Title:Pharmacological Treatment of Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Review of Recent Data
VOLUME: 3 ISSUE: 2
Author(s):Silvio Bellino, Marta Mirra, Elena Brignolo, Paola Bozzatello and Filippo Bogetto
Affiliation:Centre for Personality Disorder, Psychiatric Clinic, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126 Turin, Italy.
Keywords:Amphetamines, atomoxetine, attention deficit hyperactivity disorder, efficacy, methylphenidate, non-stimulants,
stimulants, tolerability.
Abstract:Attention-deficit/hyperactivity disorder (ADHD) is an impairing psychiatric disorder that
affects not only children, but also adult patients. The symptoms of ADHD often produce an
impairment of interpersonal functioning and educational performance with an increased school
dropout risk. The aim of the present review is to provide an update of the empirical evidences of
efficacy and safety that have been collected for stimulant and non-stimulant drugs in the treatment of
ADHD patients. A systematic search of published randomized controlled trials of medications for
ADHD was performed on the Pubmed and Cochrane databases from 2010 to 2013. Reviews and
meta-analyses of older data were also examined. The first line drugs for ADHD without comorbidity
or with comorbid conduct disorder are the stimulants methylphenidate (MPH) and dexmetylphenidate
(d-MPH), available in immediate- and extended-release formulations. Other drugs with evidences of efficacy include both
stimulants, such as amphetamines, and non-stimulants, such as atomoxetine and alpha agonists. A few non-stimulant
agents, like reboxetine, have still limited data, but are under evaluation. Among the various treatment options, stimulants
have generally demonstrated superiority compared to non-stimulants. Most of the studies are trials comparing
methylphenidate, amphetamine and atomoxetine versus placebo, but comparison of active drugs is hindered by the
absence of head-to-head works. Some meta-analyses have tried to overcome this problem, but further investigations
directly comparing different active compounds are needed.
