Attention-deficit hyperactivity disorder medical therapy

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Attention-deficit hyperactivity disorder Microchapters


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Differentiating Attention-Deficit Hyperactivity Disorder from other Diseases

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Brain Stimulation Therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2], Haleigh Williams, B.S.


The mainstay of therapy for ADHD is the administration of such stimulants as Ritalin and Adderall. While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Other treatment options include psychotherapy, education and training, or a combination of therapies.[1]

Measurement-based care may help[2].

Medical Therapy

Several different types of medications may be prescribed to mitigate the symptoms associated with ADHD.

  • Stimulants, such as Methylphenidate (Ritalin) and amphetamine salts (dextroamphetamine and amphetamine; Adderall), are used to increase the patient’s supply of the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention.[1] Ritalin is safe and effective in preschool-aged children suffering from ADHD so long as they are closely monitored while taking the drug.[3]
  • Lisdexamfetamine is a prodrug of dextroamphetamine. It may be dosed once a day and is less likely to be abused.
  • Atomoxetine (Strattera) is a selective norepinepherine reuptake inhibitor (SNRI) approved for the management of ADHD. It is effective in adult ADHD and is often favored due to lack of abuse potential[4]. Atomoxetine carries a black box warning as there is an increase risk of suicidal ideation in adolescents[5]. While it is non-inferior to methylphenidate in children, its adverse effects in children and adolescents render it a less favorable treatment option.[6]
  • Non-stimulants such as extended release Guanfacine and Clonidine (both alpha-2 adrenergic agonists) are also used to treat ADHD[7].
  • Other drugs, including anti-depressants, may also be prescribed in cases of ADHD depending on the patient’s co-morbidities.[1]
Pharmacotherapy of adult ADHD
Standard mean difference (SMD)* for
patient-reported symptoms
Discontinuation ratio
Amphetamines (dexamphetamine, lisdexamfetamine, mixed amphetamine salts)[8] -0.51 (95% CI -0.75 to -0.28) 2.69
Bupropion[9] -0.50 (95% CI -0.86 to -0.15) 1.20
* Interpretation of standard mean difference (SMD):
0.2 represents a small effect
0.5 a moderate effect
0.8 a large effect


  1. 1.0 1.1 1.2 National Institute of Mental Health (NIH). (2016). "Attention Deficit Hyperactivity Disorder."
  2. Bickman L, Kelley SD, Breda C, de Andrade AR, Riemer M (2011). "Effects of routine feedback to clinicians on mental health outcomes of youths: results of a randomized trial". Psychiatr Serv. 62 (12): 1423–9. doi:10.1176/ PMID 22193788.
  3. Riddle MA, Yershova K, Lazzaretto D, Paykina N, Yenokyan G, Greenhill L; et al. (2013). "The Preschool Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS) 6-year follow-up". J Am Acad Child Adolesc Psychiatry. 52 (3): 264–278.e2. doi:10.1016/j.jaac.2012.12.007. PMC 3660093. PMID 23452683. Review in: Evid Based Ment Health. 2013 Aug;16(3):63
  4. Garnock-Jones KP, Keating GM (2009). "Atomoxetine: a review of its use in attention-deficit hyperactivity disorder in children and adolescents". Paediatr Drugs. 11 (3): 203–26. doi:10.2165/00148581-200911030-00005. PMID 19445548.
  5. Barry, Colleen (01/21/2014). [ "ADHD Medication Use Following FDA Risk Warnings"] Check |url= value (help). NIH. Retrieved 06/12/2018. Check date values in: |access-date=, |date= (help)
  6. Michelson D, Adler L, Spencer T, Reimherr FW, West SA, Allen AJ, Kelsey D, Wernicke J, Dietrich A, Milton D (2003). "Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies". Biol. Psychiatry. 53 (2): 112–20. PMID 12547466.
  7. Southammakosane, Cathy (August 2015). [ "Pediatric Psychopharmacology for Treatment of ADHD, Depression, and Anxiety"] Check |url= value (help). AAP. Retrieved 06/12/18. Check date values in: |access-date= (help)
  8. Castells X, Blanco-Silvente L, Cunill R (2018). "Amphetamines for attention deficit hyperactivity disorder (ADHD) in adults". Cochrane Database Syst Rev. 8: CD007813. doi:10.1002/14651858.CD007813.pub3. PMC 6513464 Check |pmc= value (help). PMID 30091808.
  9. Verbeeck W, Bekkering GE, Van den Noortgate W, Kramers C (2017). "Bupropion for attention deficit hyperactivity disorder (ADHD) in adults". Cochrane Database Syst Rev. 10: CD009504. doi:10.1002/14651858.CD009504.pub2. PMC 6485546. PMID 28965364.

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