Psychostimulants such as mixed amphetamine salts (MAS, brand name Adderall) are widely used for cognitive enhancement by healthy young people, yet laboratory research on effectiveness has yielded variable results. The present study assessed the effects of MAS in healthy young adults with an adequately powered double-blind cross-over placebo-controlled trial. We examined effects in 13 measures of cognitive ability including episodic memory, working memory, inhibitory control, convergent creativity, intelligence and scholastic achievement, with the goals of determining (1) whether the drug is at least moderately enhancing (Cohen's d >= .5) to some or all cognitive abilities tested, (2) whether its effects on cognition are moderated by baseline ability or COMT genotype, and (3) whether it induces an illusory perception of cognitive enhancement. The results did not reveal enhancement of any cognitive abilities by MAS for participants in general. There was a suggestion of moderation of enhancement by baseline ability and COMT genotype in a minority of tasks, with MAS enhancing lower ability participants on word recall, embedded figures and Raven's Progressive Matrices. Despite the lack of enhancement observed for most measures and most participants, participants nevertheless believed their performance was more enhanced by the active capsule than by placebo. We conclude that MAS has no more than small effects on cognition in healthy young adults, although users may perceive the drug as enhancing their cognition. AbstractPsychostimulants such as mixed amphetamine salts (MAS, brand name Adderall) are widely used for cognitive enhancement by healthy young people, yet laboratory research on effectiveness has yielded variable results. The present study assessed the effects of MAS in healthy young adults with an adequately powered double-blind cross-over placebo-controlled trial. We examined effects in 13 measures of cognitive ability including episodic memory, working memory, inhibitory control, convergent creativity, intelligence and scholastic achievement, with the goals of determining (1) whether the drug is at least moderately enhancing (Cohen's d >= .5) to some or all cognitive abilities tested, (2) whether its effects on cognition are moderated by baseline ability or COMT genotype, and (3) whether it induces an illusory perception of cognitive enhancement. The results did not reveal enhancement of any cognitive abilities by MAS for participants in generalThere was a suggestion of moderation of enhancement by baseline abilityand COMT genotype in a minority of tasks, with MAS enhancing lower ability participants on word recall, embedded figures and Raven's Progressive Matrices. Despite the lack of enhancement observed for most measures and most participants, participants nevertheless believed their performance was more enhanced by the active capsule than by placebo. We conclude that MAS has no more than small effects on cognition in healthy young adults, although users may perceive the drug as enhancing their ...

Stimulant medication has long been effective in treating attention-deficit/hyperactivity disorder (ADHD) and is currently the first-line pharmacological treatment for children. Both methylphenidate and amphetamine modulate extracellular catecholamine levels through interaction with dopaminergic, adrenergic and serotonergic system components; it is therefore likely that catecholaminergic molecular components influence the effects of ADHD treatment. Using meta-analysis, we sought to identify predictors of pharmacotherapy to further the clinical implementation of personalized medicine. We identified 36 studies (3647 children) linking the effectiveness of methylphenidate treatment with DNA variants. Pooled-data revealed a statistically significant association between single nucleotide polymorphisms (SNPs) rs1800544 ADRA2A (odds ratio: 1.69; confidence interval: 1.12-2.55), rs4680 COMT (odds ratio (OR): 1.40; confidence interval: 1.04-1.87), rs5569 SLC6A2 (odds ratio: 1.73; confidence interval: 1.26-2.37) and rs28386840 SLC6A2 (odds ratio: 2.93; confidence interval: 1.76-4.90), and, repeat variants variable number tandem repeat (VNTR) 4 DRD4 (odds ratio: 1.66; confidence interval: 1.16-2.37) and VNTR 10 SLC6A3 (odds ratio: 0.74; confidence interval: 0.60-0.90), whereas the following variants were not statistically significant: rs1947274 LPHN3 (odds ratio: 0.95; confidence interval: 0.71-1.26), rs5661665 LPHN3 (odds ratio: 1.07; confidence interval: 0.84-1.37) and VNTR 7 DRD4 (odds ratio: 0.68; confidence interval: 0.47-1.00). Funnel plot asymmetry among SLC6A3 studies was identified and attributed largely to small study effects. Egger's regression test and Duval and Tweedie's 'trim and fill' were used to examine and correct for publication bias. These findings have major implications for advancing our therapeutic approach to childhood ADHD treatment.

Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are associated with significant morbidity/mortality risk. Prolonged episodes increase impact on quality of life, risk for suicide, and harbor greater societal costs. Current management is inadequate as half of individuals do not respond to first-line therapies. Identification of an optimal treatment may hinge on exploiting interindividual genetic variability, which-in combination with other extraneous factors-is associated with heterogeneous antidepressant response. We evaluated the use of Genecept testing in an open-label trial of 468 patients, focusing on the methylenetetrahydrofolate reductase (MTHFR) and serotonin transporter (SLC6A4) genes and evaluating their plausibility as putative predictors of MDD/GAD treatment outcome. After receiving genotyping, 50.6% of clinicians made assay-congruent changes to treatment. This yielded a selective serotonin reuptake inhibitor (SSRI) discontinuation rate of 19.0% in patients with a risk SLC6A4 genotype, and, an acute folate derivative addition rate of 41.8% in MTHFR risk allele carriers. After 8 weeks of treatment, patients with a risk MTHFR genotype that were treated with assay-guided treatment regimens-as compared to those that were not-demonstrated a greater reduction in Quick Inventory of Depressive Symptoms (QIDS-SR) and Undersøgelser (UKU) scores, and an increased quality of life score (Q-LES-Q-SF). SLC6A4 risk patients who adhered to assay-guided treatment achieved a greater reduction in QIDS-SR and UKU scores and a statistically significant increase in Q-LES-SF scores, versus those that did not. Results support the utility of genotyping in the treatment of MDD/GAD and propose SLC6A4 and MTHFR as biological predictors of treatment outcome.

Approximately one in five individuals in the United States experiences mental health issues in any given year, and these disorders are consistently among the leading causes of years lived with disability. Unfortunately, many mental illnesses are lifelong conditions that require medication and therapy to improve quality of life, yet clinical trial data show that many patients fail to achieve remission or require several pharmacological interventions prior to remission. These results indicate a need to address the variability among patients in their response to medication, in addition to developing treatment plans tailored to the individual. One approach that may help explain patient variability in response to medication is pharmacogenetic testing. The current review shows the clinical use of pharmacogenetic testing in a small subset of gene variants and how they pertain to psychiatric illness and treatment. Recent evidence suggests that genetic testing for psychiatric illness can improve patient outcomes in addition to decreasing health care costs. [Journal of Psychosocial Nursing and Mental Health Services, 56(1), 22-31.].

No abstract