Skip to main content Accessibility help
×
Home

Non-Stimulant Trials of Adult ADHD

  • Lenard A. Adler (a1)

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a lifelong condition that begins in childhood and continues with adult manifestations related to the core symptoms. Approximately 50% to 75% of children with ADHD continue to meet criteria for the disorder as adolescents and adults. Adults with the disorder increasingly present to primary care physicians, psychiatrists, and other practitioners for diagnosis and treatment. Understanding the diagnosis of ADHD in adults requires knowledge of age-dependent decline of symptoms over time. Retrospective recall of symptoms and impairment are valid methods of diagnosing the disorder. ADHD is also a brain disorder with a strong neurobiologic basis, complex etiology, and genetic component. Genetic and environmental vulnerabilities give rise to abnormalities in the brain and subsequent behavioral and cognitive deficits, which may produce the symptoms associated with ADHD. Magnetic resonance imaging studies of ADHD have provided evidence that abnormalities in the brain are caused by the disorder itself rather than treatment of the disorder. Psychiatric comorbidity is common among patients with ADHD and tends to complicate treatment. Acute and long-term use of long-acting stimulant formulations (methylphenidate and amphetamine compounds) have shown robust efficacy and tolerability consistent with the treatment response established in children with ADHD. Non-stimulant medications have demonstrated efficacy as well, and may be preferred in patients with tic and substance use disorders.

In this expert roundtable supplement, Timothy E. Wilens, MD, reviews the epidemiology and clinical presentation of adult ADHD. Next, Joseph Biederman, MD, provides an overview of recent advances in the neurobiology of ADHD. Thomas J. Spencer, MD, reviews stimulant treatment of adult ADHD, and Lenard A. Adler concludes with a discussion of non-stimulant trials in adult ADHD.

Copyright

References

Hide All
1.Spencer, T, Biederman, J, Wilens, T. Nonstimulant treatment of adult attention-deficit/hyperactivity disorder. Psychiatr Clin N Am. 2004;27:373383.
2.Michelson, D, Adler, L, Spencer, T, et al.Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies. Biol Psychiatry. 2003;53(2):112120.
3.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC; American Psychiatric Association; 1994.
4.Adler, L, Dietrich, A, Reimherr, F, et al.Safety and tolerability of once versus twice daily atomoxetine in adults with ADHD. Ann Clin Psychiatry. 2006;18:107113.
5.Biederman, J, Baldessarini, RJ, Wright, V, Knee, D, Harmatz, J. A double-blind placebo-controlled study of desipramine in the treatment of attention deficit disorder: I. Efficacy. J Am Acad Child Adolesc Psychiatry. 1989;28:777784.
6.Wilens, TE, Biederman, J, Prince, J, et al.Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder. Am J Psychiatry. 1996;153:11471153.
7.Wilens, TE, Biederman, JB, Mick, E, Spencer, T. A systematic assessment of tricyclic antidepressants in the treatment of adult attention-deficit/hyperactivity disorder. J Nerv Ment Dis. 1995;183:4850.
8.Adler, LA, Resnick, S, Kunz, M. Devinsky, O. Open-label trial of venlafaxine in adults with attention deficit disorder. Psychopharmacol Bull. 1995;31(4):785788.
9.Hornig-Rohan, M, Amsterdam, J. Venlafaxine versus stimulant therapy in patients with dual diagnoses of ADHD and depression. Presented at: Annual Meeting of the New Clinical Drug Evaluation Unit; June 10-14, 1995; Orlando, Florida. Poster #92.
10.Findling, R, Schwartz, M, Flannery, D, Manos, M. Venlafaxine in adults with ADHD: an open trial. J Clin Psychiatry. 1996;57:184189.
11.Wilens, TE. Biederman, J. Spencer, TJ. Venlafaxine for adult ADHD. [Case Reports. Letter] Am J Psychiatry. 1995;152(7):10991100.
12.Hedges, D, Reimherr, FW, Rogers, A, et al.An open trial of venlafaxine in adult patients with attention deficit hyperactivity disorder. Psychopharmacol Bull. 1995;31(4):779783.
13.Barrickman, L, Perry, P, Allen, A, et al.Bupropion versus methylphenidate in the treatment of attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1995;34:649657.
14.Wilens, TE, Spencer, TJ, Biederman, J, et al.A controlled clinical trial of bupropion for attention-deficit/hyperactivity disorder in adults. Am J Psychiatry. 2001;158:282288.
15.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):793801.
16.Zametkin, A, Rapoport, JL, Murphy, DL, et al.Treatment of hyperactive children with monoamine oxidase inhibitors: I. Clinical efficacy. Arch Gen Psychiatry. 1985;42:962966.
17.Ernst, M, Liebenauer, LL, Jons, PH, et al.Selegiline in adults with attention deficit hyperactivity disorder: clinical efficacy and safety. Psychopharmacol Bull. 1996;32:327334.
18.Trott, GE, Friese, HJ, Menzel, M, Nissen, G. [Use of moclobemide in children with attention-deficit/hyperactivity disorder] Jugendpsychiat. 1991;19:248353.
19.Biederman, J, Swanson, JM, Wigal, SB, et al.A comparison of once-daily and divided doses of modafinil in children with attention-deficit/hyperactivity disorder: a randomized, double-blind, and placebo-controlled study. J Clin Psychiatry. 2006;67(5):727735.
20.Greenhill, LL, Biederman, J, Boellner, SW, et al.A randomized, double-blind, placebo-controlled study of modafinil film-coated tablets in children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2006;45(5):503511.
21.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(1):137147.
22.Biederman, J, Swanson, JM, Wigal, SB, et al.Efficacy and safety of modafinil film-coated tablets in children and adolescents with attention-deficit/hyperactivity disorder: results of a randomized, double-blind, placebo-controlled, flexible-dose study. Pediatrics. 2005;116(6):777784.
23.Wigal, SB, Biederman, J, Swanson, JM, Yang, R, Greenhill, LL. Efficacy and safety of modafinil film-coated tablets in children and adolescents with or without prior stimulant treatment for attention-deficit/hyperactivity disorder: pooled analysis of 3 randomized, double-blind, placebo-controlled studies. Prim Care Companion J Clin Psychiatry. 2006;8(6):352360.
24.Taylor, FB, Russo, J. Efficacy of modafinil compared to dextroamphetamine for the treatment of attention deficit hyperactivity disorder in adults. J Child Adolesc Psychopharmacol. 2000;10(4):311320.
25.Turner, DC, Clark, L, Dowson, J, et al.Modafinil improves cognition and response inhibition in adult attention-deficit/hyperactivity disorder. Biol Psychiatry. 2004;55(10):10311040.
26.Conners, CK, Levin, ED, Sparrow, E, et al.Nicotine and attention in adult attention deficit hyperactivity disorder (ADHD). Psychopharmacol Bull. 1996;32(1):6773.
27.Wilens, TE, Verlinden, MH, Adler, LA, Wozniak, PJ, West, SA. ABT-089, a neuronal nicotinic receptor partial agonist, for the treatment of attention-deficit/hyperactivity disorder in adults: results of a pilot study. Biol Psychiatry. 2006;59(11):10651070.
28.Wilens, TE, Biederman, J, Spencer, TJ, et al.A pilot controlled clinical trial of ABT-418, a cholinergic agonist, in the treatment of adults with attention deficit hyperactivity disorder. Am J Psychiatry. 1999;156(12):19311937.
29.Connor, DF, Fletcher, KE, Swanson, JM. A meta-analysis of clonidine for symptoms of attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1999;38:15511559.
30.Scahill, L, Chappell, PB, Kim, YS, et al.A placebo-controlled study of guanfacine in the treatment of children with tic disorders and attention deficit hyperactivity disorder. Am J Psychiatry. 2001;158(7):10671074.
31.Taylor, FB, Russo, J. Comparing guanfacine and dextroamphetamine for the treatment of adult attention-deficit/hyperactivity disorder. J Clin Psychopharmacol. 2001;21(2):223228
32.Wilens, TE. Impact of ADHD and its treatment on substance abuse in adults. J Clin Psychiatry. 2004;65(Suppl 3):3845.
33.Allen, AJ, Kurlan, RM, Gilbert, DL, et al.Atomoxetine treatment in children and adolescents with ADHD and comorbid tic disorders. Neurology. 2005;65(12):19411949.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed