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A Randomized, Placebo-Controlled Clinical Trial of Bupropion for the Prevention of Smoking in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder
- Source :
- The Journal of Clinical Psychiatry. 68:1094-1101
- Publication Year :
- 2007
- Publisher :
- Physicians Postgraduate Press, Inc, 2007.
-
Abstract
- Objective: Since attention-deficit/hyperactivity disorder (ADHD) is a well-documented risk factor for smoking and bupropion has been shown to be effective for smoking cessation, we tested the efficacy of bupropion as a prophylactic agent for the prevention of smoking in children and adolescents with ADHD. Method: We conducted a longitudinal, randomized, double-blind, placebo-controlled, parallel-group study of bupropion at a large, urban, outpatient medical center. Recruitment began in April 1999, and the last subject was followed until September 2004. Patients were nonsmoking youth, of both sexes, between 9 and 18 years of age, with DSM-IV ADHD. After random assignment to either bupropion or placebo, subjects were assessed weekly for 8 weeks, biweekly for 4 weeks, and monthly thereafter for up to 6.5 years (mean 12 months). Also, patients received treatment with psychostimulants for ADHD symptoms as needed. To assess smoking, we used an assay of cotinine in urine. Results: Fifty-seven subjects (28 receiving bupropion and 29 receiving placebo) were randomly assigned and included in the analysis. No differences were found between the bupropion and placebo groups on demographic factors. About half of each group was treated with stimulants for ADHD. Statistical separation between bupropion and placebo in the rate of smoking initiation or continued smoking was not demonstrated. However, secondary post hoc analyses revealed that concurrent stimulant treatment was significantly associated with a lower rate of smoking onset (hazard ratio [HR] = 0.2, 95% CI = 0.08 to 0.89; z = -2.2, p = .03) and a lower rate of continued smoking (HR = 0.3, 95% CI = 0.11 to 0.85; z = -2.3, p = .02). Conclusion: While bupropion was not associated with a lower rate of smoking in youth with ADHD, post hoc analyses suggest that stimulant treatment was. Future controlled studies should investigate the role of stimulants in the prevention of smoking in children and adolescents with ADHD.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
Urban Population
medicine.medical_treatment
Smoking Prevention
Placebo
chemistry.chemical_compound
Dopamine Uptake Inhibitors
Double-Blind Method
Internal medicine
Outpatients
mental disorders
medicine
Humans
Attention deficit hyperactivity disorder
Longitudinal Studies
Risk factor
Child
Psychiatry
Bupropion
Random assignment
medicine.disease
Stimulant
Psychiatry and Mental health
Treatment Outcome
chemistry
Attention Deficit Disorder with Hyperactivity
Smoking cessation
Female
Cotinine
Psychology
medicine.drug
Subjects
Details
- ISSN :
- 01606689
- Volume :
- 68
- Database :
- OpenAIRE
- Journal :
- The Journal of Clinical Psychiatry
- Accession number :
- edsair.doi.dedup.....80932d95fa389fd274fdd7a42e56f733