Non-stimulant treatment of attention-deficit/hyperactivity disorder

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Stimulants are a highly efficacious and safe treatment for attention-deficit/hyperactivity disorder (ADHD), with 75% to 90% of patients responding well if two different stimulants (amphetamine and methylphenidate) are used. Nonetheless, a subset of ADHD patients will either fail to respond to stimulants or have side effects that preclude their use (tics, severe loss of appetite, marked insomnia). For such patients, there are a number of non-stimulant agents that serve as second-line treatments. Tricyclic antidepressants (TCAs) are the most studied of these drugs. They are superior to placebo in the treatment of ADHD and may reduce abnormal movements in patients with ADHD/tic disorder. TCAs often produce side effects of sedation, dry mouth, and constipation. Bupropion is superior to placebo in the treatment of ADHD and has a more favorable side-effect profile than the TCAs. A new selective norepinephrine reuptake inhibitor, atomoxetine, has been shown to be efficacious in the treatment of ADHD and has recently received an approvable letter from the Food and Drug Administration. The α-agonists clonidine and guanfacine have also been used as alternative agents in ADHD, though the controlled data are more limited. A recent controlled clinical trial suggests a combination of methylphenidate and clonidine has advantages in the treatment of comorbid ADHD and tics over either medication alone. Clinical guidelines for each of these agents, as well as their use in combination with stimulants in comorbid conditions, will be discussed.

Original languageEnglish (US)
Pages (from-to)253-258
Number of pages6
JournalCNS Spectrums
Volume8
Issue number4
StatePublished - Apr 1 2003

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Attention Deficit Disorder with Hyperactivity
Tricyclic Antidepressive Agents
Tics
Methylphenidate
Clonidine
Therapeutics
Guanfacine
Placebos
Tic Disorders
Bupropion
Controlled Clinical Trials
Dyskinesias
Sleep Initiation and Maintenance Disorders
Appetite
Amphetamine
United States Food and Drug Administration
Constipation
Mouth
Norepinephrine
Guidelines

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology

Cite this

Non-stimulant treatment of attention-deficit/hyperactivity disorder. / Pliszka, Steven R.

In: CNS Spectrums, Vol. 8, No. 4, 01.04.2003, p. 253-258.

Research output: Contribution to journalArticle

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