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Nonstimulants and Emerging Treatments in Adults with ADHD

Published online by Cambridge University Press:  07 November 2014

Jeffrey H. Newcorn
Jeffrey H. Newcorn*
Affiliation:
Dr. Newcorn is associate professor in the Department of Psychiatry at the, Mount Sinai School of Medicine, in New York City
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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
Information
CNS Spectrums , Volume 13 , Issue S13 , 2008 , pp. 12 - 16
Copyright
Copyright © Cambridge University Press 2008

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References

1.Biederman, J, Baldessarini, RJ, Wright, V, Knee, D, Harmatz, JS. A double-blind placebo controlled study of desipramine in the treatment of ADD: I. Efficacy. J Am Acad Child Adolesc Psychiatry. 1989;28(5):777–784.Google Scholar
2.Biederman, J, Baldessarini, RJ, Wright, V, Keenan, K, Faraone, S. A double-blind placebo controlled study of desipramine in the treatment of ADD: III. Lack of impact of comorbidity and family history factors on clinical response. J Am Acad Child Adolesc Psychiatry. 1993;32(1):199–204.Google Scholar
3.Palumbo, DR, Sallee, FR, Pelham, WE Jr, Bukstein, OG, Daviss, WB, McDermott, MP. Clonidine for attention-deficit/hyperactivity disorder: I. Efficacy and tolerability outcomes. J Am Acad Child Adolesc Psychiatry. 2008;47(2):180–188.CrossRefGoogle ScholarPubMed
4.Daviss, WB, Patel, NC, Robb, AS, et al.Clonidine for attention-deficit/hyperactivity disorder: II. ECG changes and adverse events analysis. J Am Acad Child Adolesc Psychiatry. 2008;47(2):189–198.Google Scholar
5.Tourette’s Syndrome Study Group. Treatment of ADHD in children with tics: a randomized controlled trial. Neurology. 2002;58:527–536.Google Scholar
6.Hazell, PI, Stewart, JE. A randomized controlled trial of clonidine added to psychostimulant medication for hyperactive and aggressive children. J Am Acad Child Adolesc Psychiatry. 2003;42:886–894.Google Scholar
7.Wilens, TE, Haight, BR, Horrigan, JP, et al.Bupropion XL in adults with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled study. Biol Psychiatry. 2005;57(7):793–801.Google Scholar
8.Bymaster, FP, Katner, JS, Nelson, DL, et al.Atomoxetine increases extracellular levels of norepinephrine and dopamine in prefrontal cortex of rat: a potential mechanism for efficacy in attention deficit/hyperactivity disorder. Neuropsychopharmacology. 2002;27(5):699–711.Google Scholar
9.Michelson, D, Adler, L, Spencer, T, et al.Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies. Biol Psychiatry. 2003;53(2):112–120.CrossRefGoogle ScholarPubMed
10.Adler, LA, Spencer, TJ, Milton, DR, Moore, RJ, Michelson, D. Long-term, open-label study of the safety and efficacy of atomoxetine in adults with attention-deficit/hyperactivity disorder: an interim analysis. J Clin Psychiatry. 2005;66(3):294–299.CrossRefGoogle ScholarPubMed
11.Newcorn, JH, Kratochvil, CJ, Allen, AJ, et al.Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: acute comparison and differential response. Am J Psychiatry. 2008;165(6):721–730.Google Scholar
12.Heil, SH, Holmes, HW, Bickel, WK, et al.Comparison of the subjective, physiological, and psychomotor effects of atomoxetine and methylphenidate in light drug users. Drug Alcohol Depend. 2002;67:149–156.CrossRefGoogle ScholarPubMed
13.Faraone, SV, Biederman, J, Spencer, TJ, Aleardi, M. Comparing the efficacy of medications for ADHD using meta-analysis. MedGenMed. 2006;8(4):4.Google Scholar
14.Wigal, SB, McGough, JJ, McCracken, JT, et al.A laboratory school comparison of mixed amphetamine salts extended release (Adderall XR) and atomoxetine (Strattera) in school-aged children with attention deficit/hyperactivity disorder. J Atten Disord. 2005;9(1):275–289.Google Scholar
15.Wilens, T, Spencer, TJ. The stimulants revisited. Child Adolesc Psychiatr Clin N Am. 2000;9(3);573–602.CrossRefGoogle ScholarPubMed
16.Swanson, JM, Greenhill, LL, Lopez, FA, et al.Modafinil film-coated tablets in children and adolescents with attention-deficit/hyperactivity disorder: results of a randomized, double-blind, placebo-controlled, fixed-dose study followed by abrupt discontinuation. J Clin Psychiatry. 2006;67:137–147.Google Scholar
17.Krause, J, Krause, KH, Dresel, SH, et al.ADHD in adolescence and adulthood, with a special focus on the dopamine transporter and nicotine. Dialogues Clin Neurosci. 2006;8:29–36.Google Scholar
18.Geller, D, Donnelly, C, Lopez, F, et al.Atomoxetine treatment for pediatric patients with attention-deficit/hyperactivity disorder with comorbid anxiety disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(9):1119–1127.Google Scholar
19.Allen, AJ, Kurlan, RM, Gilbert, DL. Atomoxetine treatment in children and adolescents with ADHD and comorbid tic disorders. Neurology. 2005;65(12):1941.Google Scholar
20.Pliszka, SR. Psychiatric comorbidities in children with attention deficit hyperactivity disorder: implications for management. Paediatr Drugs. 2003;5(11):741–750.Google Scholar
21.Barkley, RA, ed. Attention-Deficit Hyperactivity Disorder. A Handbook for Diagnosis and Treatment. 2nd ed. New York, NY: The Guilford Press; 1998.Google Scholar
22.Ness, J, Price, LA. Meeting the psychosocial needs of adolescents and adults with LD. Intervention in School and Clinic. 1990;26:16–21.Google Scholar
23.Weiss, M, Hechtman, LT, Weiss, G. ADHD in Adulthood. A Guide to Current Theory, Diagnosis, and Treatment. Baltimore, MD: The Johns Hopkins University Press; 1999.Google Scholar
24.Safren, SA, Otto, MW, Sprich, S, Winett, CL, Wilens, TE, Biederman, J. Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behav Res Ther. 2005;43(7):831–842.Google Scholar
25.Ramsay, JR, Rostain, AL. Psychosocial treatments for attention-deficit/hyperactivity disorder in adults: Current evidence and future directions. Professional Psychology: Research and Practice. 2007;38:338–346.Google Scholar
26.Weiss, M, Safren, SA, Solanto, MV, et al.Research forum on psychological treatment of adults with ADHD. J Atten Disord. 2008;11(6):642–651.CrossRefGoogle ScholarPubMed
27.Solanto, MV, Marks, DJ, Mitchell, KJ, Wasserstein, J, Kofman, MD. Development of a new psychosocial treatment for adult ADHD. J Atten Disord. 2008;11(6):728–736.CrossRefGoogle ScholarPubMed