Psychopharmacology of adults with attention-deficit/hyperactivity disorder

Although frequently unrecognized, as many as 4% of adults in the general population may have attention-deficit/hyperactivity disorder (ADHD). Increased public awareness is leading many adults to their family physician for treatment. While education about the disorder and specific counseling can be a great help, pharmacotherapy is the key to achieving control of the core symptoms of ADHD in most patients. This article reviews the available data for the pharmacologic treatment of adults with ADHD. Methylphenidate (MPH) is the most studied treatment for ADHD, with response rates exceeding 70% when dosed optimally. A similar response rate has been reported for dextroamphetamines. Both stimulants have a well-established safety profile from extensive experience in children, and are well tolerated in adults as well. The recently introduced extended-release stimulant formulations, OROS MPH and the mixed amphetamine salt Adderall XR, achieve symptom control for ≤12 hours following administration of a single dose. Promising preliminary results suggest that these formulations would be the treatment of choice for adults. The nonstimulant atomoxetine has also demonstrated efficacy in adults with ADHD and may be an appropriate alternative in patients unresponsive to stimulant therapy, or in whom substance abuse or tics are of concern. However, atomoxetine requires twice/day dosing in most adults and has a less well-proven efficacy and safety profile.