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Ilipilla G, Arnold LE. The role of adrenergic neurotransmitter reuptake inhibitors in the ADHD armamentarium. Expert Opin Pharmacother 2024; 25:945-956. [PMID: 38900676 DOI: 10.1080/14656566.2024.2369197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Adrenergic neurotransmitter reuptake inhibitors are gaining attention in treatment for attention-deficit hyperactivity disorder (ADHD). Due to their effects on norepinephrine, dopamine, and serotonin neurotransmission, they benefit both ADHD and comorbid disorders and have some other advantages including longer duration of action and fewer adverse effects compared to stimulants. There is continued interest in these agents with novel mechanisms of action in treatment of ADHD. AREAS COVERED The authors conducted a PubMed literature search using the following key words: 'ADHD' AND 'adrenergic reuptake inhibitors' OR 'nonstimulants' OR 'atomoxetine' OR 'Viloxazine' OR 'Dasotraline' OR 'Centanafadine' OR 'PDC-1421' OR 'Reboxetine' OR 'Edivoxetine' OR 'Bupropion' OR 'Venlafaxine' OR 'Duloxetine.' They reviewed FDA fact sheets of available medications for safety/tolerability studies and reviewed published clinical studies of these medications for treatment of ADHD. EXPERT OPINION Adrenergic neurotransmitter reuptake inhibitors fit the diverse needs of children and adolescents with ADHD with 1) poor tolerability to stimulants (e.g. due to growth suppression, insomnia, rebound irritability, co-morbid depression, anxiety and tic disorders, substance abuse or diversion concerns), 2) cardiac risks, and/or 3) need for extended duration of action. Their differences in receptor affinities and modulating effects support the unique benefits of individual agents.
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Affiliation(s)
- Geeta Ilipilla
- Department of Psychiatry and Behavioral Health, Nationwide Childrens Hospital, Columbus, OH, USA
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Nisonger Center Clinical Trials Program, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Heal DJ, Smith SL. Prospects for new drugs to treat binge-eating disorder: Insights from psychopathology and neuropharmacology. J Psychopharmacol 2022; 36:680-703. [PMID: 34318734 PMCID: PMC9150143 DOI: 10.1177/02698811211032475] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Binge-eating disorder (BED) is a common psychiatric condition with adverse psychological and metabolic consequences. Lisdexamfetamine (LDX) is the only approved BED drug treatment. New drugs to treat BED are urgently needed. METHODS A comprehensive review of published psychopathological, pharmacological and clinical findings. RESULTS The evidence supports the hypothesis that BED is an impulse control disorder with similarities to ADHD, including responsiveness to catecholaminergic drugs, for example LDX and dasotraline. The target product profile (TPP) of the ideal BED drug combines treating the psychopathological drivers of the disorder with an independent weight-loss effect. Drugs with proven efficacy in BED have a common pharmacology; they potentiate central noradrenergic and dopaminergic neurotransmission. Because of the overlap between pharmacotherapy in attention deficit hyperactivity disorder (ADHD) and BED, drug-candidates from diverse pharmacological classes, which have already failed in ADHD would also be predicted to fail if tested in BED. The failure in BED trials of drugs with diverse pharmacological mechanisms indicates many possible avenues for drug discovery can probably be discounted. CONCLUSIONS (1) The efficacy of drugs for BED is dependent on reducing its core psychopathologies of impulsivity, compulsivity and perseveration and by increasing cognitive control of eating. (2) The analysis revealed a large number of pharmacological mechanisms are unlikely to be productive in the search for effective new BED drugs. (3) The most promising areas for new treatments for BED are drugs, which augment noradrenergic and dopaminergic neurotransmission and/or those which are effective in ADHD.
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Affiliation(s)
- David J Heal
- David J Heal, DevelRx Ltd, BioCity, Nottingham, NG1 1GF, UK.
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Choi CH, Lee J, Lee KH, Hong SB, Kim SH, Han JY, Kim JW, Cho SC, Kim JW. Effects of Antidepressant Treatment on Symptom Measures of Attention in Adolescents with Depression: A Preliminary Open-Label Study. J Child Adolesc Psychopharmacol 2021; 31:288-293. [PMID: 33417814 DOI: 10.1089/cap.2020.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: The effects of selective serotonin reuptake inhibitor (SSRI) on deficits in attention and executive function in adolescents with major depressive disorder (MDD) are relatively unknown. We aimed to investigate changes in symptom measures of attention in adolescents with MDD treated with escitalopram. Methods: The study included 82 MDD adolescents and 54 healthy controls aged from 12 to 17 years. Symptom measures of attention were assessed using the Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS) and Child Behavior Checklist attention problems scale at baseline and during week 8. Adolescents who showed at least 40% improvement in the Children's Depression Rating Scale-Revised (CDRS-R) scores from baseline to week 8 were referred to as "responders." Results: No baseline differences were found between the responders (n = 47) and nonresponders (n = 35) in their age, sex, intelligence quotient, CDRS-R score, and attention measures. Linear mixed models showed significant group-by-time interaction effect in the ADHD-RS inattention subscale score, but not in the other attention measures. Conclusion: Our results suggest that treating depressive symptoms with SSRI may lead to improvements in attention in MDD adolescents. Monitoring changes in symptom measures of attention can be useful when treating adolescents with MDD. ClinicalTrials.gov identifier: NCT03547219.
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Affiliation(s)
- Chi-Hyun Choi
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jung Lee
- Integrative Care Hub, Seoul National University Children's Hospital, Seoul, Korea
| | - Kyung Hwa Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Soon-Beom Hong
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Seong-Hae Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Ji-Youn Han
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Jun Won Kim
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Soo Churl Cho
- Department of Psychiatry, Armed Forces Capital Hospital, Seongnam-si, Korea
| | - Jae-Won Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
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Naguy A, Alamiri B. Probable Bupropion-Related QTc Prolongation in an Adolescent With Major Depressive Disorder. Am J Ther 2020; 29:e124-e126. [DOI: 10.1097/mjt.0000000000001216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zaso MJ, Park A, Antshel KM. Treatments for Adolescents With Comorbid ADHD and Substance Use Disorder: A Systematic Review. J Atten Disord 2020; 24:1215-1226. [PMID: 25655767 PMCID: PMC4666815 DOI: 10.1177/1087054715569280] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Comorbid ADHD and substance use disorder (SUD) presents frequently in adolescence, a developmental period that may promote the emergence of substance misuse among individuals with ADHD. Comorbid ADHD and SUD in adolescence results in significant and unique treatment challenges, necessitating examination into effective interventions. Method: This systematic review examined existing research into the treatment of comorbid adolescent ADHD and SUD. Results: Findings from a small number of pharmacological intervention studies suggest potential efficacy of extended-release stimulant and nonstimulant medications. Efficacy of psychotherapeutic interventions has not been systematically examined. Conclusion: Current research on treatments for comorbid ADHD and SUD in adolescence is limited. Future placebo-controlled clinical trials using large samples are needed to examine the efficacy of psychotherapeutic interventions, the heightened risk of prescription stimulant misuse, and the long-term maintenance of treatment gains in this population. Clinical guidelines for the treatment of comorbid ADHD and SUD are discussed.
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Affiliation(s)
- Michelle J. Zaso
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Aesoon Park
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Kevin M. Antshel
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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Pitton Rissardo J, Fornari Caprara A. Bupropion-associated movement disorders: A systematic review. ANNALS OF MOVEMENT DISORDERS 2020. [DOI: 10.4103/aomd.aomd_35_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kweon K, Kim HW. Effectiveness and Safety of Bupropion in Children and Adolescents with Depressive Disorders: A Retrospective Chart Review. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:537-541. [PMID: 31671492 PMCID: PMC6852678 DOI: 10.9758/cpn.2019.17.4.537] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/12/2018] [Accepted: 08/14/2018] [Indexed: 11/18/2022]
Abstract
Objective This study aimed to investigate the effectiveness and safety of bupropion extended-release for the treatment of depressive disorder in children and adolescents. Methods This was a 12-week, retrospective chart review of bupropion, which included 127 youth (age, 15.3 ± 2.3 years; 66 boys) with depressive disorders (105 with major depressive disorder, 14 with dysthymia, 11 with adjustment disorder with depressed mood, and seven with depressive disorder not otherwise specified). Illness severity at baseline and at the 4th, 8th, and 12th weeks was retrospectively scored using the Clinical Global Impressions-Depression-Severity (CGI-Depression-S) and/or Clinical Global Impressions-Depression-Improvement (CGI-Depression-I). Results The mean dose of bupropion was 180.0 ± 52.6 (range, 75–300) mg/day and the mean duration 33.9 ± 53.1 (range, 7–295) weeks. The CGI-Depression-S scores were significantly decreased over 12 weeks (F = 132.125, p < 0.001, partial η2 = 0.508). Fifty-eight subjects (45.7%) were determined to be responders at 12 weeks (defined by a CGI-Depression-I score ≤ 2). Forty-six patients (36.2%) discontinued bupropion before the 12 weeks (19 due to adverse events, 15 due to poor effectiveness, three due to referral to other clinics, and nine due to follow-up loss for unknown reasons). Overall, bupropion was well tolerated. The most common adverse event was irritability (n = 12, 9.4%), which resolved spontaneously in eight subjects or after drug discontinuation in four subjects. Conclusion Our results provide preliminary evidence of the effectiveness and safety of bupropion in children and adolescents with depressive episodes. Large, prospective, placebo-controlled studies are needed to confirm these findings.
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Affiliation(s)
- Kukju Kweon
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyo-Won Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Naguy A. Psychopharmacotherapy of Attention Deficit-Hyperactivity Disorder in Children with Comorbid Conditions. Pediatr Neurol 2018; 82:7-12. [PMID: 29678368 DOI: 10.1016/j.pediatrneurol.2017.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 12/22/2022]
Abstract
One or more comorbidities occur in up to 80% of children with attention deficit-hyperactivity disorder. Attention deficit-hyperactivity disorder is also over-represented in several special populations. Pharmacotherapy can be challenging in these individuals with other conditions due to a suboptimal therapeutic response and an increased likelihood of adverse reactions. This article reviews the evidence supporting the psychopharmacologic management attention deficit-hyperactivity disorder when it occurs in individuals with common comorbidities.
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Affiliation(s)
- Ahmed Naguy
- Al-Manara CAP Centre, Kuwait Centre for Mental Health (KCMH), Shuwaikh, Kuwait.
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Verbeeck W, Bekkering GE, Van den Noortgate W, Kramers C. Bupropion for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev 2017; 10:CD009504. [PMID: 28965364 PMCID: PMC6485546 DOI: 10.1002/14651858.cd009504.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a prevalent neurobiological condition, characterised by behavioral and cognitive symptoms such as inattention, impulsivity and/or excessive activity. The syndrome is commonly accompanied by psychiatric comorbidities and is associated with educational and occupational underachievement.Although psychostimulant medications are the mainstay of treatment for ADHD, not all adults respond optimally to, or can tolerate, these medicines. Thus, alternative non-stimulant treatment approaches for ADHD have been explored. One of these alternatives is bupropion, an aminoketone antidepressant and non-competitive antagonism of nicotinic acetylcholine receptors. Bupropion is registered for the treatment of depression and smoking cessation, but is also used off-label to treat ADHD. OBJECTIVES To assess the effects and safety of bupropion for the treatment of adults with ADHD. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and seven other databases in February 2017. We also searched three trials registers and three online theses portals. In addition, we checked references of included studies and contacted study authors to identify potentially relevant studies that were missed by our search. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that evaluated the effects (including adverse effects) of bupropion compared to placebo in adults with ADHD. DATA COLLECTION AND ANALYSIS Two review authors (WV, GB) independently screened records and extracted data using a data extraction sheet that we tested in a pilot study. We extracted all relevant data on study characteristics and results. We assessed risks of bias using the Cochrane 'Risk of bias' tool, and assessed the overall quality of evidence using the GRADE approach. We used a fixed-effect model to pool the results across studies. MAIN RESULTS We included six studies with a total of 438 participants. Five studies were conducted in the USA, and one in Iran. All studies evaluated a long-acting version of bupropion, with the dosage ranging from 150 mg up to 450 mg daily. Study intervention length varied from six to 10 weeks. Four studies explicitly excluded participants with psychiatric comorbidity and one study included only participants with opioid dependency. Four studies were funded by industry, but the impact of this on study results is unknown. Two studies were publicly funded and in one of these studies, the lead author was a consultant for several pharmaceutical companies and also received investigator-driven funding from two companies, however none of these companies manufacture bupropion. We judged none of the studies to be free of bias because for most risk of bias domains the study reports failed to provide sufficient details. Using the GRADE approach, we rated the overall quality of evidence as low. We downgraded the quality of the evidence because of serious risk of bias and serious imprecision due to small sample sizes.We found low-quality evidence that bupropion decreased the severity of ADHD symptoms (standardised mean difference -0.50, 95% confidence interval (CI) -0.86 to -0.15, 3 studies, 129 participants), and increased the proportion of participants achieving clinical improvement (risk ratio (RR) 1.50, 95% CI 1.13 to 1.99, 4 studies, 315 participants), and reporting an improvement on the Clinical Global Impression - Improvement scale (RR 1.78, 95% CI 1.27 to 2.50, 5 studies, 337 participants). There was low-quality evidence that the proportion of participants who withdrew due to any adverse effect was similar in the bupropion and placebo groups (RR 1.20, 95% CI 0.35 to 4.10, 3 studies, 253 participants). The results were very similar when using a random-effects model and when we analysed only studies that excluded participants with a psychiatric comorbidity. AUTHORS' CONCLUSIONS The findings of this review, which compared bupropion to placebo for adult ADHD, indicate a possible benefit of bupropion. We found low-quality evidence that bupropion decreased the severity of ADHD symptoms and moderately increased the proportion of participants achieving a significant clinical improvement in ADHD symptoms. Furthermore, we found low-quality evidence that the tolerability of bupropion is similar to that of placebo. In the pharmacological treatment of adults with ADHD, extended- or sustained-release bupropion may be an alternative to stimulants. The low-quality evidence indicates uncertainty with respect to the pooled effect estimates. Further research is very likely to change these estimates. More research is needed to reach more definite conclusions as well as clarifying the optimal target population for this medicine. Treatment response remains to be reported in a DSM5-diagnosed population. There is also a lack of knowledge on long-term outcomes.
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Affiliation(s)
- Wim Verbeeck
- Centrum ADHD/ASS, GGZ Vincent van Gogh Instituut Venray, Noordsingel 39, Venray, Netherlands, 5801 GJ
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Ng QX. A Systematic Review of the Use of Bupropion for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. J Child Adolesc Psychopharmacol 2017; 27:112-116. [PMID: 27813651 DOI: 10.1089/cap.2016.0124] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neuropsychiatric disorders of childhood and adolescence. Stimulants are usually the first choice of drug; however, as many as 20% of patients do not respond to them. Stimulants may also worsen comorbid sleep, mood, and anxiety disorders, and they are associated with problems of misuse and diversion. Bupropion, a dopamine and norepinephrine reuptake inhibitor, is a promising nonstimulant alternative with reports of positive outcomes for ADHD management in both adolescent and adult populations. This study systematically reviews clinical trials on the subject. METHODS Using the keywords bupropion or Wellbutrin or Zyban or Elontril and attention deficit hyperactivity disorder or ADHD or ADDH, a preliminary search on the PubMed and Ovid databases yielded 25,455 articles published in English between January 1, 1988 and May 1, 2016. Of these, there were only six articles on clinical trials involving children. Full articles were also reviewed for references of interest. RESULTS All available open, controlled, and randomized trials demonstrated bupropion's efficacy in improving ADHD symptoms. The three head-to-head trials found that bupropion had efficacy comparable to methylphenidate (p > 0.05). However, a large double-blind, placebo-controlled multicenter study of bupropion found smaller effect sizes for bupropion, as quantified using teacher and parent ratings of ADHD symptoms, than methylphenidate. In terms of tolerability, a head-to-head trial found that headache was observed more frequently in the methylphenidate-treated group than in the bupropion-treated group, whereas the frequency of other side effects did not differ significantly. CONCLUSION Current findings should be interpreted with caution because of the very limited database. Bupropion should be considered for pharmacological management of childhood and adolescent ADHD, but more randomized controlled trials with larger sample sizes are warranted. There is also some evidence of its benefits in children with comorbid ADHD and conduct, substance use, or depressive disorders.
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Affiliation(s)
- Qin Xiang Ng
- Yong Loo Lin School of Medicine, National University of Singapore , Singapore, Singapore
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Developmental Risk Relationships between ADHD and Depressive Disorders in Childhood. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Depression is a relatively common diagnosis in children and adolescents, and is associated with significant morbidity and suicidality in this population. Evidence-based treatment of the acute illness is imperative to try to prevent the development of treatment-resistant depression or other complications. In situations where response to acute treatment is inadequate, clinicians should first consider factors that may influence outcome, such as psychiatric or medical comorbidities, psychosocial stressors, and treatment noncompliance. Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for depression in children and adolescents. For treatment-resistant depression, a switch to an alternate SSRI is recommended before trials of other antidepressants. Psychotherapy, such as cognitive behavioral therapy or interpersonal therapy, may improve treatment response. More research is needed examining medication augmentation strategies for treatment-resistant depression in children and adolescents.
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Affiliation(s)
- Melissa DeFilippis
- Department of Child and Adolescent Psychiatry, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0188, USA,
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Abstract
The aim of this study was to review current epidemiological data on the use of antidepressants in co-prescription with other psychotropic drugs in children and adolescents, as well as available efficacy and safety information. A Medline search from inception until February 2012 was performed to identify epidemiological and clinical studies, reviews and reports containing potentially relevant information on polypharmacy with antidepressants in young people. There has been an increase in polypharmacy in children and adolescents involving antidepressants in recent years. Antidepressants have become one of the drug classes most frequently prescribed in combination and are commonly co-prescribed with stimulants and antipsychotics. Most information regarding efficacy and safety of polypharmacy patterns was provided by case series and open-label studies. Efficacy studies gave some support for the use of a combination of antidepressants and antipsychotics in the management of refractory obsessive-compulsive disorder and some residual symptoms in major depressive disorder. Even less empirical support was found for a combination of stimulants and antidepressants in co-morbid attention deficit hyperactivity disorder and mood or anxiety disorders. Adverse events were similar to those found with individual medication groups, with severe adverse events mostly reported by individual case reports. The use of polypharmacy with antidepressants has become a regular practice in clinical settings. Although there is still little efficacy and safety information, preliminary evidence points to the potential clinical usefulness of some polypharmacy patterns. Further research on patients with co-morbidities or more severe conditions is needed, in order to improve knowledge of this issue.
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Emotional processing modulates attentional capture of irrelevant sound input in adolescents. Int J Psychophysiol 2013; 88:40-6. [PMID: 23313604 DOI: 10.1016/j.ijpsycho.2013.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 12/30/2012] [Accepted: 01/02/2013] [Indexed: 11/23/2022]
Abstract
The main goal of this study was to investigate how emotional processing modulates the allocation of attention to irrelevant background sound events in adolescence. We examined the effect of viewing positively and negatively valenced video clips on components of event-related brain potentials (ERPs), while irrelevant sounds were presented to the ears. All sounds evoked the P1, N1, P2, and N2 components. The infrequent, randomly occurring novel environmental sounds evoked the P3a component in all trial types. The main finding was that the P3a component was larger in amplitude when evoked by salient, distracting background sound events when participants were watching negatively charged video clips, compared to when viewing of the positive or neutral video clips. The results suggest that the threshold for involuntary attention to the novel sounds was lowered during viewing of the negative movie contexts. This indicates a survival mechanism, which would be needed for more automatic processing of irrelevant sounds to monitor the unattended environment in situations perceived as more threatening.
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Shier AC, Reichenbacher T, Ghuman HS, Ghuman JK. Pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: clinical strategies. J Cent Nerv Syst Dis 2012; 5:1-17. [PMID: 23650474 PMCID: PMC3616598 DOI: 10.4137/jcnsd.s6691] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder of childhood that can result in significant functional impairment, and if not adequately treated can lead to impaired quality of life. Pharmacotherapy is considered the first-line treatment for ADHD in children and adolescents. We review both recent literature and seminal studies regarding the pharmacological treatment of ADHD in children and adolescents. There is ample evidence for the efficacy and safety of both stimulants and non-stimulants in the treatment of ADHD. We review important aspects of evaluation and assessment and discuss first-line pharmacological treatments and as well as when to consider using alternative pharmacological agents. Treatment approaches to manage frequently seen comorbid disorders with ADHD are also covered.
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De Sousa A, Kalra G. Drug therapy of attention deficit hyperactivity disorder: current trends. Mens Sana Monogr 2012; 10:45-69. [PMID: 22654382 PMCID: PMC3353606 DOI: 10.4103/0973-1229.87261] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 10/15/2011] [Accepted: 10/17/2011] [Indexed: 11/04/2022] Open
Abstract
Attention deficit hyperactivity disorder is a developmental disorder with an age onset prior to 7 years. Children with ADHD have significantly lower ability to focus and sustain attention and also score higher on impulsivity and hyperactivity. Stimulants, such as methylphenidate, have remained the mainstay of ADHD treatment for decades with evidence supporting their use. However, recent years have seen emergence of newer drugs and drug delivery systems, like osmotic release oral systems and transdermal patches, to mention a few. The use of nonstimulant drugs like atomoxetine and various other drugs, such as α-agonists, and a few antidepressants, being used in an off-label manner, have added to the pharmacotherapy of ADHD. This review discusses current trends in drug therapy of ADHD and highlights the promise pharmacogenomics may hold in the future.
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Affiliation(s)
- Avinash De Sousa
- Consultant Psychiatrist & Founder Trustee, Desousa Foundation, Carmel, 18, St. Francis Avenue, Off SV Road, Santacruz West, Mumbai-400 054, Maharashthra, India
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Abstract
This article reviews the assessment and treatment for depression in children and adolescents, emphasizing the implementation of evidence-based treatments into clinical care. Past trials of antidepressant medications are reviewed, as well as the clinical use of antidepressants and pharmacologic strategies for refractory illness or in the context of comorbid conditions. Clinicians who treat youth now have a body of empiric research to help guide treatment decisions; however, personalized treatment based on associated symptoms, comorbid conditions, contextual factors, and psychiatric history is essential. Further research is needed in the pharmacologic treatment of depressed youth, including expanding the study of non-SSRI antidepressants, augmentation and adjunctive strategies, and treatment in patients with comorbid conditions.
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Affiliation(s)
- Christine J Choe
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-8589, USA.
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Jafarinia M, Mohammadi MR, Modabbernia A, Ashrafi M, Khajavi D, Tabrizi M, Yadegari N, Akhondzadeh S. Bupropion versus methylphenidate in the treatment of children with attention-deficit/hyperactivity disorder: randomized double-blind study. Hum Psychopharmacol 2012; 27:411-8. [PMID: 22806822 DOI: 10.1002/hup.2242] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the safety and efficacy of bupropion with methylphenidate in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS In a 6-week randomized double-blind study, 44 patients with a DSM-IV-TR diagnosis of ADHD were randomly assigned to receive bupropion 100-150 mg/day (100 mg/day for <30 kg and 150 mg/day for >30 kg) or methylphenidate 20-30 mg/day. Symptoms were assessed using Teacher and Parent Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) at baseline and weeks 3 and 6. RESULTS Forty patients had at least one post-baseline measurement, and 38 patients completed the trial. No significant difference was found between the two groups on the Parent and Teacher ADHD-RS-IV scores ([F(1, 38) = 0.266, p = 0.609] and [F(1, 38) = 0.001, p = 0.972], respectively). By week 6, 18 patients (90%) in each group achieved response on the Parent scale (Fisher's exact test p-value = 1.0). With the Teacher ADHD-RS-IV used, eight (40%) patients in the bupropion group and 12 (60%) patients in the methylphenidate group achieved response by week 6 (χ(2) (1) = 1.600, p = 0.206). Headache was observed more frequently in the methylphenidate group. Frequency of other side effects was not significantly different between the two groups. CONCLUSIONS Bupropion has a comparable safety and efficacy profile with methylphenidate in children and adolescents with ADHD.
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Affiliation(s)
- Morteza Jafarinia
- Psychiatric Research Centre, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Maalouf FT, Brent DA. Child and adolescent depression intervention overview: what works, for whom and how well? Child Adolesc Psychiatr Clin N Am 2012; 21:299-312, viii. [PMID: 22537728 DOI: 10.1016/j.chc.2012.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors review the currently available evidence-based treatments of child and adolescent major depressive disorder. Medication monotherapy, namely with selective serotonin reuptake inhibitors, is supported by large clinical trials in adolescents. For mild to moderate depression, cognitive behavior therapy (CBT) and interpersonal therapy are reasonable options as monotherapies. There is also evidence that the combination of medication and CBT is superior to medication alone for accelerating the pace of treatment response and remission, despite some negative studies. Response, remission, and recurrence rates after acute treatment and during long-term follow-ups are also presented and discussed.
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Affiliation(s)
- Fadi T Maalouf
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon.
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21
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Wilens TE, Morrison NR, Prince J. An update on the pharmacotherapy of attention-deficit/hyperactivity disorder in adults. Expert Rev Neurother 2012; 11:1443-65. [PMID: 21955201 DOI: 10.1586/ern.11.137] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adults with attention-deficit/hyperactivity disorder (ADHD) are more frequently presenting for diagnosis and treatment. Medication is considered to be appropriate among available treatments for ADHD; however, the evidence supporting the use of pharmacotherapeutics for adults with ADHD remains less established. In this article, the effectiveness and dosing parameters of the various agents investigated for adult ADHD are reviewed. In adults with ADHD, short-term improvements in symptomatology have been documented through the use of stimulants and antidepressants. Studies suggest that methylphenidate and amphetamine maintained an immediate onset of action, whereas the ADHD response to the nonstimulants appeared to be delayed. At a group level, there appears to be some, albeit not entirely consistent, dose-dependent responses to amphetamine and methylphenidate. Generally speaking, variability in diagnostic criteria, dosing parameters and response rates between the various studies was considerable, and most studies were of a relatively short duration. The aggregate literature shows that the stimulants and catecholaminergic nonstimulants investigated had a clinically significant beneficial effect on treating ADHD in adults.
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Affiliation(s)
- Timothy E Wilens
- Clinical Research Program in Pediatric Psychopharmacology, Child Psychiatry Service, Massachusetts General Hospital, Boston, MA, USA.
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Abstract
The stimulants, amphetamine and methylphenidate, have long been the mainstay of attention-deficit hyperactivity disorder (ADHD) therapy. They are rapidly effective and are generally the first medications selected by physicians. In the development of alternative pharmacological approaches, drug candidates have been evaluated with a wide diversity of mechanisms. All of these developments have contributed real progress in the field, but there is still much room for improvement and unmet clinical need in ADHD pharmacotherapy. The availability of a wide range of compounds with a high degree of specificity for individual monoamines (dopamine and noradrenaline) and/or different pharmacological mechanisms has refined our understanding of the essential elements for optimum pharmacological effect in managing ADHD. In this chapter, we review the pharmacology of the different classes of drug used to treat ADHD and provide a neurochemical rationale, predominantly from the use of in vivo microdialysis experiments, to explain their relative efficacy and potential to elicit side effects. In addition, we will consider how predictions based on results from animal models translate into clinical outcomes. The treatment of ADHD is also described from the perspective of the physician. Finally, the new research development for drugs to treat ADHD is discussed.
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Affiliation(s)
- David J Heal
- RenaSci Consultancy Ltd, BioCity, Nottingham, NG1 1GF, UK,
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Maalouf FT, Atwi M, Brent DA. Treatment-resistant depression in adolescents: review and updates on clinical management. Depress Anxiety 2011; 28:946-54. [PMID: 21898710 DOI: 10.1002/da.20884] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 07/08/2011] [Accepted: 07/08/2011] [Indexed: 12/23/2022] Open
Abstract
Treatment-resistant depression (TRD) in adolescents is prevalent and impairing. We here review the definition, prevalence, clinical significance, risk factors, and management of TRD in adolescents. Risk factors associated with TRD include characteristics of depression (severity, level of hopelessness, and suicidal ideation), psychiatric and medical comorbidities, environmental factors (family conflict, maternal depression, and history of abuse), and pharmacokinetics and other biomarkers. Management options include review of the adequacy of the initial treatment, re-assessment for the above-noted factors that might predispose to treatment resistance, switching antidepressants, and augmentation with medication or psychotherapy. Other modalities, such as electroconvulsive therapy, vagal nerve stimulation, and repetitive transcranial magnetic stimulation, are also reviewed.
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Affiliation(s)
- Fadi T Maalouf
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon.
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Ahn JH, Patkar AA. Escitalopram for the treatment of major depressive disorder in youth. Expert Opin Pharmacother 2011; 12:2235-44. [DOI: 10.1517/14656566.2011.604632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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25
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Park JH, Kim BN, Kim JW, Kim JH, Son JW, Shin DW, Shin YM, Yang SJ, Yoo HK, Yoo HJ, Lee SI, Cheon KA, Hong HJ, Hwang JW. A Preliminary Study on the Development of Korean Medication Algorithm for Attention-Deficit Hyperactivity Disorder. Soa Chongsonyon Chongsin Uihak 2011. [DOI: 10.5765/jkacap.2011.22.1.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Although much debate continues about the prevalence of depressive disorders in prepubertal children, depression clearly is common in adolescents, increasing rapidly throughout the teen years. All physicians who work with young patients must to be able to recognize and treat these disorders. This article provides a brief overview of depressive disorders in children and adolescence, including their clinical presentation, prevalence, etiology, course, and prognosis. Psychopharmacological treatment options are reviewed in detail, including practical information for medication management including patient education, making the decision to treat with medication, selection of specific medications, strategies for nonresponsive patients, and decisions about stopping medication.
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Affiliation(s)
- Susan M Smiga
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA.
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Maalouf FT, Brent DA. Pharmacotherapy and psychotherapy of pediatric depression. Expert Opin Pharmacother 2011; 11:2129-40. [PMID: 20707755 DOI: 10.1517/14656566.2010.496451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Depressive disorders in children and adolescents are prevalent and impairing. Current available treatments of childhood depression have advanced over the years but still leave many patients with residual symptoms. AREAS COVERED IN THIS REVIEW We here review the pharmacotherapy and psychoptherapy of pediatric major depressive disorder. We conducted a Pubmed review on this topic covering the last 30 years. WHAT THE READER WILL GAIN The reader will learn about the current evidence on the efficacy and safety of the different pediatric depression treatment modalities. We review evidence-based treatments, namely cognitive behavioral therapy, interpersonal therapy, and antidepressant treatments. We critically review the extant clinical trials for these treatments, and discuss both antidepressants efficacy and adverse events, including risk for suicidal events. TAKE HOME MESSAGE Current treatments lead to a sustained response rate of up to 80% and a remission rate of 60% by 6 months, but we are in need of more personalized treatment to optimize treatment response. The identification of biomarkers of response may be the first step towards personalized treatment development.
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Affiliation(s)
- Fadi T Maalouf
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon.
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Abstract
Attention deficit/hyperactivity disorder (ADHD) is among the most common neurobehavioral disorders requiring treatment in children and adolescents. The disorder is often chronic, with prominent symptoms and impairment spanning into adulthood. It is often associated with co-occurring disorders, including disruptive, mood, anxiety, and substance abuse disorders. The diagnosis of ADHD is clinically established by review of symptoms and impairment. The biological underpinning of the disorder is supported by genetic, neuroimaging, neurochemistry, and neuropsychological data. All aspects of an individual's life need to be considered in the diagnosis and treatment of ADHD. Multimodal treatment includes educational, family, and individual support. Psychotherapy alone and in combination with medication is helpful for treating patients with ADHD and comorbid disorders. Pharmacotherapy, including stimulants, noradrenergic agents, α-agonists, and antidepressants, plays a fundamental role in the long-term management of ADHD.
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Affiliation(s)
- Timothy E Wilens
- Timothy E. Wilens, MD, Pediatric Psychopharmacology Unit, YAW 6A, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
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Quintero J, López-Muñoz F, Alamo C, Loro M, García-Campos N. Reboxetine for ADHD in children non-responders or with poor tolerance to methylphenidate: a prospective long-term open-label study. ACTA ACUST UNITED AC 2010; 2:107-13. [DOI: 10.1007/s12402-010-0027-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
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30
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Tao R, Emslie G, Mayes T. Pharmacotherapy for Pediatric Major Depression. Psychiatr Ann 2010. [DOI: 10.3928/00485713-20100330-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Marshall is a 6-year-old child who displayed significant symptoms of hyperactivity, impulsivity, defiance, and temper tantrums since 2 years of age. Marshall lives with his mother, a single parent, and two siblings, ages 4 and 1. His problematic behavior, defiance, and argumentativeness were significant problems at home for his mother, which often made her late to work in the morning. These behaviors were also problematic in the evenings at dinnertime and at bedtime not only for his mother but also for the whole family. Marshall was also having social problems at school including being increasingly shunned by other children because of his aggressiveness and impulsivity as well as being defiant and argumentative with his teachers.His mother initially sought out her pediatrician, who indicated that Marshall was too young for medication and that better discipline techniques were necessary. Medical workup at that point was unrevealing of any significant condition responsible for Marshall's behavior. Marshall's mother continued to pursue a psychiatric evaluation for Marshall, and a formal psychiatric evaluation revealed diagnoses of attention-deficit/hyperactivity disorder (ADHD), combined type, and oppositional defiant disorder (ODD). Paper and pencil instruments were used including the Swanson, Nolan, and Pelham (SNAP) form for assessing ADHD and ODD symptoms. On the form, both Marshall's mother and teacher indicated that he was significantly elevated in both ADHD and ODD symptom domains, and target symptoms were identified: hyperactivity, impulsivity, short attention span, difficulty with follow through, defiance, argumentativeness, tantrums, and the beginnings of aggressiveness.
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32
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Wigal SB. Efficacy and safety limitations of attention-deficit hyperactivity disorder pharmacotherapy in children and adults. CNS Drugs 2009; 23 Suppl 1:21-31. [PMID: 19621975 DOI: 10.2165/00023210-200923000-00004] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
There have been major advances in the treatment and understanding of attention-deficit hyperactivity disorder (ADHD) in the last decade. Among these are the availability of newer stimulant formulations, an appreciation of the combined effects of medication and behavioural therapies, and a better understanding of the neurobiology of the disorder in children (aged 6-12 years), adolescents and adults. This article focuses on the evaluation of the efficacy and safety profiles of medications used for the management of ADHD. In assessing the various medical treatments for ADHD, certain issues and analyses have become important to address. The diagnosis, characterization and quantification of ADHD symptoms are crucial to assessing treatment effectiveness. A standardized setting for measuring the severity of ADHD symptoms is the laboratory school protocol, which simulates a school environment with tightly controlled timing of measurements. This method has been adapted successfully to the adult workplace environment to help with the evaluation of adult ADHD symptoms. Statistical analyses, such as effect size and number needed to treat, may aid in the comparison and interpretation of ADHD study results. Although an objective approach to evaluating the efficacy and safety profiles of the available medications provides necessary details about the medical options, typical clinical decisions are often based on trial and error and may be individualized based on a patient's daily routine, comorbidities and risk factors. Stimulants remain the US FDA-approved medical treatment of choice for patients with ADHD and are associated with an exceptional response rate. Findings of the Multimodal Treatment of Children With ADHD study suggest that the combination of behavioural and medical therapy may benefit most patients. Nonstimulant agents, such as atomoxetine (FDA-approved), and several non-approved agents, bupropion, guanfacine and clonidine, may offer necessary alternatives to the stimulants. This is especially important for patients who have comorbidities that are contraindicated for stimulant use based on medical issues and/or risk for stimulant abuse. Typical psychiatric comorbidities in patients with ADHD include oppositional defiant disorder, conduct disorder, major depressive disorder, bipolar disorder, anxiety, substance abuse disorder, tic disorder, and Tourette's syndrome. Although relatively safe, both stimulants and atomoxetine have class-related warnings and contraindications and are associated with adverse effects that require consideration when prescribing. Polypharmacy is a common psychiatric approach to address multiple symptoms or emergent adverse effects of necessary treatments. Future research may provide an improved understanding of polypharmacy and better characterization of the factors that influence the diagnosis and successful treatment of patients with ADHD.
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Affiliation(s)
- Sharon B Wigal
- Child Development Center, University of California-Irvine, Irvine, California 92162, USA
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Kratochvil CJ, May DE, Silva SG, Madaan V, Puumala SE, Curry JF, Walkup J, Kepley H, Vitiello B, March JS. Treatment response in depressed adolescents with and without co-morbid attention-deficit/hyperactivity disorder in the Treatment for Adolescents with Depression Study. J Child Adolesc Psychopharmacol 2009; 19:519-27. [PMID: 19877976 PMCID: PMC2830214 DOI: 10.1089/cap.2008.0143] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In the Treatment for Adolescents with Depression Study (TADS), fluoxetine (FLX) and the combination of fluoxetine with cognitive-behavioral therapy (COMB) had superior improvement trajectories compared to pill placebo (PBO), whereas cognitive-behavioral therapy (CBT) was not significantly different from PBO. Because attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD) frequently co-exist, we examined whether ADHD moderated these outcomes in TADS. METHOD A total of 439 adolescents with MDD, 12-17 years old, were randomized to FLX, CBT, COMB, or PBO. Random coefficients regression models examined depression improvement in 377 depressed youths without ADHD and 62 with ADHD, including 20 who were treated with a psychostimulant. RESULTS Within the ADHD group, the improvement trajectories of the three active treatments were similar, all with rates of improvement greater than PBO. For those without ADHD, only COMB had a rate of improvement that was superior to PBO. CONCLUSIONS Co-morbid ADHD moderated treatment of MDD. CBT alone or FLX alone may offer benefits similar to COMB in the treatment of MDD in youths with co-morbid MDD and ADHD, whereas monotherapy may not match the benefits of COMB for those without ADHD. The ADHD subgroup analysis presented in this paper is exploratory in nature because of the small number of youths with ADHD in the sample. CLINICAL TRIAL REGISTRY www.clinicaltrials.gov Identifier: NCT00006286. The TADS protocol and all of the TADS manuals are available on the Internet at https://trialweb.dcri.duke.edu/tads/index.html .
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Affiliation(s)
| | - Diane E. May
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Vishal Madaan
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska
| | - Susan E. Puumala
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska
| | - John F. Curry
- Duke University Medical Center, Durham, North Carolina
| | - John Walkup
- Johns Hopkins University, Baltimore, Maryland
| | - Hayden Kepley
- University of North Carolina at Wilmington, Wilmington, North Carolina
| | | | - John S. March
- Duke University Medical Center, Durham, North Carolina
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Greydanus DE, Nazeer A, Patel DR. Psychopharmacology of ADHD in pediatrics: current advances and issues. Neuropsychiatr Dis Treat 2009; 5:171-81. [PMID: 19557112 PMCID: PMC2695228 DOI: 10.2147/ndt.s4075] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral developmental disorder found in 3% to 8% of children and adolescents. An important part of ADHD management is psychopharmacology, which includes stimulants, norepinephrine reuptake inhibitors, alpha-2 agonists, and antidepressants. Medications with the best evidence-based support for ADHD management are the stimulants methylphenidate and amphetamine. A number of newer, long-acting stimulants are now available and a number of new medications are considered that are under current research.
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Affiliation(s)
- Donald E Greydanus
- Michigan State University College of Human Medicine, Michigan State University/Kalamazoo Center for Medical Studies, Kalamazoo, MI, USA
| | - Ahsan Nazeer
- Michigan State University College of Human Medicine, Michigan State University/Kalamazoo Center for Medical Studies, Kalamazoo, MI, USA
| | - Dilip R Patel
- Michigan State University College of Human Medicine, Michigan State University/Kalamazoo Center for Medical Studies, Kalamazoo, MI, USA
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35
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Affiliation(s)
- Stephen Lowis
- Department of Paediatric and Adolescent Oncology, Bristol Royal Hospital for Children, Bristol, UK.
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36
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Daviss WB. A review of co-morbid depression in pediatric ADHD: etiology, phenomenology, and treatment. J Child Adolesc Psychopharmacol 2008; 18:565-71. [PMID: 19108661 PMCID: PMC2699665 DOI: 10.1089/cap.2008.032] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This paper reviews the literature and highlights the need for further research regarding the phenomenology, etiology, assessment, and treatment of co-morbid depression in patients with attention-deficit/hyperactivity disorders (ADHD). Depression occurs in youths with ADHD at a significantly higher rate than in youths without ADHD. Youths with ADHD and depression together have a more severe course of psychopathology and a higher risk of long-term impairment and suicide than youths with either disorder alone. Assessment of such co-morbid depression is complicated by overlapping symptoms with ADHD and with other disorders that commonly occur with ADHD. Depressive disorders typically emerge several years after the onset of ADHD and may arise from environmental difficulties associated with chronic ADHD that interact with genetic risks as the child gets older. Despite a scarcity of well-designed treatment studies for youths with ADHD and co-morbid depression, there is increasing preliminary evidence for the role of stimulants, selective serotonergic reuptake inhibitors, bupropion, and atomoxetine to target either or both disorders. There is also some indirect evidence for the benefit of combining pharmacological treatments with psychosocial interventions that specifically target relevant environmental factors and functional impairments.
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Affiliation(s)
- W. Burleson Daviss
- Deparment of Psychiatry, University of Texas Science Center at San Antonio, San Antonio, Texas
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Waxmonsky J, Pelham WE, Gnagy E, Cummings MR, O'Connor B, Majumdar A, Verley J, Hoffman MT, Massetti GA, Burrows-MacLean L, Fabiano GA, Waschbusch DA, Chacko A, Arnold FW, Walker KS, Garefino AC, Robb JA. The efficacy and tolerability of methylphenidate and behavior modification in children with attention-deficit/hyperactivity disorder and severe mood dysregulation. J Child Adolesc Psychopharmacol 2008; 18:573-88. [PMID: 19108662 PMCID: PMC2680095 DOI: 10.1089/cap.2008.065] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study examines the tolerability and efficacy of methylphenidate (MPH) and behavior modification therapy (BMOD) in children with attention-deficity/hyperactivity disorder (ADHD) and severe mood dysregulation (SMD). METHODS Children (ages 5-12) from a summer program for ADHD were screened for SMD and additional manic-like symptoms using structured assessments and direct clinical interview with the Young Mania Rating Scale (YMRS). The SMD group was comprised of 33 subjects with SMD and elevated YMRS scores (mean = 23.7). They underwent weekly mood assessments plus the daily ADHD measures that are part of the program. The comparison group (n = 68) was comprised of the rest of the program participants. Using a crossover design, all subjects in both groups were treated with three varying intensities of BMOD (no, low, high) each lasting 3 weeks, with MPH dose (placebo, 0.15 mg/kg t.i.d., 0.3mg/kg t.i.d., and 0.6 mg/kg t.i.d.) varying daily within each behavioral treatment. RESULTS Groups had comparable ADHD symptoms at baseline, with the SMD group manifesting more oppositional defiant disorder/conduct disorder (ODD/CD) symptoms (p < 0.001). Both groups showed robust improvement in externalizing symptoms (p < 0.001). There was no evidence of differential treatment efficacy or tolerability. Treatment produced a 34% reduction in YMRS ratings in SMD subjects (p - 0.001). However, they still exhibited elevated YMRS ratings, more ODD/CD symptoms (p < 0.001), and were more likely to remain significantly impaired at home than non-SMD subjects (p < 0.05). CONCLUSIONS MPH and BMOD are tolerable and effective treatments for children with ADHD and SMD, but additional treatments may be needed to optimize their functioning.
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Affiliation(s)
- James Waxmonsky
- Department of Psychiatry, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York, USA.
| | - William E. Pelham
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Elizabeth Gnagy
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Michael R. Cummings
- Department of Psychiatry, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Briannon O'Connor
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Antara Majumdar
- Department of Biostatistics, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Jessica Verley
- Department of Psychiatry, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Martin T. Hoffman
- Department of Pediatrics, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Greta A. Massetti
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Lisa Burrows-MacLean
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Gregory A. Fabiano
- Department of Counseling, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Daniel A. Waschbusch
- Department of Pediatrics, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Anil Chacko
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Frances W. Arnold
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Kathryn S. Walker
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Allison C. Garefino
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Jessica A. Robb
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
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Treating adolescents for substance abuse and comorbid psychiatric disorders. SCIENCE & PRACTICE PERSPECTIVES 2008; 2:18-29. [PMID: 18552718 PMCID: PMC2851046 DOI: 10.1151/spp032118] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recent research has identified a cluster of standardized approaches that effectively treat adolescents with substance abuse disorders. Many of these approaches share elements that may be adopted to improve outcomes in substance treatment programs. In adolescents, treatment goals should be informed by a comprehensive assessment that includes the adolescent patient’s developmental history and evaluation of psychiatric comorbidity. Treatment for behavioral, psychosocial, and psychiatric problems should be integrated with substance abuse interventions. The author describes practical clinical guidelines, grounded in current research, for providing integrated treatment services. Special emphasis is given to strategies for integrating the treatment of comorbid psychiatric disorders with substance use disorders in adolescents.
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Abstract
As a general principle, separate treatments are often needed for attention-deficit/hyperactivity disorder (ADHD) and comorbid psychiatric disorders. There are few treatments for mood disorders that also treat ADHD, and vice versa. This discussion will review the literature on agents that are effective for both disorders, or that may potentially be combined. Physicians must bear in mind that none of these agents is approved by the Food and Drug Administration for the treatment of comorbid ADHD and depression.
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Attention-deficit/hyperactivity disorder in pediatric patients with epilepsy: review of pharmacological treatment. Epilepsy Behav 2008; 12:217-33. [PMID: 18065271 DOI: 10.1016/j.yebeh.2007.08.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 07/31/2007] [Accepted: 08/01/2007] [Indexed: 11/22/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) in children with epilepsy is a common source of impairment. Based on review of Medline indexed articles, meeting abstracts, and data requested from drug manufacturers, a summary of evidence that might guide treatment and research is presented. Methylphenidate (MPH) has shown high response rates and no increase in seizures in small trials. However, low baseline seizure rates, small numbers of subjects, and short observation periods limit the power of these studies to detect increases in seizure risk. Although longer-term effects of MPH and its effects in children with frequent seizures need to be studied, the evidence available at this time best supports use of MPH for the treatment of ADHD not amenable to changes in antiepileptic drugs or improvements in seizure control. This treatment should be part of a biopsychosocial approach. Other agents show promise. Preclinical, retrospective and open-label studies on amphetamines and atomoxetine support undertaking randomized controlled studies of these agents in patients with ADHD plus epilepsy. In contrast, additional data on guanfacine and modafinil should be gathered before undertaking randomized controlled studies with these agents.
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Tao R, Moore JK, Mayes TL, Emslie GJ. Depression in children and adolescents: optimizing treatment. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/17455111.1.2.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Depression is a severe and prevalent illness among children and adolescents. Recent controversies regarding antidepressant use among pediatric patients have left healthcare providers, particularly primary-care providers, feeling uncertain of how to approach the care of depressed pediatric patients. Several large-scale studies of the treatment of pediatric depression have been completed. In addition, substantial progress has been made in our understanding of benefit versus risk in the treatment of pediatric depression. This paper presents the most updated scientific evidence in pediatric depression treatment. The review covers a wide range of treatment modalities including psychotherapy, antidepressant and alternative remedies. Recommendations based on both the scientific evidence and the most current guidelines and treatment algorithms are outlined.
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Affiliation(s)
- Rongrong Tao
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| | - Jarrette K Moore
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| | - Taryn L Mayes
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
| | - Graham J Emslie
- University of Texas Southwestern Medical Center, Department of Psychiatry, MC 8589 5323 Harry Hines Blvd, Dallas, Texas 75390-8589, USA
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Wood JG, Crager JL, Delap CM, Heiskell KD. Beyond methylphenidate: nonstimulant medications for youth with ADHD. J Atten Disord 2007; 11:341-50. [PMID: 17932386 DOI: 10.1177/1087054707305968] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This review was conducted to provide information on nonstimulant medications used to treat ADHD. METHOD Previous investigations on several groups of nonstimulant medications were reviewed, and a discussion of antidepressants, antihypertensives, atypical antipsychotics, anticonvulsants, and cholinergic agents is included. RESULTS The results of this review provide information on several viable options of treatment in situations in which the use of a stimulant would be inappropriate or in situations in which stimulants have provided limited effectiveness. CONCLUSION Despite their viability as alternatives, each type of medication has certain limitations, side effects, and varying amounts of research available to substantiate its use for the treatment of ADHD. These medications offer several potentially successful options to those who fail to respond to stimulants or to those who find the side effects of stimulants bothersome.
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Affiliation(s)
- Jamie G Wood
- Department of Psychology and Counseling, Pittsburg State University, Pittsburg, KS 66762 USA.
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Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry 2007; 46:1503-26. [PMID: 18049300 DOI: 10.1097/chi.0b013e318145ae1c] [Citation(s) in RCA: 560] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice.
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Kim JW, Biederman J, Arbeitman L, Fagerness J, Doyle AE, Petty C, Perlis RH, Purcell S, Smoller JW, Faraone SV, Sklar P. Investigation of variation in SNAP-25 and ADHD and relationship to co-morbid major depressive disorder. Am J Med Genet B Neuropsychiatr Genet 2007; 144B:781-90. [PMID: 17455213 DOI: 10.1002/ajmg.b.30522] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Synaptosomal-associated protein of 25 kDa (SNAP-25), a protein involved in presynaptic neurotransmitter release, is a candidate gene for attention deficit/hyperactivity disorder (ADHD). Previous investigators have reported association initially with two single nucleotide polymorphisms (SNPs) (rs3746544, rs1051312) and their associated haplotypes. Subsequently, additional SNPs across the region were also reported to be associated with ADHD. We attempted to replicate these observations in a sample of 229 families with ADHD offspring by genotyping 61 SNPs spanning the region containing SNAP-25. A single SNP (rs3787283) which is in strong linkage disequilibrium (LD) with rs3746544 and rs1051312 (D' = 0.89-0.94) resulted in a nominally significant association (P = 0.002). When we pooled our data with those from prior studies, results were modestly significant for rs3746544 (P = 0.048) and rs6077690 (P = 0.031). As an attempt to determine if specific ADHD-related phenotypes may be more relevant to SNAP-25 than the categorical diagnosis, we carried out exploratory subgroup analysis in our ADHD sample according to co-morbid status. We found the strongest association result in the ADHD patients with co-morbid major depressive disorder (MDD). Six SNPs were nominally associated with the ADHD and co-morbid MDD cases (P = 0.012-0.045). Furthermore, a haplotype block located 11 kb 3' of the gene showed positive evidence for association with this phenotype (global P = 0.013). In conclusion, we report some evidence supporting the association of previously implicated SNPs (rs3746544, rs1051312) of SNAP-25 to ADHD. We further suggest that co-morbidity with MDD may enhance detection of the association between SNAP-25 and ADHD.
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Affiliation(s)
- J W Kim
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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45
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Singh MK, Pfeifer JC, Barzman DH, Kowatch RA, DelBello MP. Medical management of pediatric mood disorders. Pediatr Ann 2007; 36:552-63. [PMID: 17910203 DOI: 10.3928/0090-4481-20070901-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Manpreet K Singh
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, OH 45267-0559, USA
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46
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Hughes CW, Emslie GJ, Crismon ML, Posner K, Birmaher B, Ryan N, Jensen P, Curry J, Vitiello B, Lopez M, Shon SP, Pliszka SR, Trivedi MH. Texas Children's Medication Algorithm Project: update from Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry 2007; 46:667-686. [PMID: 17513980 DOI: 10.1097/chi.0b013e31804a859b] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To revise and update consensus guidelines for medication treatment algorithms for childhood major depressive disorder based on new scientific evidence and expert clinical consensus when evidence is lacking. METHOD A consensus conference was held January 13-14, 2005, that included academic clinicians and researchers, practicing clinicians, administrators, consumers, and families. The focus was to review, update, and incorporate the most current data to inform and recommend specific pharmacological approaches and clinical guidance for treatment of major depressive disorder in children and adolescents. RESULTS Consensually agreed on medication algorithms for major depression (with and without psychosis) and comorbid attention-deficit disorders were updated. These revised algorithms also incorporated approaches to address issues of suicidality, aggression, and irritability. Stages 1, 2, and 3 of the algorithm consist of selective serotonin reuptake inhibitor and norepinephrine serotonin reuptake inhibitor medications whose use is supported by controlled, acute clinical trials and clinical experience. Recent studies provide support that selective serotonin reuptake inhibitors in addition to fluoxetine are still encouraged as first-line interventions. The need for additional assessments, precautions, and monitoring is emphasized, as well as continuation and maintenance treatment. CONCLUSIONS Evidence and expert clinical consensus support the use of selected antidepressants in the treatment of depression in youths. The use of the recommended antidepressant medications requires appropriate monitoring of suicidality and potential adverse effects and consideration of other evidence-based treatment alternatives such as cognitive behavioral therapies.
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Affiliation(s)
- Carroll W Hughes
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio.
| | - Graham J Emslie
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio
| | - M Lynn Crismon
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio
| | - Kelly Posner
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio
| | - Boris Birmaher
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio
| | - Neal Ryan
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio
| | - Peter Jensen
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio
| | - John Curry
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio
| | - Benedetto Vitiello
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio
| | - Molly Lopez
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio
| | - Steve P Shon
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio
| | - Steven R Pliszka
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio
| | - Madhukar H Trivedi
- Drs. Hughes, Emslie, and Trivedi are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Dr. Crismon is with the College of Pharmacy, University of Texas at Austin; Dr. Posner is with Columbia University, New York; Drs. Birmaher and Ryan are with the Western Psychiatric Institute and Clinic, Pittsburgh; Dr. Jensen is with the Center for the Advancement of Children's Mental Health, Department of Psychiatry, Columbia University, and the Office of Mental Health, New York; Dr. Curry is with Duke University, Durham, NC; Dr. Vitiello is with the National Institute of Mental Health, Bethesda, MD; Drs. Lopez and Shon are with the Texas Department of State Health Services, Austin; and Dr. Pliszka is with the Department of Psychiatry, University of Texas Health Science Center at San Antonio
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Abstract
Approximately one-half of children medicated for attention-deficit hyperactivity disorder (ADHD) will continue to experience sufficient impairment during adolescence to warrant the continuation of their treatment; a smaller number of people with ADHD may require treatment for the first time during adolescence. The academic and social demands of adolescence can exaggerate the impairment caused by attentional problems, as adolescents, more so than children, have activities in the afternoon and evening that will tax their attentional abilities. Stimulant and nonstimulant medications are likely to be as effective for adolescent patients as they are for younger children, provided treatment adherence is satisfactory. Long-acting medications are preferred over immediate-release compounds as they provide better coverage of symptoms throughout the day. Patterns of comorbidity with ADHD change from childhood to adolescence and may require a shift in treatment strategy. The choice of time to discontinue treatment should be a decision shared by the clinician and the patient. A negotiated trial of time off treatment followed by a review of the patient's symptoms can avert premature discontinuation of treatment.
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Affiliation(s)
- Philip Hazell
- Thomas Walker Hospital (Rivendell) Child, Adolescent and Family Mental Health Service, Concord West, New South Wales, Australia.
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49
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Kunwar A, Dewan M, Faraone SV. Treating common psychiatric disorders associated with attention-deficit/hyperactivity disorder. Expert Opin Pharmacother 2007; 8:555-62. [PMID: 17376012 DOI: 10.1517/14656566.8.5.555] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) often occurs along with other psychiatric disorders, with estimated comorbidity rates of 50--90%. Comorbidity greatly influences presentation, diagnosis and prognosis, complicates treatment and significantly increases the morbidity and disease burden of ADHD. Commonly co-occurring psychiatric disorders are disruptive behavior disorder, anxiety, depression, bipolar disorder and substance use disorders. This article provides a brief review of effective strategies for treating the most common psychiatric disorders associated with ADHD. This paper also discusses knowledge gaps in the understanding of treatment of comorbid disorders associated with ADHD, and directions for future research.
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Affiliation(s)
- Arun Kunwar
- Department of Psychiatry, State University of New York--Upstate Medical University, Syracuse, NY 13210 USA
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Friedlander AH, Yagiela JA, Mahler ME, Rubin R. The pathophysiology, medical management and dental implications of adult attention-deficit/hyperactivity disorder. J Am Dent Assoc 2007; 138:475-82; quiz 535, 537. [PMID: 17403737 DOI: 10.14219/jada.archive.2007.0199] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Few published reports in the dental literature have focused on adult attention-deficit/hyperactivity disorder (ADHD) and its dental implications. TYPES OF STUDIES REVIEWED The authors conducted a MEDLINE search for the period 2000 through 2005 using the terms "adult" and "attention-deficit" to define ADHD's pathology, medical treatment and dental implications. RESULTS ADHD is a developmental condition that affects slightly more than 4 percent of the adult U.S. population. Its symptoms include inattention, hyperactivity and impulsivity that can cause personal, social, occupational and leisure-time dysfunction. Medications used to treat the disorder include stimulants, selective noradrenergic uptake inhibitors and tricyclic antidepressants. CLINICAL IMPLICATIONS The oral health of people with ADHD may be compromised by inattention and impulsivity that impair home care regimens and can lead to cigarette addiction, which may cause oral cancer and damage the periodontium, and excessive ingestion of caffeinated sugar-laden soft drinks that promote dental caries. To safely care for this patient population, dentists must be familiar with the stimulant and nonstimulant medications used to treat adult ADHD, because these drugs can cause adverse orofacial and systemic reactions and interact adversely with dental therapeutic agents.
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Affiliation(s)
- Arthur H Friedlander
- Graduate Medical Education, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
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