Nonstimulants and Emerging Treatments in Adults with ADHD

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S13) ◽  
pp. 12-16 ◽  
Author(s):  
Jeffrey H. Newcorn
Keyword(s):  
Adult Adhd ◽  
Treatment Strategies ◽  
Stimulant Use ◽  
Hyperactivity Disorder ◽  
Adhd Treatment ◽  
Norepinephrine Reuptake Inhibitor ◽  
Emerging Treatments ◽  
Adults And Children ◽  
Core Symptoms ◽  
Adhd Medications

AbstractTreatment 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

Neurobiology and Genetics of ADHD in Adults

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S13) ◽  
pp. 5-7 ◽  
Author(s):  
Thomas J. Spencer
Keyword(s):  
Adult Adhd ◽  
Extended Release ◽  
Treatment Strategies ◽  
Stimulant Use ◽  
Hyperactivity Disorder ◽  
Adhd Treatment ◽  
Norepinephrine Reuptake Inhibitor ◽  
Adults And Children ◽  
Core Symptoms ◽  
Adhd Medications

AbstractTreatment 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.

Neurobiology, Pharmacology, and Emerging Treatment

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S13) ◽  
pp. 4-4
Author(s):  
Lenard A. Adler
Keyword(s):  
Adult Adhd ◽  
Extended Release ◽  
Treatment Strategies ◽  
Stimulant Use ◽  
Hyperactivity Disorder ◽  
Adhd Treatment ◽  
Norepinephrine Reuptake Inhibitor ◽  
Adults And Children ◽  
Core Symptoms ◽  
Adhd Medications

AbstractTreatment 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.

Treating Adult ADHD with Stimulants

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S13) ◽  
pp. 8-11 ◽  
Author(s):  
Mark A. Stein
Keyword(s):  
Adult Adhd ◽  
Extended Release ◽  
Treatment Strategies ◽  
Stimulant Use ◽  
Hyperactivity Disorder ◽  
Adhd Treatment ◽  
Norepinephrine Reuptake Inhibitor ◽  
Adults And Children ◽  
Core Symptoms ◽  
Adhd Medications

AbstractTreatment 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.

scholarly journals Pharmacotherapy for Comorbid Adult Attention-Deficit Hyperactivity Disorder and Stimulant Dependence: A Systematic Review

2020 ◽  
Vol 17 (2) ◽  
Author(s):  
Woon LS ◽  
Hazli Z ◽  
Gan LLY
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Small Sample ◽  
Retention Rates ◽  
Adhd Symptoms ◽  
Stimulant Use ◽  
Hyperactivity Disorder ◽  
Stimulant Medications ◽  
Stimulant Dependence

Comorbid adult attention-deficit hyperactivity disorder (ADHD) and stimulant dependence is widely recognized, but efficacy of pharmacotherapy in this patient population is not well established. We aimed to review whether pharmacotherapy is efficacious in reducing ADHD symptoms and stimulant use in comorbid adult ADHD and stimulant use disorder. English articles until June 2017 were systematically searched in electronic databases (MEDLINE and PsycINFO), an online clinical trials register (ClinicalTrial.gov), and through hand-search of article references. Randomized, double-blind, placebo-controlled trials that studied efficacy of pharmacotherapy in adults with comorbid ADHD and stimulant dependence were included. Two reviewers assessed studies for inclusion and extracted data; disagreements were resolved by consensus. Study outcomes included were changes in ADHD symptom severity, substance abstinence, treatment retention rates and safety. From the 1394 records identified, five trials (n=358) were included. Four studies involved methylphenidate; in another study extended-release mixed amphetamine were used. The comorbid stimulant was cocaine in three studies, and amphetamines in the rest. All were short-term studies involving predominantly young male adults conducted in outpatient settings. There is early promising but mixed evidence for therapeutic efficacy in improving ADHD symptoms. Stimulant medications did not worsen stimulant dependence or adverse effects of stimulant medications. Side effects were mild and tolerable. High attrition rates and small sample size limited the generalizability of findings. Current limited evidence suggests that stimulant treatment for comorbid adult ADHD and stimulant dependence is feasible. Welldesigned trials with adequate power are needed for more robust evidence on ADHD and stimulant use outcomes.

Neurobiological marker for child and adult ADHD diagnoses

2017 ◽  
Vol 41 (S1) ◽  
pp. S454-S455
Author(s):  
H. Super ◽  
J. Cañete ◽  
S.V. Faraone ◽  
P. Asherson ◽  
J.A. Ramos-Quiroga
Keyword(s):  
Clinical Diagnosis ◽  
Adult Adhd ◽  
Neurodevelopmental Disorder ◽  
Correct Diagnosis ◽  
Adult Life ◽  
Event Related Potentials ◽  
Hyperactivity Disorder ◽  
Medical Disorders ◽  
Related Potentials ◽  
Core Symptoms

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorder. It is a chronic disease where 50–60% of ADHD cases persist into adult life. ADHD is associated with a range of clinical and psychosocial impairments. In children hyperactivity, impulsivity and inattention are the core symptoms of ADHD. In adults these core symptom are also present but inattention is more prominent. Correct diagnosis of ADHD remains challenging, especially as several other psychiatric and medical disorders show the similar symptomology.ObjectivesThe diagnosis of ADHD is clinical based upon a cluster of symptoms and criteria established by guidelines such as the DSM-5. Yet, objective markers are needed to support the clinical ADHD diagnosis in children and adults. Studies suggest that a neurobiological marker (eye vergence i.e. where the eyes move in opposite directions) can detect ADHD in children and adults. The eyes converge during orienting attention, as evidenced by visual event related potentials at parietal locations. This attention related vergence is impaired in ADHD patients.MethodsWe review the neurobiology and findings of eye vergence and the relevance of its measurement for the clinical diagnosis of ADHD.ResultsNeural circuits underlying eye vergence and attention largely overlap. Using machine learning, eye vergence measurements can classify ADHD in children and adults with high (> 90%) accuracy.ConclusionsEye vergence is a promising candidate for an objective clinical diagnosis of ADHD.Disclosure of interestPart of this research was paid by Braingaze. HS is co-founder and shareholder of Braingaze.

scholarly journals Individualization of attention-deficit/hyperactivity disorder treatment: pharmacotherapy considerations by age and co-occurring conditions

CNS Spectrums ◽  
2020 ◽  
pp. 1-20 ◽  
Author(s):  
Greg W. Mattingly ◽  
Joshua Wilson ◽  
Leticia Ugarte ◽  
Paul Glaser
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Neurodevelopmental Disorder ◽  
Treatment Options ◽  
Hyperactivity Disorder ◽  
Psychosocial Therapy ◽  
Adhd Treatment ◽  
Disorder Treatment ◽  
Adhd Medications

Abstract Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that manifests in childhood and can persist into adolescence and adulthood. Impairments associated with ADHD can impact quality of life, social interactions, and increase the risk of morbidity and mortality; however, for many patients, effective treatment can lessen these effects. Pharmacotherapy with stimulants or nonstimulants is recommended in conjunction with psychosocial therapy for most patients. Determining the optimal pharmacotherapy can be complex, and the clinician needs to consider many factors such as the patient’s age, comorbidities, and lifestyle. Furthermore, the needs of the patient with ADHD will change over time, with specific challenges to consider at each stage of life. A variety of Food and Drug Administration (FDA)-approved stimulant and nonstimulant formulations are available with different modes of delivery and durations of effect. This armamentarium of ADHD medications can be used to individualize ADHD treatment for each patient’s needs. This article combines current information from the literature and the first-hand experience of the authors to provide guidance on ADHD treatment options for patients of different ages and for some of the more common comorbidities.

The Novelty of Bupropion As a Dopaminergic Antidepressant for the Treatment of Adult Attention Deficit Hyperactive Disorder

2018 ◽  
Vol 20 (2) ◽  
pp. 210-219 ◽  
Author(s):  
Kanit Tha Deang ◽  
Hatta Sidi ◽  
Hazli Zakaria ◽  
Raja Lope Adam ◽  
Srijit Das ◽  
...  
Keyword(s):  
Attention Deficit ◽  
Adult Adhd ◽  
Medical Condition ◽  
Attention Deficit Hyperactive Disorder ◽  
Hyperactivity Disorder ◽  
Arduous Task ◽  
Adhd Treatment ◽  
Dopamine Reuptake Inhibitor ◽  
High Level ◽  
High Index Of Suspicion

Attention deficit hyperactive disorder (ADHD), a hyperactivity disorder prevalent among children may continue as an adulthood attention deficit. To date, treating an individual with an adult ADHD may be an arduous task as it involves numerous challenges, which include a need for high index of suspicion to diagnose this medical condition. Many psychiatric disorders masquerade as ADHD and delay the necessary assessment and proper treatment for this debilitating medical disorder. Adult ADHD is often misdiagnosed (or under diagnosed) due to the fact that this medical condition is being masked by the patients’ high level of intellectual achievement. As the ADHD in adult persists, it may end-up with impairment in the personal-social-occupational function in which the management becomes a great challenge. The treatment of ADHD can be optimized by using various drugs targets agents like norepinephrine-dopamine reuptake inhibitor (NDRI), with or without psycho stimulants like methylphenidate, which is marketed as Ritalin. Bupropion, an NDRI has a novel effect on ADHD as the molecule exerts its effects by modulating the reward-pleasure mesolimbic dopaminergic system and at the same time regulates the elevating mood dimension of the noradrenergic neurotransmission. The role of Bupropion in the neural and psychopharmacological perspective treatment of ADHD was deliberated. The present review highlights the novel effects of Bupropion in ADHD treatment, together with the help of other successful bio-psycho-social measures. This may be of immense benefit to the psychiatrists for treating their patients.

scholarly journals Pharmacological treatment for attention deficit hyperactivity disorder in adults

2021 ◽  
Vol 64 (1) ◽  
pp. 49-56
Author(s):  
Kukju Kweon
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Neurodevelopmental Disorder ◽  
Self Report ◽  
Hyperactivity Disorder ◽  
The Core ◽  
Symptom Patterns ◽  
Long Acting ◽  
Core Symptoms

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by attention deficits, hyperactivity, and impulsivity. In the past, ADHD was considered to be limited to children and adolescents. However, ADHD has now been reconceptualized as a lifelong disorder, and two-thirds of ADHD patients continue to have core symptoms and dysfunction in adulthood. Currently, the public and clinicians’ interest in adult ADHD is rapidly increasing in Korea. In addition to interviews with patients for an adult ADHD diagnosis, interviews with family members, existing school records, and neuropsychological tests help clinicians to make a diagnosis. It is necessary to check whether the core symptoms of ADHD were expressed in childhood. Since adults’ symptom patterns differ from those of children, a self-report tool designed for adult ADHD is useful. The medications currently approved for ADHD in adults by the Ministry of Food and Drug Safety of Korea are long-acting methylphenidate and atomoxetine. Both methylphenidate and atomoxetine improve the core symptoms of ADHD as well as daily function. Methylphenidate and atomoxetine can be used safely as first-line treatments, and the overall adverse effects are tolerable. However, attention should be paid to possible cardiovascular adverse events and misuse. Bupropion, modafinil, alpha2-agonist, and tricyclic antidepressants can also be used off-label.

Attention deficit hyperactivity disorder (ADHD): perspective of the general adult psychiatrist

2018 ◽  
Vol 35 (3) ◽  
pp. 247-249
Author(s):  
D. Murray ◽  
P. Devitt
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Adult Adhd ◽  
Ad Hoc ◽  
Neurodevelopmental Disorder ◽  
Psychiatric Services ◽  
Hyperactivity Disorder ◽  
Adhd Treatment

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with onset in childhood. In Ireland adult ADHD treatment is drifting in an ad hoc manner into general adult psychiatric services. We propose this process should be halted in favour of a delivering a carefully planned adult ADHD service.

Neuroimage Studies: The Effect of Methylphenidate in Cocaine Users with ADHD

2017 ◽  
Vol 41 (S1) ◽  
pp. S54-S55
Author(s):  
C. Crunelle
Keyword(s):  
Prevalence Rate ◽  
Adult Adhd ◽  
Treatment Effectiveness ◽  
Neurocognitive Dysfunction ◽  
High Prevalence Rate ◽  
Hyperactivity Disorder ◽  
Adhd Treatment ◽  
High Prevalence ◽  
Competing Interest ◽  
Comorbid Adhd

BackgroundAttention deficit/hyperactivity disorder (ADHD) is an important contributing factor in the pathophysiology of substance use disorders (SUD), and ADHD occurs more often in populations with SUD compared to the general population. This high prevalence rate and comorbidity may relate to a shared neurobiological vulnerability, including a deregulation of the brain's dopamine system. This comorbidity directly impacts the treatment of ADHD: treatment with methylphenidate is less effective in patients with ADHD and SUD compared to ADHD patients without SUD.MethodsWe investigate the underlying neurobiological background of reduced treatment effectiveness for adult ADHD patients with comorbid SUD.ResultsWe observed lower available dopamine transporters, as well as a reduced binding of methylphenidate to these transporters, and more neurocognitive dysfunction in adults ADHD patients with SUD compared to ADHD patients without SUD.ConclusionComorbid ADHD and SUD has a high prevalence rate and reduces ADHD treatment effectiveness, which makes it necessary to screen for the presence of ADHD in patients seeking SUD treatment. Neurobiological and neurocognitive differences are present between ADHD patients with and without SUD, which together may partially explain the reduced effectiveness of methylphenidate in adult ADHD patients with SUD.Disclosure of interestThe author has not supplied his declaration of competing interest.

Sign in / Sign up

Export Citation Format

Share Document