Stimulants are more effective than placebo for ADHD, study finds

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Attention-deficit hyperactivity disorder (ADHD) was long thought to be a disorder that only affected children. But it is now well established that symptoms can persist into adulthood, and a large new study is evaluating which treatments are most effective at relieving symptoms. did.

Stimulants and atomoxetine (a type of antidepressant) placebo A study was published Tuesday in the journal ADHD that reduced core symptoms of ADHD over a 12-week period. lancet psychiatry. The core symptoms of neurodevelopmental disorders are inattention, hyperactivity and impulsivity, study author Dr. Samuele Cortese, professor of child and adolescent psychiatry at the University of Southampton, UK, said in a Tuesday interview hosted by the Science Media Center. He said this at a press conference.

Prior to conducting this study, Cortese and several other study authors had various types of consulting and research partnerships with pharmaceutical companies, including one that manufactures ADHD drugs. Some companies have However, the study found that affiliation did not influence any aspect of the study.

According to Harvard University's Center for Child Development, approximately 5% to 7% of children and 2.5% of adults worldwide have ADHD, which is caused by underdeveloped or impaired executive function and self-regulation skills, Cortese said. Then he said. These skills help people plan, focus their attention, remember instructions, multitask, and more. Symptoms of inattention, hyperactivity, and impulsivity mean that people with ADHD have difficulty staying organized, concentrating, managing time, and controlling impulses, which can affect all areas of life. may give.

Health care providers determine the diagnosis by evaluating whether symptoms are persistent, widespread, developmentally inappropriate, and interfere with the patient's daily activities. The disorder can also be accompanied by a variety of additional challenges, such as mental or physical conditions, social problems, and societal problems. High risk of early death.

“It's a serious condition. It's not easy,” said Cortese, who is also chair of the European ADHD Guidelines Group.

“If you look at it, Current guidelines In the UK, Cortese said, “drug therapy is recommended as the first choice'' for managing ADHD. It also mentions non-drug therapy when drug therapy is ineffective or poorly tolerated, but does not specify what type of non-drug therapy. They also mention possible combinations. ”

Prof. Cortese said there remains uncertainty about the best treatment for adults with ADHD, so he and the other authors wrote, The aim was to provide the latest and most comprehensive evidence. The study was conducted in collaboration with people with lived experience of ADHD, the authors said.

This study represents one of 113 published and unpublished randomized comparisons comparing various types of interventions with placebo or other controls for symptoms in a total of approximately 14,900 adult participants with a formal diagnosis of ADHD. A systematic review and meta-analysis of trials.

Over a short period of 12 weeks, only stimulants such as lisdexamfetamine and methylphenidate and atomoxetine produced better results than placebo as assessed by both clinicians and patients for symptom improvement.

There was a discrepancy between clinicians' opinions and patients' own opinions regarding the effectiveness of non-pharmacological treatments and placebos. cognitive behavioral therapy, cognitive remediationMindfulness, psychoeducation Transcranial direct current stimulation was also more effective than placebo in reducing patients' symptoms, but this result was only reported by clinicians.

Transcranial direct current stimulation This is a non-invasive and painless brain stimulation technique that uses low-intensity electrical current to stimulate specific parts of the brain.

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The authors found several other results, including that the medication was more likely to be discontinued due to adverse events than the placebo. Cortese says atomoxetine and stimulants are more effective than placebos for emotional dysregulation, which many people with ADHD experience. However, none of the treatments had a different effect than placebo on executive function and quality of life.

“This study uses a very sensible approach to pooling and contrasting different types of ADHD treatments, and there are some points to take away from this study.” said Dr. Philip Shaw, professor at the Institute of Psychology and Neuroscience. Statement to Science Media Center.

“First, this study shows that there are effective interventions for adults living with ADHD and looking for ways to reduce the undesirable effects of the condition,” said the author, who was not involved in the study. Mr. Shaw said. “The downside is that some drugs have nasty side effects, but that wasn't the case for the most widely used psychostimulants.”

The study also highlights “significant gaps in our knowledge,” he said.

Clinical psychologist Dr. Margaret Sibley, professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, said the study's limitations are due to deficiencies in the literature analyzed for the review and a lack of research on several factors. He said it was a thing. . Sibley was not involved in the study.

Most of the treatment trials included in the review lasted less than three months, so it's difficult to be sure how long the effects last, Shaw said. The authors also looked at results at 26 and 52 weeks, but were limited by insufficient data, said study author Eduardo G., senior research fellow and deputy director of the Oxford Institute for Precision Psychiatry at the University of Oxford.・Dr. Ostinelli said. Science Media Center information session.

However, “Non-drug treatments (like cognitive behavioral therapy) are not designed to alleviate the core symptoms of ADHD, although they may do so indirectly,” Sibley said in an email. “The aim is to teach coping skills to reduce the impact that symptoms have on people's lives. It is therefore important to note that the main findings of this review are whether coping skills for functional impairment or ADHD, or self-esteem, self-efficacy, autonomy, etc. If it had been a psychological variable, we might have gotten different results.”

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Differences in treatment effectiveness also likely come down to the fact that one size does not simply fit all, Ostinelli said.

Dr Alessio Berato, a lecturer in child and adolescent mental health at the University of Southampton who was not involved in the study, said some people with ADHD feel anxious about taking medication or experience unpleasant side effects. It is said that there are some.

“This review also points to continuing challenges in conducting ADHD research in adults,” Sibley added. “Everyone's self-perception of ADHD symptoms can be flawed to some degree. However, there is no 'objective' test that can accurately measure ADHD symptoms. A practical best practice is to use informant reports (i.e., loved one reports) in conjunction with self-reports when assessing ADHD in adults. ”

These reports are sometimes integrated with clinician reports to ultimately determine whether symptoms are present, but most treatment studies do not employ this strategy, and therefore research The results could be unclear, he added.

All things considered, best practices for adult ADHD treatment typically include both pharmacological and non-pharmacological care, as people with ADHD typically seek treatment in hopes of improving beyond their core symptoms. Sibley said. The study had no data on this combination, but it does “help people learn to control their ADHD and write their own instruction manual in building a life that works for them.” is possible.

The study reflects the need for more long-term research into different types and combinations of treatments, especially in adults, experts said.