Pharmacotherapy of emotional dysregulation in adults with ADHD: a systematic review and meta-analysis
Pharmacotherapy of emotional dysregulation in adults with ADHD: a systematic review and meta-analysis
Emotional dysregulation (ED) is a dysfunction in modifying an emotional state in an adaptive and goal oriented way, with excitability, ease anger, and mood lability. It is present in up to 70% of adults with ADHD, regardless of other comorbidities, and substantially worsens the psychosocial outcomes of the disorder. Besides fronto-parietal circuits mediating top-down control, brain regions involved in bottom-up processes (e.g., amygdala, orbitofrontal cortex, and ventral striatum) are implicated in ED. We performed a systematic review/meta-analysis of double-blind randomized controlled trials of ADHD medications to assess their effects on ED in adults with ADHD. We searched an extensive set of databases, international trials registries, and contacted study authors/drug companies for unpublished data. We retained 21 trials. We found small-to-moderate effects (methylphenidate: SMD=0.34, 95% CI=0.23-0.45; atomoxetine: SMD=0.24, 95% CI=0.15-0.34; lisdexamfetamine: SMD=0.50, 95% CI=0.21-0.8). We suggest that, whilst ADHD medications are effective on ADHD core symptoms, they may be less effective on bottom-up mechanisms underlying ED. Further research on novel pharmacological and non-pharmacological strategies for ED in adults with ADHD is warranted.
Lenzi, Francesca
54a127b4-923a-4494-8ce8-43df979d7073
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Harris, Joseph
fdc48ceb-081f-4d6b-95c4-7c1f3ed7b047
Masi, Gabriele
e7db93b8-b7a7-4782-9106-82f28d2db0ca
Lenzi, Francesca
54a127b4-923a-4494-8ce8-43df979d7073
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Harris, Joseph
fdc48ceb-081f-4d6b-95c4-7c1f3ed7b047
Masi, Gabriele
e7db93b8-b7a7-4782-9106-82f28d2db0ca
Lenzi, Francesca, Cortese, Samuele, Harris, Joseph and Masi, Gabriele
(2017)
Pharmacotherapy of emotional dysregulation in adults with ADHD: a systematic review and meta-analysis.
Neuroscience & Biobehavioral Reviews.
(doi:10.1016/j.neubiorev.2017.08.010).
Abstract
Emotional dysregulation (ED) is a dysfunction in modifying an emotional state in an adaptive and goal oriented way, with excitability, ease anger, and mood lability. It is present in up to 70% of adults with ADHD, regardless of other comorbidities, and substantially worsens the psychosocial outcomes of the disorder. Besides fronto-parietal circuits mediating top-down control, brain regions involved in bottom-up processes (e.g., amygdala, orbitofrontal cortex, and ventral striatum) are implicated in ED. We performed a systematic review/meta-analysis of double-blind randomized controlled trials of ADHD medications to assess their effects on ED in adults with ADHD. We searched an extensive set of databases, international trials registries, and contacted study authors/drug companies for unpublished data. We retained 21 trials. We found small-to-moderate effects (methylphenidate: SMD=0.34, 95% CI=0.23-0.45; atomoxetine: SMD=0.24, 95% CI=0.15-0.34; lisdexamfetamine: SMD=0.50, 95% CI=0.21-0.8). We suggest that, whilst ADHD medications are effective on ADHD core symptoms, they may be less effective on bottom-up mechanisms underlying ED. Further research on novel pharmacological and non-pharmacological strategies for ED in adults with ADHD is warranted.
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Submitted date: 25 July 2017
Accepted/In Press date: 16 August 2017
e-pub ahead of print date: 26 August 2017
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Local EPrints ID: 414373
URI: http://eprints.soton.ac.uk/id/eprint/414373
ISSN: 0149-7634
PURE UUID: 760dee5a-09cf-4aed-9089-84dc7c084a32
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Date deposited: 27 Sep 2017 16:30
Last modified: 16 Mar 2024 05:44
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Author:
Francesca Lenzi
Author:
Joseph Harris
Author:
Gabriele Masi
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