Comprehensive study highlights effectiveness and limitations of ADHD treatments in adults

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Comprehensive study highlights effectiveness and limitations of ADHD treatments in adults
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Findings indicate stimulants and atomoxetine effectively reduce ADHD symptoms, though non-pharmacological therapies show potential for long-term efficacy.

By Tarun Sai LomteReviewed by Danielle Ellis, B.Sc.Dec 20 2024 Stimulants and atomoxetine emerge as most effective for core symptoms, but non-pharmacological therapies show promise in specific contexts and long-term data remains limited

Both pharmacological and non-pharmacological interventions are available for ADHD. Guidelines from the United Kingdom’s National Institute for Health and Care Excellence recommend non-pharmacological support if patients prefer it, medications are ineffective or poorly tolerated, or adherence to medicines is difficult. Given the concerns about the safety of ADHD medicines, gaining insights into the safety and efficacy of available ADHD interventions in adults is crucial.

Acceptability was defined as an all-cause discontinuation rate. Effect sizes were estimated from pairwise meta-analyses and network meta-analyses using odds ratios for dichotomous outcomes and standardized mean differences for continuous outcomes. Secondary symptoms were ADHD core symptom severity at around 26 weeks and 52 weeks, tolerability, emotional dysregulation, quality of life, and executive dysfunction.

Twenty-four RCTs compared active interventions, 16 of which did not include control conditions. No RCT on non-pharmacological interventions provided evidence that subjects were ineligible for pharmacological intervention. The team found that stimulants and atomoxetine were better than placebo in reducing the core symptoms of ADHD at around 12 weeks on both self- and clinician-rated scales.

When analyses were restricted to RCTs with a low risk of bias, bupropion, stimulants, and atomoxetine were more efficacious than placebo in reducing self-reported symptoms; atomoxetine was also less acceptable than placebo.

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