Twenty-four-week treatment with extended release methylphenidate improves emotional symptoms in adult ADHD

Abstract

Objectives. Treatment investigations with methylphenidate in adults with ADHD focus preferentially on the classical psychopathology: inattention, hyperactivity and impulsivity. ADHD-associated emotional symptoms, which are frequently present at least in ADHD subpopulations, were studied rarely. The vast majority of the placebo-controlled trials had observation periods between 4 and 8 weeks. To assess the medium- to long-term effects of extended release methylphenidate (MPH-ER) on emotional symptoms and other psychopathology frequently seen in ADHD patients, we conducted a large-scale, multicenter treatment study. Methods. We performed a randomised, 24-week, double-blind, placebo-controlled study in adults with ADHD. The diagnosis was made on the basis of the DSM-IV criteria, which were confirmed by clinical history and a structured psychopathological interview and the use of rating instruments. 363 patients were randomized to MPH-ER or placebo at a ratio of 2:1. The duration of the titration period was 5 weeks followed by a maintainance phase of 19 weeks. The efficacy measures were the observer rated 10-item Emotional Dysregulation Scale (EDS) derived from the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) and a self-report, six-item Emotional Lability Scale (ELS) extracted from the long version of the Conners Adult ADHD Self Report Scale (CAARS:S:L). In addition we used the SCL-90-R for the assessment of ADHD associated and comorbid psychopathology. Results. MPH-ER was statistically superior to placebo in reducing emotional symptoms as assessed by the EDS and the ELS. Obsessive-compulsive symptoms and those of problems with self-concept declined until the end of the observation period. The decline was more pronounced in MPH-ER treated individuals. The effects remained robust during the entire maintenance period until week 24. Symptoms of anxiety, depression, anger and hostility, phobia, paranoid ideations and psychoticism were not improved. Conclusions. MPH-ER appears to be an efficacious treatment for emotional symptoms with ADHD. Also obsessive-compulsive symptoms and problems with self-concept were affected positively.

Key words::

• Adult ADHD
• methylphenidate
• clinical trial
• emotional symptoms
• long-term effects

Acknowledgements

The following clinicians and researchers participated in this clinical trial: Central Institute of Mental Health, Mannheim (B. Alm, E. Sobanski); H.-H. Decker, Arnsberg; Department of Psychiatry and Psychotherapy, University Münster (J. Deckert); W. Droll, Berlin; Department of Psychiatry, University of Freiburg (D. Ebert, A. Philipsen); LWL Clinic Bochum, Department of Psychiatry and Psychotherapy and Preventive-Medicine, University Bochum (M.-A. Edel); J. Eysell, Pforzheim; J. Fuhr, Bad Wildungen; H. Goossens-Merkt, Hamburg; P. Greven, Berlin; Department of Psychiatry and Psychotherapy CCM, Charite´-University Medicine Berlin (J. Hein); Department of Psychiatry and Psychotherapy, University Rostock (S. Herpertz); Department of Psychiatry, University Würzburg (C. Jakob; K.-P. Lesch); V. H. Köster, Hamburg; Department of Psychiatry, University of Cologne, Köln (S. Lee); Section for Phacomatosis, Department of Maxcillofacial Surgery, University-Hospital, Hamburg-Eppendorf (V.-F. Mautner); N. Niemczyk, Berlin; T. Nissen, Saarbrücken; K.-U. Oehler, Würzburg; Clinical Psychiatry and Psychotherapy, Hannover Medical School (M. Ohlmeier); Mediclin Deister-Weser-Clinic, Department of Psychosomatic and Behaviour Medicine, Bad Münder (D. Pütz, B. Rothe); Neurocenter, Saarland University Hospital, Homburg/Saar (W. Retz, M. Rösler); U. Rothfelder, München; J. Schneider, Berlin; Center for Social Psychiatry Kurhessen, Department of Neuropsychiatry, Bad Emstal (S. Serafin); T. Wirth, Ludwigsburg; R. Wolf, Marsberg.

Statement of interest

M. Rösler is speaker and member of the advisory board from Lilly Germany, Janssen-Cilag, Shire and Medice. He has received research support from Medice. He has grants from the German Federal Ministery of Education and Research. M. Retz has no financial interests in the connection with this manuscript. R. Fischer is the Medical Director of the study sponsor. C. Ose has received honoraria from Medice. B. Alm has no financial interests in connection with this study. J. Deckert has received honoraria from Medice and Janssen-Cilag. A. Philipsen is member of the advisory board of Medice and Janssen-Cilag. She has received research support from Medice. S. Herpertz has no financial interests in connection with this study. R. Ammer is member of the general management of the study sponsor Medice.