you don’t feel any “flu-like” effects as your body adjusts to being without it.

What are the side effects of this medication and what should I do if I get them?

As with most medications, side effects may occur when taking bupropion. Most side effects are mild and
temporary. A study of 104 children taking bupropion found that most children did not have many uncomfortable
side effects. Sometimes, the side effect may occur before any beneficial effects. It is possible to experience a side
effect that you feel is serious or long lasting. If this occurs, speak to your doctor about ways to manage these side
effects. Here are some of the more common side effects of taking this medication. In brackets are suggested
ways to lessen these effects.

Common side effects

Should any of these side effects be too troublesome for you, please discuss them with your doctor, nurse or
(increase exercise, fluids, fruits and fibre) (try taking the medication earlier in the day) Child & Adolescent Mental Health Programs, BC Children’s Hospital, 4480 Oak Street, Vancouver, B.C., Canada V6H 3V4 (try getting up slowly from a sitting or lying down position) (avoid caffeine from colas and coffee) (try using a pain reliever like acetaminophen) • Loss of appetite (try eating smaller, more frequent meals) • Skin rash or itchy skin (use special moisturizers like aveeno) • Stomach Uncommon side effects (e.g., those that occur in less than 5% of patients)
Contact your doctor IMMEDIATELY if you have any of these side effects:
(usually at very high doses; risk is less than 1%) • An uncomfortable sense of inner restlessness or agitation • Sweating, muscle twitches or stiffness • Vivid • A switch in mood to an unusual state of excitement, irritability or happiness • Thoughts of self harm, hostility or suicide
What precautions should my doctor and I be aware of when taking this medication?

Tell your doctor or pharmacist if you:
• have any allergies or have had bad reactions to medications. • take any other prescription or non-prescription medications. Some medications may interact with bupropion. Your doctor may need to change the doses of your medication(s) or monitor you carefully for side effects if you are taking other medications. • have any changes in mood or thoughts of self harm. • have a history of heart disease, seizures, kidney or liver disease. • miss a period, become pregnant or are trying to become pregnant.
What should I do if I forget to take a dose?
If you miss a dose of this medication, take it as soon as possible. However, if it is almost time for your next dose (e.g., within 4 hours), do not take the missed dose or double your next dose. Instead, continue your regular dosing schedule. What storage conditions are needed for this medication?
¾ Keep this medication in the original container, stored at room temperature away from moisture and ¾ Keep this medication out of reach from children. Developed by the health care professionals of Child & Adolescent Mental Health Programs and reviewed by the Department of Learning and Development. Child & Adolescent Mental Health Programs, BC Children’s Hospital, 4480 Oak Street, Vancouver, B.C., Canada V6H 3V4


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