Longer-acting drugs now a mainstay in ADHD treatment

January 1, 2007

Attention-deficit/hyperactivity disorder (ADHD) is marked by patterns of inattention, careless mistakes, difficulty waiting, forgetfulness and restlessness. People who have ADHD are distracted most of the time. Even when they try to concentrate, they find that it's hard to pay attention. They have trouble organizing things, listening to instructions or remembering details. Someone with this condition is impulsive. They often fidget, don't wait for their turn and interrupt others. In school, children with ADHD may blurt out answers and move around a lot; they seem to be "always on the go."

Attention-deficit/hyperactivity disorder (ADHD) is marked by patterns of inattention, careless mistakes, difficulty waiting, forgetfulness and restlessness. People who have ADHD are distracted most of the time. Even when they try to concentrate, they find that it's hard to pay attention. They have trouble organizing things, listening to instructions or remembering details. Someone with this condition is impulsive. They often fidget, don't wait for their turn and interrupt others. In school, children with ADHD may blurt out answers and move around a lot; they seem to be "always on the go."

However, a person may be distracted and jittery for many different reasons. This means diagnosis of ADHD requires a careful analysis to rule out other potential problems, including depression, anxiety, panic attacks, lead exposure, thyroid or other hormone problems, side effects of medications, alcoholism or illegal drug use.

Except for Strattera, they are all stimulants, and are all classified as controlled substances by the U.S. Drug Enforcement Administration (DEA). Even though these medicines have a stimulating effect in most people, they have a calming effect in children and adults with ADHD.

Methylphenidate (Ritalin) is the active ingredient in the majority of stimulant medications prescribed in the U.S., and has been shown to be effective in reducing ADHD symptoms in both children and adults. It works by blocking reuptake of dopamine in the central nervous system, thus increasing dopamine levels in the brain. "Dopamine is a neurotransmitter that affects brain processes controlling movement, emotional responses and the ability to experience pleasure," says Mark Abramowicz, MD, editor of The Medical Letter on Drugs and Therapeutics, a non-profit newsletter that critically appraises drugs.

The various stimulant medications are available in a number of different forms: short-acting, intermediate and long-acting. Short-acting medications are often used together with long-acting forms to provide a boost early in the morning, or to smooth withdrawal in the late afternoon. When short-acting forms are used on their own, they usually require another dose in the middle of the day. Because of this, longer-acting preparations with once-daily dosing have become the mainstay of clinical practice.

The use of any stimulant can lead to adverse effects such as delayed sleep onset, headache and weight loss. Infrequently, they can lead to exaggerated emotional reactions. Occasionally they can lead to involuntary movements, involuntary speech, and/or fast heartbeat. The most common adverse events leading to discontinuation of treatment with stimulants are motor or vocal tics, anorexia, insomnia and tachycardia (fast heartbeat).

NON-STIMULANTS

Strattera was the first drug approved by the FDA to treat ADHD in both children and adults. It isn't a stimulant, and it isn't a controlled substance. Because it isn't a stimulant, it can be taken in the evening as well as in the morning, while stimulant medications cannot be taken in the evening.

Strattera works by slowing the re-absorption of norepinephrine, a brain chemical considered important in regulating attention, impulse control and organization. In effect, Strattera increases norepinephrine levels.

Strattera is less effective than the stimulants in reducing the symptoms of ADHD. However, it is particularly valuable for patients who have not responded to stimulants or cannot tolerate them and for those who do not want to take a controlled substance.