The most effective treatment for adult ADHD identified

Of all the currently available pharmacological and non-pharmacological treatments for attention-deficit and hyperactivity disorder,ADHD) For adults, stimulants only; atomoxetine Results from a large comprehensive meta-analysis showed that it is effective in reducing core symptoms.

A study of 113 randomized controlled trials involving approximately 15,000 adults with a formal diagnosis of ADHD also found consistent results regarding poor patient acceptance of atomoxetine and the effectiveness of non-pharmacological strategies. It became clear that there was no.

The researchers noted that data on the long-term effectiveness of ADHD treatments is lacking, so these results apply only to short-term effectiveness.

“There is a lot of debate about pharmacotherapy, so these are very encouraging data and certainly support the role of pharmacotherapy as a treatment for ADHD,” said study researchers at the University of Southampton in Southampton, UK. said Samuel Cortese, MD, PhD. The research results were announced at a press conference hosted by the UK Science Media Centre.

The results also point to “a possible role for non-pharmacological interventions, which is not yet well established in current guidelines.” However, better evidence is needed to fully understand the precise effects of these non-pharmacological interventions,” Cortese said.

The study was published online on December 17th. lancet psychiatry.

fill the knowledge gap

Once thought to be a childhood-only disorder, ADHD is now well known to persist into adulthood, affecting approximately 2.5% of the general adult population worldwide. The comparative benefits and harms of available interventions for ADHD in adults remain unclear.

To address this knowledge gap, researchers conducted a comprehensive systematic review and component network meta-analysis to compare a wide range of pharmacological and non-pharmacological treatments for adults with ADHD across several outcomes. did.

The researchers found that only stimulants and atomoxetine were superior to placebo in reducing core symptoms of ADHD at 12 weeks on self-report and clinician-report measures.

For stimulants, the standardized mean difference (SMD) for the self-report and clinician-report scales were 0.39 and 0.61, respectively. The corresponding SMDs for atomoxetine were 0.38 and 0.51.

There was no evidence that ADHD medications were superior to placebo in improving additional relevant outcomes such as quality of life.

Regarding non-drug interventions, cognitive behavioral therapy, cognitive remediation, mindfulness, psychoeducation, and transcranial direct current stimulation were superior to placebo only on clinician-reported measures, with SMDs of −1.35 and −1, respectively. They were 0.79, -0.77, and -0.78. .

However, the evidence for non-drug strategies is overall inconclusive, with “results inconsistent across assessor types and based on a small body of evidence,” the authors write in their paper.

And they said evidence of long-term effectiveness (beyond 12 weeks) of ADHD interventions is “limited and understudied.”

In terms of acceptability, all strategies except atomoxetine and placebo were similar to placebo. Guanfacine It was less well tolerated than placebo.

“It's very important to emphasize that we're focusing on average effects, not on the individual level,” lead author Edoardo Ostinelli, MD, from the University of Oxford, UK, said at a briefing. “Therefore, recommendations cannot be made at the individual level. Studies with data from individual participants are needed so that treatment can be individualized.”

Cortese said the information gleaned from this analysis could be particularly important for “psychoeducation” of patients before they actually begin a treatment plan. Patients often ask about non-pharmacological interventions, he said, and this study is “the best synthesis of data available to inform these discussions.”

experts give their opinions

In a statement from the UK Science Media Center, several experts commented on the results.

Celso Arango, MD, a psychiatrist at the Gregorio Maranhão General Hospital in Madrid, Spain, says, “Research on ADHD in adulthood, particularly research on mid-term (>12 weeks) and long-term treatment outcomes, is… There is clearly a shortage.” . Therefore, this finding applies only to short-term treatments. ”

Another strength of the study is that it was developed with input from people with ADHD, making it “highly relevant,” Arango added.

Dr. Katia Rubia, Professor of Cognitive Neuroscience at King's College London in London, UK, said the majority of studies available for analysis included pharmacological treatments, which should be taken into account when interpreting the results. He pointed out that it is important to do so.

“For example, when it comes to nerve stimulation, we only included 10 studies with highly heterogeneous stimulation methods,” Rubia said. “Therefore, the evidence regarding the effectiveness of neurostimulation is largely inconclusive and further research is needed to establish its effectiveness.”

Dr. Roy Cohen-Kadosh, professor of cognitive neuroscience at the University of Surrey in Guildford, UK, agreed. He said the study is a “valuable contribution to the literature” while highlighting “both the paucity of neurostimulation research and the limitations of exploring combination treatment approaches for ADHD.”

“New neurostimulation methods related to neuroplasticity (such as the one we have shown to be superior in children with ADHD) were not covered here, but they have shown promising and long-lasting effects. In contrast, research in adults remains relatively underdeveloped. Future research will need to be innovative, well-tolerated, and individualized to meet the unmet clinical needs of adults with ADHD. It is essential to place greater emphasis on sustainable neurostimulation approaches,” Kadosh added.

In the explanation of of lancet psychiatryDr David Coghill from the University of Melbourne in Melbourne, Australia, cautioned that the study results did not mean the potential benefits of non-pharmacological interventions should be ignored.

“Some non-drug treatments (e.g., cognitive behavioral therapy, cognitive remediation, mindfulness, psychoeducation, transcranial direct current stimulation) are comparable to, and in some cases better than, pharmacotherapy for clinician-assessed outcomes. also showed large effects, but did not show similar effects on self-reported outcomes. Therefore, these interventions are considered to be less robust than pharmacological treatments, which showed changes on both measurement types. ” he wrote.

This study received no commercial funding. Ostinelli received research and consulting fees from Angelini Pharma. Mr. Cortese received reimbursement for travel and accommodation costs in connection with lectures given for the Children and Youth Central Health Association, Canadian ADHD Alliance Resources, and the British Psychopharmacology Society. I received honoraria from MEDICE. He also chairs the European ADHD Guidelines Group. Arango, Rubia, and Kadosh had no relevant disclosures. Mr. Coghill has received honoraria from CCM Conecta, Takeda Pharmaceuticals, Novartis, Servier, and Medice.