HelixTalk Episode #93 - Focusing in on ADHD Treatment

Date posted: March 26, 2019, 6:00 am

In this episode, we take a deep dive into the use of stimulants and other medications for management of ADHD. After decades of use, technology has resulted in changes to how they are administered. Furthermore new agents have become available, but are they an improvement?

---

Key Concepts

1. Changes in prevalence of ADHD do not appear to be due to overdiagnosis or regional factors but inconsistency in reporting between sources and difference in the diagnostic method used.
2. Despite the identification of alternate agents for management of ADHD symptoms, stimulants such as methylphenidate and amphetamine salts remain first line for most individuals. Tolerability may lead to methylphenidate being preferred in children and efficacy data may support amphetamines in adults. That being said, there are important considerations before starting a stimulant including the potential for growth suppression,  tachycardia, and elevations in blood pressure.
3. For those individuals who prefer to avoid (due to tic disorder or cardiac disease) or are unable to tolerate stimulant agents, alternatives include atomoxetine, clonidine, and guanfacine. Important counseling points include the potential for sedation instead of insomnia and the delay in response compared to the stimulants.

References

• Timeline of ADHD Prevalence, Medications, and Diagnostic Criteria from 1990s to Current. CDC. https://www.cdc.gov/ncbddd/adhd/documents/Timeline.pdf.
• Gautam M, Prabhakar D. Stimulant Formulations for the Treatment of Attention-Deficit/Hyperactivity Disorder. Prim Care Companion CNS Disord. 2018;20(6).
• Cortese S, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018; 5(9): 727–38.