Attention-deficit hyperactivity disorder medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2], Haleigh Williams, B.S.
Overview
The mainstay of therapy for ADHD is the administration of such stimulants as Ritalin and Adderall. While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Other treatment options include psychotherapy, education and training, or a combination of therapies.[1]
Measurement-based care may help[2][3].
Practice guidelines are available[4]<[5]
Medical Therapy
Several different types of medications may be prescribed to mitigate the symptoms associated with ADHD. Approximately 3% of adults are treated with persistent medication[6].
The research on treatment is summarized within reviews by the Cochrane Developmental, Psychosocial & Learning Problems Group. '
- Stimulants, such as Methylphenidate (Ritalin) and amphetamine salts (dextroamphetamine and amphetamine; Adderall), are used to increase the patient’s supply of the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention.[1] Ritalin is safe and effective in preschool-aged children suffering from ADHD so long as they are closely monitored while taking the drug.[7]
- Lisdexamfetamine is a prodrug of dextroamphetamine. It may be dosed once a day and is less likely to be abused.
- Atomoxetine (Strattera) is a selective norepinepherine reuptake inhibitor (SNRI) approved for the management of ADHD. It is effective in adult ADHD and is often favored due to lack of abuse potential[8]. Atomoxetine carries a black box warning as there is an increase risk of suicidal ideation in adolescents[9]. While it is non-inferior to methylphenidate in children, its adverse effects in children and adolescents render it a less favorable treatment option.[10]
- Non-stimulants such as extended release Guanfacine and Clonidine (both alpha-2 adrenergic agonists) are also used to treat ADHD[11].
- Other drugs, including anti-depressants, may also be prescribed in cases of ADHD depending on the patient’s co-morbidities.[1]
| Standard mean difference (SMD)* for patient-reported symptoms |
Discontinuation ratio | |
|---|---|---|
| Amphetamines (dexamphetamine, lisdexamfetamine, mixed amphetamine salts)[12] | -0.51 (95% CI -0.75 to -0.28) • dexamphetamine: SMD -0.77, 95% CI -1.14 to -0.40; two studies, 35 participants • lisdexamfetamine: SMD -0.33, 95% CI -0.65 to -0.01; three studies, 67 participants |
2.69 |
| Bupropion[13] | -0.50 (95% CI -0.86 to -0.15) | 1.20 |
| Methylphenidate, immediate-release[14] | -0.59, 95% CI -1.25 to 0.06; I2 = 69%; 2 trials | |
| Methylphenidate, extended-release[15] | −0.37, 95% CI −0.43 to −0.30; I2 = 0%; 16 trials | |
| * Interpretation of standard mean difference (SMD): 0.2 represents a small effect 0.5 a moderate effect 0.8 a large effect | ||
References
- ↑ 1.0 1.1 1.2 National Institute of Mental Health (NIH). (2016). "Attention Deficit Hyperactivity Disorder."
- ↑ Bickman L, Kelley SD, Breda C, de Andrade AR, Riemer M (2011). "Effects of routine feedback to clinicians on mental health outcomes of youths: results of a randomized trial". Psychiatr Serv. 62 (12): 1423–9. doi:10.1176/appi.ps.002052011. PMID 22193788.
- ↑ Lawrence-Sidebottom D, Huffman LG, Huberty J, Beatty C, Roots M, Roots K; et al. (2023). "Using Digital Measurement-Based Care to Address Symptoms of Inattention, Hyperactivity, and Opposition in Youth: Retrospective Analysis of Bend Health". JMIR Form Res. 7: e46578. doi:10.2196/46578. PMC 10173032 Check
|pmc=value (help). PMID 37099379 Check|pmid=value (help). - ↑ Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J; et al. (2019). "Updated European Consensus Statement on diagnosis and treatment of adult ADHD". Eur Psychiatry. 56: 14–34. doi:10.1016/j.eurpsy.2018.11.001. PMID 30453134.
- ↑ Baughman DJ, Watson CM, Beich JW, Herboso MNJ, Cuttie LK, Marlyne AC (2023). "Recommendation for Long-term Management of Adult Attention-Deficit/Hyperactivity Disorder in Military Populations, Veterans, and Dependents: A Narrative Review". Mil Med. doi:10.1093/milmed/usad403. PMID 37878798 Check
|pmid=value (help). - ↑ Li L, Chang Z, Sun J, Jangmo A, Zhang L, Andersson LM; et al. (2022). "Association Between Pharmacological Treatment of Attention-Deficit/Hyperactivity Disorder and Long-term Unemployment Among Working-Age Individuals in Sweden". JAMA Netw Open. 5 (4): e226815. doi:10.1001/jamanetworkopen.2022.6815. PMC 9047436 Check
|pmc=value (help). PMID 35476068 Check|pmid=value (help). - ↑ Riddle MA, Yershova K, Lazzaretto D, Paykina N, Yenokyan G, Greenhill L; et al. (2013). "The Preschool Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS) 6-year follow-up". J Am Acad Child Adolesc Psychiatry. 52 (3): 264–278.e2. doi:10.1016/j.jaac.2012.12.007. PMC 3660093. PMID 23452683. Review in: Evid Based Ment Health. 2013 Aug;16(3):63
- ↑ Garnock-Jones KP, Keating GM (2009). "Atomoxetine: a review of its use in attention-deficit hyperactivity disorder in children and adolescents". Paediatr Drugs. 11 (3): 203–26. doi:10.2165/00148581-200911030-00005. PMID 19445548.
- ↑ Barry, Colleen (01/21/2014). [www.ncbi.nlm.nih.gov/pmc/articles/PMC3896970/ "ADHD Medication Use Following FDA Risk Warnings"] Check
|url=value (help). NIH. Retrieved 06/12/2018. Check date values in:|access-date=, |date=(help) - ↑ Michelson D, Adler L, Spencer T, Reimherr FW, West SA, Allen AJ, Kelsey D, Wernicke J, Dietrich A, Milton D (2003). "Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies". Biol. Psychiatry. 53 (2): 112–20. PMID 12547466.
- ↑ Southammakosane, Cathy (August 2015). [www.pediatrics.aappublications.org/content/136/2/351 "Pediatric Psychopharmacology for Treatment of ADHD, Depression, and Anxiety"] Check
|url=value (help). AAP. Retrieved 06/12/18. Check date values in:|access-date=(help) - ↑ Castells X, Blanco-Silvente L, Cunill R (2018). "Amphetamines for attention deficit hyperactivity disorder (ADHD) in adults". Cochrane Database Syst Rev. 8: CD007813. doi:10.1002/14651858.CD007813.pub3. PMC 6513464 Check
|pmc=value (help). PMID 30091808. - ↑ Verbeeck W, Bekkering GE, Van den Noortgate W, Kramers C (2017). "Bupropion for attention deficit hyperactivity disorder (ADHD) in adults". Cochrane Database Syst Rev. 10: CD009504. doi:10.1002/14651858.CD009504.pub2. PMC 6485546. PMID 28965364.
- ↑ Cândido RCF, Menezes de Padua CA, Golder S, Junqueira DR (2021). "Immediate-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults". Cochrane Database Syst Rev. 1 (1): CD013011. doi:10.1002/14651858.CD013011.pub2. PMC 8092481 Check
|pmc=value (help). PMID 33460048 Check|pmid=value (help). - ↑ Boesen K, Paludan-Müller AS, Gøtzsche PC, Jørgensen KJ (2022). "Extended-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults". Cochrane Database Syst Rev. 2 (2): CD012857. doi:10.1002/14651858.CD012857.pub2. PMC 8869321 Check
|pmc=value (help). PMID 35201607 Check|pmid=value (help).