Novel Treatments for ADHD

The optimal medication for a child with attention-deficit/hyperactivity disorder would be one that is effective, long-acting, be well tolerated and not cause mood swings or worsen ‘co-morbid’ conditions (i.e., accompanying conditions like tics, depression, anxiety). 

Stimulants are still the first-line treatment.  This includes methylphenidate, amphetamine and dextroamphetamine. (e.g., Adderall, Concerta, Methylin, Metadate, Ritalin)   Their advantage is their safety and effectiveness in over 70% of patients.  Side effects are weight loss, stomachaches, headaches and initial insomnia.  Less common are exacerbation of tics and raised blood pressure and pulse.

Tricyclic antidepressants are the next most studied class of treatment for ADHD.   Of these, imipramine and desipramine (e.g., Tofranil), have the best effects, even at  low doses.  They work for about 70% of patients with ADHD, even without depression.  Unfortunately, these drugs affect cardiac conduction, can cause sudden death,and require close monitoring.  They are not prescribed very often for ADHD.  Bupropion (Wellbutrin) is another class of antidepressant, that shows some promise for ADHD, but is inferior to stimulants.

Antihypertensives:  Clonidine and Guanfacine (Catapres, Tenex) have been effective in reducing ADHD symptoms in some children.  For children with ADHD who also have an oppositional defiant disorder, conduct disorder or sleep disturbance, this medication may help both conditions.  Sedation and rebound hypertension are possible adverse affects.

Atomoxetine:  This drug is still in the investigational phase, but is one of the most promising ADHD medications expected on the market.  It seems to have minimal adverse reactions and significant beneficial effects that are comparable with methylphenidate.  

Other:  MAO Inhibitors are effective in ADHD but are rarely prescribed because of severe dietary restrictions associated with taking these drugs.  SSRIs (e.g., Prozac, Zoloft) do not seem to be effective for ADHD.

(Spencer TJ et al: J Clin Psychiatr 2002; 63(suppl 12)16-64.)

Comment:  Brand names in italics were not in the original article and are not complete lists, but were added here for reader familiarity.        –H.T.