Stimulating Improvement for Adult ADHD

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Stimulating Improvement for Adult ADHD

Debate continues about the frequency of attention deficit hyperactivity disorder (ADHD) in adults and the degree to which it responds to stimulants. In this carefully designed, random-assignment, placebo-controlled, crossover, and manufacturer-supported study, researchers measured the effects of a mixture of levo- and dextroamphetamine salts (brand name, Adderall) in 27 adults with ADHD. Participants had onset of DSM-IV ADHD by age 7 and a chronic course with moderate-to-severe impairment.

Most participants (93 percent) had lifetime histories of comorbid psychiatric disorders (major depression, anxiety, substance abuse, antisocial personality, or a combination of these), and 22 percent had current comorbid diagnoses of major depression or an anxiety disorder. Participants received 3 weeks of twice-daily Adderall or placebo with one-week washouts between conditions; doses were gradually increased to a mean of 54 mg/day. Adderall was associated with significant reductions in symptoms of hyperactivity, impulsivity, and inattentiveness, compared with placebo. ADHD symptoms worsened in 55 percent of patients while taking placebo, but in none taking the active medication. The most significant side effects of Adderall were appetite suppression and agitation. Comorbidity did not seem to affect improvement rates, but this analysis was tentative due to small subgroup sizes.

Comment: These results confirm findings in other research demonstrating that ADHD is a valid diagnosis in adults. Unlike comorbidity in children with ADHD, comorbidity in adults may not significantly affect treatment response; this needs to be confirmed with direct prospective comparisons of comorbid and noncomorbid ADHD patients. Twice-daily dosing of Adderall may be effective for ADHD, but it remains to be seen whether this preparation is any better than cheaper stimulants.

— S Dubovsky

Published in Journal Watch Psychiatry September 20, 2001

Citation(s):

Spencer T et al. Efficacy of a mixed amphetamine salts compound in adults with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 2001 Aug 58 775-782.

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