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The mixed amphetamine salt extended release (Adderall XR, Max-XR) as an adjunctive to SSRIS or SNRIS in the treatment of adult ADHD patients with comorbid partially responsive generalized anxiety: an open-label study

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ADHD Attention Deficit and Hyperactivity Disorders

Abstract

To examine the changes in partially responsive anxiety symptoms utilizing adjunctive treatment with the mixed amphetamine salt extended release (Adderall XR, MAX-XR) in the treatment of adult ADHD patients, with comorbid refractory anxiety. Consenting adult patients (n = 32) with confirmed diagnosis of generalized anxiety (GA) and comorbid (ADHD) participated in this open-label study. All patients had significant comorbid anxiety symptoms (HAM-A > 7) and failed to respond to 8-week trials of Serotonin Reuptake Inhibitors (SSRIs) or Norepinephrine Reuptake inhibitors (SNRIs). All patients were treated with the “Mixed Amphetamine salts Extended Release Adderall XR, (MAS-XR), as adjunctive to SSRIs or to SNRIs and were followed for at least 12 weeks. The primary effectiveness measure was the Clinical Global Impression severity subscale (CGI-S). Other scales included the Hamilton Anxiety Scale (HAM-A), the adult ADHD Self-Report Scale (ASRS-v1.1) symptom checklist, and Sheehan’s disability scale. Baseline measures prior to the treatment with MAS-XR were compared to those at 4, 8, and at 12 weeks of treatment. Monitoring for pulse, blood pressure, and weight changes was carried out at baseline and at end point. All patients completed this open-label trial. There was significant and robust resolution of symptoms of all effectiveness measures, including the symptoms of anxiety, as shown by changes from baseline in HAM-A, ASRS-v1.1, and CGI at 8 weeks. Also there was significant reduction in the disability score at 12 weeks. Patients tolerated the treatment, and there were no significant cardiovascular changes at 12 weeks. There was decrease in mean weight at 12 weeks by 2.2 kg (P < .001). Mixed amphetamine salts MAS-XR can be used in adult patients with ADHD and comorbid anxiety symptoms. Larger controlled studies are needed to support the effectiveness of mixed amphetamine salts in patients with comorbid anxiety symptoms. Treatments need to include the targeting of the ADHD symptoms effectively in order to achieve better resolution of anxiety symptoms.

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References

  • Adler L, Spencer T, Farone S, Kessler R, Howes M, Beiderman J, Secnik C (2006) Validity of pilot Adult ADHD Self Report Scale (ASRS) to rate Adult ADHD symptoms. Ann Clin Psychiatry 18(3):145–148

    Article  PubMed  Google Scholar 

  • Baldwin D, Anderson I, Nutt D, Bandelow B, Bond A, Davidson J, den Boer J, Fineberg N, Knapp M, Scott J, Wittchen H (2005) Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 19:567–596

    Article  CAS  PubMed  Google Scholar 

  • Barkley R, Brown T (2008) Unrecognized attention-deficit/hyperactivity disorder in adults presenting with other psychiatric disorders. CNS Spectr 13(11):977–984

    PubMed  Google Scholar 

  • Biederman J, Faraone SV, Spencer TJ, Mick E, Monuteaux MC, Aleardi M (2006) Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. J Clin Psychiatry 67(4):524–540

    Article  PubMed  Google Scholar 

  • Biederman J, Mick E, Surman C, Doyle R, Hammerness P, Michel E, Martin J, Spencer T (2007) Comparative acute efficacy and tolerability of OROS and immediate release formulations of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder. BMC Psychiatry 14(7):49

    Article  Google Scholar 

  • Brown R, Amler R, Freeman W (2005) Treatment of attention deficit hyperactivity disorder: overview of evidence. Paediatrics 115:e749–e757

    Article  Google Scholar 

  • Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (2008) Canadian ADHD Practice Guidelines. CADDRA, Toronto

    Google Scholar 

  • Cumyn L, Kolar D, Keller A, Hechtman L (2007) Current issues and trends in the diagnosis and treatment of adults with ADHD. Expert Rev Neurother 7(10):1375–1390

    Article  PubMed  Google Scholar 

  • Cumyn L, French L, Hechtman L (2009) Comorbidity in adults with attention-deficit hyperactivity disorder. Can J Psychiatry 54(10):673–683

    PubMed  Google Scholar 

  • Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55

    CAS  PubMed  Google Scholar 

  • Henning ER, Turk CL, Mennin DS, Fresco DM, Heimberg RG (2007) Impairment and quality of life in individuals with generalized anxiety disorder. Depress Anxiety 24:342–349

    Article  PubMed  Google Scholar 

  • Kessler R, Brandenburg N, Lane M, Roy-Byrne P, Stang P, Stein DJ, Wittchen H (2005) Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Comorbidity Survey Replication. Psychol Med 35:1073–1082

    Article  PubMed  Google Scholar 

  • Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky A (2006) The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 163(4):716–723

    Article  PubMed  Google Scholar 

  • Klassen L, Katzman M, Chokka P (2009) Adult ADHD and its comorbidities, with a focus on bipolar disorder. J Affect Disord [Epub ahead of print]

  • McGough J, Smalley S, McCracken J, Yang M, Del’Homme M, Lynn D, Loo S (2005) Psychiatric comorbidity in adult attention deficit hyperactivity disorder: findings from multiplex families. Am J Psychiatry 162(9):1621–1627

    Article  PubMed  Google Scholar 

  • McIntyre RS, Konarski JZ, Mancini DA, Fulton KA, Parikh SV, Grigoriadis S, Grupp LA, Bakish D, Filteau MJ, Gorman C, Nemeroff CB, Kennedy SH (2005) Measuring the severity of depression and remission in primary care: validation of the HAMD-7 scale. CMAJ 173(11):1327–1334

    PubMed  Google Scholar 

  • Montano B (2004) Diagnosis and treatment of ADHD in adults in primary care. J Clin Psychiatry 65(Suppl 3):18–21

    PubMed  Google Scholar 

  • MTA cooperative group (1999) A 14 month randomized clinical trial of treatment strategies for attention deficit hyperactivity disorder: multimodal treatment study of children with ADHD. Arch Gen Psychiatry 56:1073–1086

    Article  Google Scholar 

  • National Institute of Mental health (1970) CGI: Clinical global impression. In: Guy W, Bonato RR (eds) Manual for the ECDEU assessment battery, 2nd rev. edn. Chevy Chase, Maryland, pp P12-1–P12-6

  • Newcorn JH, Weiss M, Stein MA (2007) The complexity of ADHD: diagnosis and treatment of the adult patient with comorbidities. CNS Spectr 12(8 Suppl 12):1–14 (quiz 15–16)

    Google Scholar 

  • Poulton A (2006) Long-term outcome of stimulant medication in attention deficit hyperactivity disorder. Expert Rev Neurother 6:551–561

    Article  CAS  PubMed  Google Scholar 

  • Ruscio A, Chiu W, Roy-Byrne P, Stang P, Stein D, Wittchen H, Kessler R (2007) Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication. J Anxiety Disord 21:662–676

    Article  PubMed  Google Scholar 

  • Schweizer E (1995) Generalized anxiety disorder. Longitudinal course and pharmacologic treatment. Psychiatr Clin North Am 18:843–857

    CAS  PubMed  Google Scholar 

  • Sheehan D, Hamett-Sheehan K, Raj B (1996) The measurement of disability. Int Clin Psychopharmcol 11(Suppl 3):89–95

    Article  Google Scholar 

  • Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar G (1998) The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33 (quiz 34–57)

    PubMed  Google Scholar 

  • Simon V, Czobor P, Bálint S, Mészáros A, Murai Z, Bitter I (2007) Detailed review of epidemiologic studies on adult Attention Deficit/Hyperactivity Disorder (ADHD). Psychiatr Hung 22(1):4–19

    PubMed  Google Scholar 

  • Sobanski E, Brüggemann D, Alm B, Kern S, Deschner M, Schubert T, Philipsen A, Rietschel M (2007) Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 257(7):371–377

    Article  PubMed  Google Scholar 

  • Spencer TJ, Wilens TE, Biederman J, Weisler RH, Read SC, Pratt R (2006) Efficacy and safety of mixed amphetamine salts extended release (Adderall XR) in the management of attention-deficit/hyperactivity disorder in adolescent patients: a 4-week, randomized, double-blind, placebo-controlled, parallel-group study. Clin Ther 28(2):266–279

    Article  CAS  PubMed  Google Scholar 

  • Wilens T, Biederman J, Faraone S, Martelon M, Westerberg D, Spencer T (2009) Presenting ADHD symptoms, subtypes, and comorbid disorders in clinically referred adults with ADHD. J Clin Psychiatry 70(11):1557–1562

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Author would like to thank Dr T.C.R. Wilkes Division Chief, Child and Adolescent Psychiatry Alberta Health Services and University of Calgary for time gave to review the manuscript of this paper. This research project did not receive support of findings from any sources.

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Correspondence to Adel Gabriel.

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Gabriel, A. The mixed amphetamine salt extended release (Adderall XR, Max-XR) as an adjunctive to SSRIS or SNRIS in the treatment of adult ADHD patients with comorbid partially responsive generalized anxiety: an open-label study. ADHD Atten Def Hyp Disord 2, 87–92 (2010). https://doi.org/10.1007/s12402-010-0025-z

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