Psychopharmacological Treatment of Attention-Deficit Hyperactivity Disorder in Adults

Abstract

Attention-deficit hyperactivity disorder (ADHD) in adults is a common disorder which results in a lot of secondary problems. Pharmacological treatment is essential in the management of ADHD. Stimulant treatment has for decades been proven to be effective and safe. Amphetamine was the first drug for this indication; most studies have been carried out with methylphenidate, which has been shown to be very effective and well tolerated. Newer extended-release methylphenidate preparations have considerable advantages. Because of hepatic side effects, pemoline no longer plays a role. Modafinil seems to have comparable effects like amphetamine. Atomoxetine is a potent norepinephrine-specific reuptake inhibitor which is approved for the treatment of ADHD in children, adolescents and adults. Tricyclic antidepressants may be third-line agents. Bupropion targets both ADHD and depressive symptoms which are frequent comorbid conditions. Clonidine and guanfacine have positive effects in patients with ADHD and comorbid tics. Several other compounds may be beneficial in ADHD treatment.Attention-deficit hyperactivity disorder (ADHD) has been increasingly recognized as a chronic condition [1]. Already in the 1980s, Paul Wender [2] realized that ADHD patients remain in treatment also in early adulthood. Approximately one-to twothirds of children with ADHD continue to manifest at least some clinically significant symptoms of the disorder into adulthood [3]. The symptom of hyperactivity shows best remission in adolescence, whereas impulsivity and inattention decline only slightly [4]. The prevalence of adult ADHD has been estimated in a recent study to be 4.4% [5].There is common consent that untreated ADHD has a high risk of secondary problems in later life [6]. Studies in adults who have been diagnosed in childhood showed significantly higher rates of lower academic degrees, substance abuse and delinquency, impaired problems in occupational integration, more unwanted pregnancies, more children, more divorces and more contacts to medical services [7].

Hilfe für Zappelphilipp und Träumerchen

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