Antidepressants in the treatment of adult attention-deficit hyperactivity disorder: a systematic review
- 498 Downloads
Stimulant medications are the most effective drugs in the treatment of attention-deficit hyperactivity disorder (ADHD) in children and in adults. However, some patients do not respond to this treatment and other patients suffer from adverse effects. Very often there are also comorbid disorders that warrant treatment or there is somatic comorbidity that precludes the prescription of stimulants. As a result, alternative treatments for the treatment of ADHD have been explored, such as antidepressant agents. In this systematic review the evidence base for the effect of antidepressants for ADHD in adult patients is determined.
Electronic and hand searches were conducted in order to identify clinical trials studying antidepressants for the treatment of ADHD in adult patients. The trials were screened for methodological characteristics and treatment-effect sizes. The odds ratio was calculated for randomized controlled trials with bupropion. A descriptive review of all the randomized controlled studies and an overview of the nonrandomized studies was developed.
Only eight randomized controlled trials were retrieved with four different compounds. Five studies concerned bupropion and the meta-analysis indicates a beneficial effect for bupropion compared with placebo as measured with the Clinical Global Improvement Scale (odds ratio 2.42 [95% CI 1.09 to 5.36]). Several studies suffer from clinical and methodological shortcomings, such as exclusion of patients with comorbid disorders, short treatment duration, or a lack of information with respect to the randomization procedure.
Although there is a need for alternative interventions for the treatment of ADHD, such as with antidepressant agents, the evidence base is not large. Only treatment with bupropion seems to have a medium-range effect size, but this is less than that of stimulant medications.
Keywordsadult antidepressant agents attention-deficit hyperactivity disorders systematic review treatment
Unable to display preview. Download preview PDF.
- 6.Spencer T, Biederman J, Wilens T, Harding M, O’Donnell D, Griffin S. Pharmacotherapy of attention-deficit/hyperactivity disorder across the life cycle: a literature review. J Am Acad Child Adolesc Psychiatry. 1996;35:09–432.Google Scholar
- 7.Wilens TE, Spencer TJ. The stimulants revisited. Child Adolesc Psychiatr Clin N Am. 2000;9:73–603.Google Scholar
- 8.Spencer T. Stimulant treatment for adult attentiondeficit/hyperactivity disorder. Psychiatr Clin N Am. 2004;27:61–372.Google Scholar
- 10.Greenhill L, Pliska S, Dulcan MK, et al. Practice parameters for the use of stimulant medication in the treatment of children, adolescent and adults. Am Acad Child Adolesc Psychiatry. 2002;41(suppl.):26–49.Google Scholar
- 11.Stone KJ, Viera AJ, Parman CL. Off-label applications for SSRIs. Am Fam Physician. 2003;68:98–504.Google Scholar
- 12.Chen H, Reeves JH, Finchman JE Kennedy WK, Dorfman JH, Martin BC. Off-label use of antidepressants, anticonvulsant, and antipsychotic medications among Georgia Medicaid Enrolees in 2001. J Clin Psychiatry. 2006;67:72–982.Google Scholar
- 13.Het doelmatig gebruik van antidepressiva in de behandeling van andere indicaties dan stemmingsstoornissen. Concensus vergadering RIZIV, comité voor de evaluatie van de medische praktijk inzage geneesmiddelen. Folia Pharmacother. 2008;35:4.Google Scholar
- 15.Deeks JJ, Higgins JPT, Altman DG. Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 (updated September 2008). The Cochrane Collaboration; 2008. Available at: www.cochrane-handbook.org.Google Scholar
- 25.Wilens TE, Dodson W. A clinical perspective of attention-deficit/hyperactivity disorder into adulthood. J Clin Psychiatry. 2004;65:301–1313.Google Scholar
- 27.Wellbutrin XL (bupropion hydrochloride extendedrelease tablets) prescribing information. Research Triangle Park, NC: GlaxoSmithKline; 2005.Google Scholar
- 28.Spencer T, Wilens T, Biederman J, Faraone SV, Ablon JS, Lapey K. A double-blind, crossover comparison of methylphenidate and placebo in adults with childhood-onset attention-deficit hyperactivity disorder. Arch Gen Psychiatry. 1995;52:34–443.Google Scholar
- 29.Wender PH, Reimherr FW. Bupropion treatment of attention-deficit hyperactivity disorder in adults. Am J Psychiatry. 1990;147:018–1020.Google Scholar
- 31.Wilens TE, Prince J, Biederman J, et al. An open study of sustained release bupropion in adults with attention-deficit/hyperactivity disorder and substance use disorders. Presented at the 48th annual meeting of the Academy of Child and Adolescent Psychiatry; October 23–28, 2001; Honolulu, Hawaii.Google Scholar
- 33.Wilens TE, Biederman J, Mick E, Spencer TJ. A systematic assessment of tricyclic antidepressants in the treatment of adult attention-deficit hyperactivity disorder. J Nerv Ment Dis. 1995;183:8–50.Google Scholar
- 36.Popper CW. Pharmacologic alternatives to psychostimulants for the treatment of attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am. 2000;9:05–646Google Scholar
- 38.Abramowicz M. Sudden death in children treated with a tricyclic antidepressant. Med Lett Drugs Ther. 1990;32:3–54.Google Scholar
- 40.Popper CW, Zimnitzky B. Sudden death putatively related to desipramine treatment in youth: a fifth case and a review of speculative mechanisms. J Child Adolesc Psychopharmacol. 1995;5:83–300.Google Scholar
- 41.Biederman J, Thisted R, Greenhill L, Ryan N. Estimation of the association between desipramine and the risk for sudden death in 5- to 14 year-old children. J Clin Psychiatry. 1995;56:7–93.Google Scholar
- 44.Cozza KL, Armstrong SC, Oesterheld JR. Drug Interaction Principles for Medical Practice. Arlington, VA: American Psychiatric Publishing, Inc.; 2003.Google Scholar
- 45.Wilens TE, Spencer TJ, Biederman J. A review of the pharmacotherapy of adults with attention-deficit/hyperactivity disorder. J Atten Disord. 2002;5:89–202.Google Scholar
- 48.Double blind, four week trial of [S,S] reboxetine and atomoxetine in adults with ADHD. Clinical Trials. gov web site. Trial no. NCT005620SS. Available at: www.clinicaltrials.gov/ct2/show/NCT005620SS. Accessed October 30 2008.Google Scholar
- 49.Stahl SM. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and Practical Applications. 3rd edition. Cambridge University Press; 2008.Google Scholar
- 50.Ernst M, Liebenauer LL, Jons PH, Tebeka D, Cohen RM, Zametkin AJ. Selegeline in adults with attention deficit hyperactivity disorder: clinical efficacy and safety. Psychopharmacol Bull. 1996;32:27–334.Google Scholar
- 53.Szabadi E, Bradshaw CM. Seminars in Clinical Psychopharmacology. 2nd edition. London: Royal College of Psychiatrists; 2004.Google Scholar
- 56.Schmitt JA, Ramaekers JG, Kruizinga MJ, van Boxtel MP, Vuurman EF, Riedel WJ. Additional dopamine reuptake inhibition attenuates vigilance impairment induced by serotonin reuptake inhibition in man. J Psychopharmacol. 2002;16:07–214.Google Scholar
- 58.Hoehn-Saric R, Harris GJ, Pearlson GD, Cox CS, Machlin SR, Camargo EE. A fluoxetine induced frontal lobe syndrome in an obsessive compulsive patient. J Clin Psychiatry. 1991;52:31–133.Google Scholar
- 59.Popper CW. Antidepressants in the treatment of attention-deficit/hyperactivity disorder. J Clin Psychiatry. 1997;58(suppl. 14):4–29.Google Scholar
- 60.Hedges D, Reimherr FW, Rogers A, Strong R, Wender PH. An open trial of venlafaxine in adult patients with attention deficit hyperactivity disorder. Psychopharmacol Bull. 1995;31:79–783.Google Scholar
- 61.Baker GB, Bornstein RA, Roujet AC, Ashton SE, van Muyden JC, Coutts RT. Phenylethylaminergic mechanismens in attention deficit disorder. Biol Psychiatry. 1991;29:5–22.Google Scholar
- 62.Berigan TR. Off-label use of venlafaxine in psychiatric and nonpsychiatric conditions. Prim Psychiatry. 2003;10:2–116.Google Scholar
- 63.Biederman J, Spencer T. Psychopharmacology of adults with attention-deficit/hyperactivity disorder. Prim Care Companion J Clin Psychiatry. 2004;1:7–62.Google Scholar