Evidence-Based Reviews

Attention-deficit/hyperactivity disorder: Tips to individualize drug therapy

Current Psychiatry. 2002 May;1(5):32-41

References

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Pharmacologic intervention for prominent concomitant mood disorders (depression and bipolarity) and anxiety should be sequenced prior to ADHD treatment.

Summary of treatment recommendations

Based on efficacy and safety, stimulants are first-line agents for routine management of ADHD, followed by antidepressants and antihypertensives. Patients who do not respond to the initial stimulant or who manifest adverse effects should be considered for a trial with an alternate stimulant. If two stimulant trials are unsuccessful, bupropion and the tricyclic antidepressants are reasonable second-line agents.

Antihypertensives alone or in combination with other ADHD medication may help youths with tics,³¹ prominent hyperactivity, impulsivity, or aggressiveness. MAOIs may be considered for refractory patients, and cholinergic agents (e.g., donepezil) may be used for excessive cognitive difficulties such as organization, planning, and time management.

Related resources

Barkley RA. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York: The Guilford Press, 1998.
Wilens T. Straight Talk About Psychiatric Medications for Kids. New York: The Guilford Press, 1998.
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), www.chadd.org

Drug brand names

Atomoxetine • (under development)
Bupropion • Wellbutrin
Clonidine • Catapress
Dextro-amphetamine • Dexedrine
Dexmethylphenidate • Focalin
Donepezil • Aricept
Guanfacine • Tenex
Methylphenidate • Ritalin, Concerta, Metadate
Pemoline • Cylert
Venlafaxine • Effexor

Disclosure

Dr. Biederman reports that he receives research/grant support from, and is on the speaker’s bureau and advisory boards of Eli Lilly & Co. and Shire Laboratories. He also reports that he receives research/grant support from Wyeth-Ayerst Pharmaceuticals, Pfizer Inc., Cephalon Pharmaceutical, Janssen Pharmaceutica, and Noven Pharmaceutical; is on the speaker's bureau of GlaxoSmithKline, Pfizer Inc., Wyeth-Ayerst Pharmaceuticals, Alza/McNeil Pharmaceutical and Cephalon Pharmaceutical; and is on the advisory board of Cell Tech, Noven Pharmaceutical, and Alza/McNeil Pharmaceuticals.

Drs. Wilens and Spencer report that they receive research/grant support from, are on the speakers bureau of, and/or serve as consultants to Abbott Laboratories, McNeil Pharmaceuticals, Celltech Medieva, GlaxoSmithKline, Eli Lilly & Co., Novartis Pharmaceuticals Corp., Pfizer Inc., Shire Pharmaceuticals Group, and Wyeth-Ayerst Pharmaceuticals.