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Pharmacology of Adult ADHD with Stimulants

  • Thomas J. Spencer (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.

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References

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1.Spencer, T, Wilens, T, Biederman, J, Faraone, S, Ablon, J, Lapey, K. A double-blind crossover comparison of methylphenidate and placebo in adults with childhood onset ADHD. Arch Gen Psychiatry. 1995;52(6):434443; Psychiatry Drug Alerts. 1995;IX(9):71-72.
2.Spencer, TJ, Biederman, J, Wilens, T, et al.A large double blind randomized clinical trial of methylphenidate in the treatment of adults with ADHD. Biol Psychiatry. 2005;57(5):456463.
3.Spencer, TJ, Biederman, J, Mick, E, Martin, J, Aleardi, M. Long term treatment with methylphenidate in adults with ADHD: results from a 6 month study. Poster Presented at: 159th Annual Meeting of The American Psychiatric Association; May 2006; Toronto, Canada.
4.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(9):829–35. Epub 2005 Dec 20.
5.Spencer, TJ, Adler, LA, McGough, JJ, Muniz, R, Jiang, H, Pestreich, L; Adult ADHD Research Group. Efficacy and safety of dexmethylphenidate extended-release capsules in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2006 Nov 28; [Epub ahead of print].
6.Adler, LA, McGough, J, Muniz, R, Pestreich, L, Agoropoulou, C, Jiang, H. Long-term efficacy of extended-release dexmethylphenidate in adult ADHD. Presented at: 158th Meeting of the American Psychiatric Association; May 21-25, 2005: Atlanta, Ga.
7.Spencer, T, Biederman, J, Wilens, T, et al.Efficacy of a mixed amphetamine salts compound in adults with attention deficit hyperactivity disorder. Arch Gen Psychiatry. 2001;58:775782.
8.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(8):625639.
9.Biederman, J, Spencer, TJ, Wilens, TE, Weisler, RH, Read, SC, Tulloch, SJ. Long-term safety and effectiveness of mixed amphetamine salts extended release in adults with ADHD. CNS Spectr. 2005;10(12 Suppl 20):1625.

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