From the Guidelines
Stimulant medication, specifically methylphenidate (MPH) or dextroamphetamine (DEX), is the first-line treatment for Attention Deficit Hyperactivity Disorder (ADHD) in adults. According to the practice parameter for the use of stimulant medications in the treatment of adults with ADHD 1, stimulant medications have been shown to be effective in treating ADHD in adults, with response rates ranging from 23% to 75%. The study suggests that using higher doses of MPH, such as a total daily dose of 1 mg/kg, can produce robust effects, with 78% of adults showing improvement on MPH versus 4% who responded to placebo 1.
Key Considerations for Treatment
- Starting doses for MPH are often 5 to 20 mg tid, and for DEX, 5 mg tid to 20 mg bid 1
- Treatment should be carefully evaluated and monitored, particularly in adults with comorbid substance abuse disorder 1
- Common side effects of stimulant medications include loss of appetite, insomnia, and anxiety 1
- Non-stimulant medications like fluoxetine, bupropion, or certain antidepressants may be considered for patients who cannot tolerate stimulants or have contraindications 1
Importance of Comprehensive Treatment
- Behavioral therapy and psychoeducation are important components of comprehensive ADHD treatment and should ideally be combined with medication for optimal outcomes
- Regular monitoring of side effects, such as decreased appetite, insomnia, increased heart rate, and blood pressure, is crucial for ensuring the safe and effective use of stimulant medications.
From the FDA Drug Label
Atomoxetine hydrochloride was administered as a single dose in the early morning and titrated on a weight-adjusted basis according to clinical response, up to a maximum dose of 1.5 mg/kg/day. The effectiveness of atomoxetine hydrochloride in the treatment of ADHD was established in 2 randomized, double-blind, placebo-controlled clinical studies of adult patients, age 18 and older, who met DSM-IV criteria for ADHD Atomoxetine hydrochloride was administered as a divided dose in the early morning and late afternoon/early evening and titrated according to clinical response in a range of 60 to 120 mg/day
The first-line treatment for Attention Deficit Hyperactivity Disorder (ADHD) in adults is atomoxetine or methylphenidate.
- Key points:
From the Research
First-Line Treatment for Attention Deficit Hyperactivity Disorder (ADHD) in Adults
- The first-line treatment options for ADHD in adults include pharmacotherapy with stimulants, such as methylphenidate and amphetamine salts, as well as non-stimulant alternatives like atomoxetine 4, 5, 6.
- Stimulant medications, including methylphenidate and amphetamines, are considered the mainstay of ADHD treatment, but they pose risks of abuse and dependence 4, 5.
- Non-stimulant options, such as atomoxetine, viloxazine, and bupropion, provide alternatives for patients who cannot tolerate stimulants or have concurrent anxiety/depression 6, 7, 8.
- Clinical guidelines recommend a subset of amphetamine and methylphenidate stimulants as first-line pharmacotherapy, which may be more effective when combined with psychotherapy 6.
- Emerging therapeutic devices, including the Monarch eTNS System and EndeavorRx, offer innovative drug-free treatment options, and psychological therapy may be beneficial in adults who continue to experience clinically significant symptoms while receiving pharmacotherapy 4, 7.
Treatment Approaches
- A multidisciplinary approach that integrates pharmacotherapy, behavioral therapy, and novel technology-based interventions holds promise for improving patient outcomes and addressing the societal impact of ADHD 4.
- Non-pharmacological approaches, such as cognitive-behavioral treatment, mindfulness-based approaches, psycho-education, and dialectical-focused therapies, have been identified as effective treatments for adult ADHD 8.
- Neuro-stimulation methods, including bright light treatment and neurofeedback, have also been reported as efficacious in treating adult ADHD 8.
Considerations
- When evaluating for adult ADHD, other mental disorders should be included in the differential diagnosis due to the substantial overlap of symptoms and ADHD concurrence with anxiety/stress, mood, personality, impulse control, and substance use disorders 6.
- Physicians should consider employing controlled substance agreements and prescription drug monitoring programs to monitor for patient misuse or diversion of stimulants 6.