A practical, evidence-informed approach to managing stimulant-refractory Attention Deficit Hyperactivity Disorder (ADHD)
A practical, evidence-informed approach to managing stimulant-refractory Attention Deficit Hyperactivity Disorder (ADHD)
Stimulants (methylphenidate or amphetamines) are the recommended first-line option for the pharmacological treatment of individuals with attention deficit hyperactivity disorder (ADHD). However, some patients with ADHD will not respond optimally to stimulants. Here, we discuss strategies to manage stimulant-refractory ADHD, based on the recommendations advanced in clinical guidelines, knowledge of expert practice in the field, and our own clinical recommendations, informed by a comprehensive literature search in PubMed, PsycInfo, EMBASE + EMBASE classic, OVID Medline, and Web of Science (up to 30 March 2021). We first highlight the importance of stimulant optimization as an effective strategy to increase response. We then discuss a series of factors that should be considered before using alternative pharmacological strategies for ADHD, including poor adherence, time action properties of stimulants (and wearing-off of effects), poor tolerability (that prevents the use of higher, more effective doses), excessive focus on or confounding from presence of comorbid non-ADHD symptoms, and tolerance. Finally, we consider the role of non-stimulants and combined pharmacological approaches. While the choice of medication for ADHD is still to a large extent based on a trial-and-error process, there are reasonably accepted data and guidelines to aid in clinical decision-making. It is hoped that advances in precision psychiatry in the years ahead will further guide prescribers to tailor medication choice to the specific characteristics of the patient.
1035-1051
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Newcorn, Jeff
65719ded-1347-46bf-b849-43faea8b2723
Coghill, David
d7cba8fd-4fcb-48bc-9e92-5aff85a75b50
October 2021
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Newcorn, Jeff
65719ded-1347-46bf-b849-43faea8b2723
Coghill, David
d7cba8fd-4fcb-48bc-9e92-5aff85a75b50
Cortese, Samuele, Newcorn, Jeff and Coghill, David
(2021)
A practical, evidence-informed approach to managing stimulant-refractory Attention Deficit Hyperactivity Disorder (ADHD).
CNS drugs, 35 (10), .
(doi:10.1007/s40263-021-00848-3).
Abstract
Stimulants (methylphenidate or amphetamines) are the recommended first-line option for the pharmacological treatment of individuals with attention deficit hyperactivity disorder (ADHD). However, some patients with ADHD will not respond optimally to stimulants. Here, we discuss strategies to manage stimulant-refractory ADHD, based on the recommendations advanced in clinical guidelines, knowledge of expert practice in the field, and our own clinical recommendations, informed by a comprehensive literature search in PubMed, PsycInfo, EMBASE + EMBASE classic, OVID Medline, and Web of Science (up to 30 March 2021). We first highlight the importance of stimulant optimization as an effective strategy to increase response. We then discuss a series of factors that should be considered before using alternative pharmacological strategies for ADHD, including poor adherence, time action properties of stimulants (and wearing-off of effects), poor tolerability (that prevents the use of higher, more effective doses), excessive focus on or confounding from presence of comorbid non-ADHD symptoms, and tolerance. Finally, we consider the role of non-stimulants and combined pharmacological approaches. While the choice of medication for ADHD is still to a large extent based on a trial-and-error process, there are reasonably accepted data and guidelines to aid in clinical decision-making. It is hoped that advances in precision psychiatry in the years ahead will further guide prescribers to tailor medication choice to the specific characteristics of the patient.
Text
210504_Cortese et al._refractory_ADHD_latest
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Accepted/In Press date: 15 July 2021
e-pub ahead of print date: 17 August 2021
Published date: October 2021
Additional Information:
Funding Information:
SC declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non-profit associations: Association for Child and Adolescent Central Health (ACAMH), Canadian ADHD Alliance Resource (CADDRA), British Association of Pharmacology (BAP), and the Healthcare Convention for educational activity on ADHD. In the past year, JN has been an advisor and/or consultant for Adlon Therapeutics, Arbor, Cingulate Therapeutics, Corium, Eisai, Lundbeck, Medice, Myriad Neuroscience, NLS, OnDosis, Rhodes, Shire/Takeda, and Supernus. He has received research support from the National Institute on Drug Abuse (NIDA), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Adlon, Shire and Supernus. He also has received speaker fees from Shire/Takeda for disease-state presentations and has served as a consultant for the US National Football League. DC has received research support from the National Health and Medical Research Council (NHMRC) Australia, research support and/or honoraria from Shire/Takeda, Medice, and Servier, and royalties from Oxford University Press and Cambridge University Press.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG.
Identifiers
Local EPrints ID: 451131
URI: http://eprints.soton.ac.uk/id/eprint/451131
ISSN: 1172-7047
PURE UUID: 10774d48-34fe-478c-a5df-606e2687676d
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Date deposited: 14 Sep 2021 10:37
Last modified: 17 Mar 2024 06:48
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Author:
Jeff Newcorn
Author:
David Coghill
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