ADHD & Stimulants
Although stimulants remain the main treatment in the pharmacotherapy of Attention Deficit Hyperactivity Disorder, there are new and innovative approaches being developed. In general, approximately seventy-five percent of patients treated with stimulants for ADHD will respond. However, this still leaves a substantial number of patients who don’t respond to stimulants. In addition, there remain a number of people, who although their symptoms respond to stimulants, are not able to either tolerate the side effects or comply with the multiple doses required in order to achieve effective pharmacotherapy. Towards this end, researchers and clinicians have recently been developing new approaches to the medication treatment of ADHD. In addition to the new formulations of stimulants, there are a variety of new and alternative medications which are being studied. Traditionally, the focus of pharmacotherapy for ADHD has been on medications which will increase both neuromenergic and double menergic neurotransmission. A novel approach to this has recently been reported which involves the cholinergic system. There are a number of reports of the use of nicotine derived products that improve focus and attention. And recently our group reported on a novelagent, ABT-418, to be used in the treatment of ADHD. This holds some promise and appears to work through the nicotinic cholinergic system in a manner that is complimentary to the stimulants. Our group has also recently reported on experiences in the use of Donepizel. This is a medication which is an acetylcholinesterase inhibitor, and is approved for use in the treatment of Alzheimers. Based on clinical experience in cases of ADHD, the use of this medication, sometimes alone and sometimes in combination with stimulants, has improved patient focus and attention, and has diminished hyperactivity and impulsivity also offers the advantage of being a once a day medication. The main side effect, in my clinical experience, has been extreme nausea. However, this could be remedied if the medication is initiated at a low dose, and slowly titrated upwards. In addition to these novel approaches, there are currently a number of medications under study which are more specific inhibitors of neuropenethrine. These medications hold promise as do medications which may soon be approved in the United States as antidepressants. They include both Meclobmid, which is a reversible inhibitor of mono ameanoxydac A, as well as Reboxtenine, which is a highly specific inhibitor of norepinephrine. There are other medications of similar pharmacologic profiles with on-going clinical trials. In addition to these new compounds, we are learning more and more about the use of medications such as Bupropion, used in the treatment of both child and adult ADHD, both alone and in combination with stimulants. Furthermore, we are learning more about the combination of Guanfacine or Tenex, both alone and in combination with stimulants. As ADHD becomes more and more recognized, and we understand more of the neurobiology, as well as genityping sub-types of ADHD, we will hopefully be able to direct our pharmacotherapy in a more thoughtful manner .Until such technology is available in a clinical utility, we will continue to rely on the use of history taking and behavioral scales in order to assess the efficacy of these medications. This is a very exciting time to be involved in this work as we are developing many new approaches which offer much help to our patients. Become a member to receive our newsletter.
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