From the Guidelines
The combination of ADHD stimulants, such as amphetamines, and benzodiazepines is not recommended as a standard treatment approach due to concerns about opposing pharmacological actions, increased risk of substance dependence, and complicated side effect profiles. While stimulants effectively treat ADHD symptoms by increasing dopamine and norepinephrine, benzodiazepines work as CNS depressants for anxiety. In specific clinical situations where a patient has both ADHD and severe anxiety disorders, psychiatrists might occasionally use both medication classes, but this requires careful monitoring, typically with non-benzodiazepine anxiety treatments tried first (such as SSRIs or SNRIs), limited benzodiazepine duration, and close follow-up for adverse effects 1.
Key Considerations
- Stimulants, such as methylphenidate and amphetamines, are first-line treatments for ADHD due to their efficacy in reducing symptoms and improving quality of life 1.
- Benzodiazepines, like Xanax or Klonopin, are not typically recommended for long-term use due to their potential for dependence and withdrawal symptoms 1.
- Non-stimulant ADHD medications, such as atomoxetine or guanfacine, may be considered as alternatives, especially in patients with anxiety disorders, as they may have less potential to exacerbate anxiety 1.
Clinical Decision-Making
When deciding on a treatment approach for a patient with ADHD and anxiety, it is essential to weigh the potential benefits and risks of each medication class. Careful monitoring and regular follow-up are crucial when using stimulants and benzodiazepines together, as the combination can increase the risk of adverse effects and substance dependence 1. By prioritizing non-benzodiazepine anxiety treatments and considering non-stimulant ADHD medications, clinicians can minimize risks and optimize treatment outcomes for patients with complex mental health needs.
From the Research
Combination Therapy for ADHD
- The use of combination therapy for Attention-Deficit/Hyperactivity Disorder (ADHD) has been studied, with a focus on the combination of stimulants, such as amphetamine, and non-stimulants, such as atomoxetine 2, 3.
- Research has shown that atomoxetine can be used as an adjunctive treatment in adult patients with ADHD and comorbid partially responsive anxiety symptoms, with significant resolution of symptoms of anxiety and ADHD 4.
- A head-to-head randomized clinical trial compared the efficacy of methylphenidate and atomoxetine in improving executive functions in adults with ADHD, finding that both medications improved various executive functions, with atomoxetine showing greater improvement in spatial planning 5.
Safety and Adverse Effects
- A retrospective analysis of the FAERS database found significant adverse event signals for methylphenidate, atomoxetine, and amphetamine, including psychotic disorders, psychiatric and reproductive disorders, and cardiovascular and neurological effects 6.
- The analysis also found that the three ADHD medications are associated with suicide-related signals, with amphetamine associated with coronary artery dissection, methylphenidate associated with precocious puberty, and atomoxetine associated with testicle, penile lesions, and liver damage 6.
Role of Amphetamine and Benzodiazepine Combination Therapy
- There is limited research on the specific combination of amphetamine and benzodiazepine for ADHD treatment, and the available studies do not provide direct evidence for this combination 2, 3, 4, 5, 6.
- However, the studies suggest that combination therapy can be effective for ADHD treatment, and that atomoxetine can be used as an adjunctive treatment for patients with comorbid anxiety symptoms 3, 4.