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Treating Adult ADHD with Stimulants

Published online by Cambridge University Press:  07 November 2014

Mark A. Stein*
Affiliation:
Dr. Stein is professor in the Department of Psychiatry at the, University of Illinois, in Chicago and director of the Adult ADHD Clinic

Abstract

Treatment of attention-deficit/hyperactivity disorder (ADHD) may positively impact the neurobiology of adult patients with ADHD. Treatment may also minimize impairment from core symptoms and may alter the course of co-morbid disorders such as depression and substance use disorder. However, much of the information on stimulant use in adult ADHD comes from studies conducted in children, and it remains unclear whether there is a difference between children and adults when it comes to the side effects and tolerability of ADHD treatments. It is known that clinical presentation differs between adults and children, with adults demonstrating a higher percentage of mood disorders. Current treatments for adult ADHD include psychosocial therapies and pharmacologic therapies, the latter of which include the stimulants d-methylphenidate extended release (XR), OROS methylphenidate, lisdexamfetamine, and mixed amphetamine salts XR; and the nonstimulant atomoxetine, a selective norepinephrine reuptake inhibitor. There is need for additional study of treatment strategies for adult ADHD. Although all classes of ADHD medications are approved in adults, there are fewer approved formulations for adults than for children. Efficacy in adults is more subjective than in children, which may affect how efficacy rates for adult treatments are calculated. Adults also present a greater diversion risk than children. In addition, there are several new and emerging medication treatments worth considering.

This Expert Roundtable Supplement represents part 2 of a 3-part supplement series on adult ADHD led by Lenard A. Adler, MD. In this activity, Thomas J. Spencer, MD, discusses the neurobiology and genetics of adult ADHD; Mark A. Stein, PhD, discusses stimulant therapy; and Jeffrey H. Newcorn, MD, reviews nonstimulants and psychosocial treatments.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2008

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References

1.Weisler, RH, Biederman, J, Spencer, TJ, et al.Mixed amphetamine salts extended-release in the treatment of adult ADHD: a randomized, controlled trial. CNS Spectr. 2006;11:625639.Google Scholar
2.Spencer, T, Biederman, J, Wilens, T, et al.A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2005;57:456463.Google Scholar
3.Biederman, J, Mick, E, Surman, C, et al.A randomized, placebo-controlled trial of OROS methylphenidate in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2006;59:829835.Google Scholar
4.Medori, R, Ramos-Quiroga, JA, Casas, M, et al.A randomized, placebo-controlled trial of three fixed dosages of prolonged-release OROS methylphenidate in adults with Attention-Deficit/Hyperactivity Disorder. Biol Psychiatry. 2008;63(10):981989.Google Scholar
5.Robinson, MR, Keating, GM. Dexmethylphenidate extended release in attention-deficit hyperactivity disorder. Drugs. 2006;66:661668.Google Scholar
6.Chronis-Tuscano, A, Seymour, KE, Stein, MA, et al.Efficacy of OROS methylphenidate for mothers with ADHD: preliminary effects on ADHD symptoms and parenting. J Clin Psychiatry. 2008. In press.Google Scholar
7.Wilens, TE, Spencer, TJ, Biederman, J. A review of the pharmacotherapy of adults with attention-deficit/hyperactivity disorder. J Atten Disord. 2002;5(4):189202.Google Scholar
8.Faraone, SV, Spencer, T, Aleardi, M, et al.Meta-analysis of the efficacy of methylphenidate for treating adult attention-deficit/hyperactivity disorder. J Clin Psychopharmacol. 2004;24(1):2429.Google Scholar
9.Stein, MA, Sarampote, CS, Waldman, ID, et al.A dose-response study of OROS methylphenidate in children and adolescents with ADHD. Pediatrics. 2003;112:e404.Google Scholar
10.Wilens, TE, Gignsc, M, Swezey, A, Allison, BA, Monuteaux, M, Biederman, J. Characteristics of adolescents and young adults with ADHD who divert or misuset heir prescribed medications. J Am Acad Child Adoles Psychiatry. 2006;45(4):408414.Google Scholar
11.Kadison, R. Getting an edge--use of stimulants and antidepressants in college. N Engl J Med. 2005;353(11):10891091.Google Scholar
12.Robinson, RJ, Reimherr, FW, Marchant, BK, Faraone, SC, Adler, LA, West, SA. Gender differences in 2 clinical trials of adults with attention-deficit hyperactivity disorder: a retrospective data analysis. J Clin Psychiatry. 69:213221.Google Scholar