An update on the pharmacotherapy of attention-deficit/hyperactivity disorder in adults

Abstract

Adults with attention-deficit/hyperactivity disorder (ADHD) are more frequently presenting for diagnosis and treatment. Medication is considered to be appropriate among available treatments for ADHD; however, the evidence supporting the use of pharmacotherapeutics for adults with ADHD remains less established. In this article, the effectiveness and dosing parameters of the various agents investigated for adult ADHD are reviewed. In adults with ADHD, short-term improvements in symptomatology have been documented through the use of stimulants and antidepressants. Studies suggest that methylphenidate and amphetamine maintained an immediate onset of action, whereas the ADHD response to the nonstimulants appeared to be delayed. At a group level, there appears to be some, albeit not entirely consistent, dose-dependent responses to amphetamine and methylphenidate. Generally speaking, variability in diagnostic criteria, dosing parameters and response rates between the various studies was considerable, and most studies were of a relatively short duration. The aggregate literature shows that the stimulants and catecholaminergic nonstimulants investigated had a clinically significant beneficial effect on treating ADHD in adults.

Keywords::

• adult
• amphetamine
• antidepressants
• atomoxetine
• attention-deficit/hyperactivity disorder
• methylphenidate
• pharmacotherapy
• stimulants

Financial & competing interests disclosure

This work was supported by the NIH and by K24 DA016264 to Timothy Wilens. Timothy Wilens receives or has received grant support from the following sources: Abbott, Lilly, McNeil, Merck, NIH (NIDA) and Shire. He has also been a speaker for the following: Lilly, McNeil, Novartis and Shire, and is or has been a consultant for: Abbott, Astra-Zeneca, Euthymics, Lilly, McNeil, Merck, NIH, Novartis and Shire. Timothy Wilens has a published book with Guilford Press: Straight Talk About Psychiatric Medications for Kids.

In the last 18 months, Jefferson Prince has received support from the American Academy of Child and Adolescent Psychiatry, the American Psychiatric Association and the MGH Psychiatric Academy. Jefferson Prince has also received grant monies from the Tower Foundation and the Norman H. Read Trust, and has received monies for a CME program sponsored by Shire and Lilly. Over Jefferson Prince’s professional career he was at one time on the speaker’s bureau for Ortho-McNeil, Celltech, Lilly and Forest; has acted as a consultant for Ortho-McNeil, Shire, Lilly, Forest, Abbott, Pfizer and GlaxoSmithKline; and has received grant monies from the American Academy of Child and Adolescent Psychiatry, Lilly, GlaxoSmithKline and Forest.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.