ADHD in adults: drugs or psychotherapy?

Retain – Adhd adults: drugs psychotherapy?

• Stimulant class drugs as well as atomoxetine would be the only treatments to effectively reduce key symptoms of attention deficit with hyperactivity (ADHD) in adults, from both patients and caregivers.
• This is the result of a large network meta-analysis of pharmacological, psychological and neurostimulant interventions that have been published in Lancet Psychiatry.

Context – Adhd adults: drugs psychotherapy?

The relationship between profits and possible risks of the interventions available for ADHD in adults is not elucidated. Consequently, Researchers led by Eduardo Ostinelli. In addition, deputy director of theOxford Precision Psychiatry Lab At the University of Oxford therefore set out to fill this lack of knowledge by analyzing the available literature.

Methodology

Systematic review. For example, network meta-analysis of randomized and unpublished randomized trials adhd adults: drugs psychotherapy? randomized and unpublished trials evaluating the effectiveness of pharmacological and non-pharmacological interventions in adults with ADHD (diagnosed according to the DSM-III and following, CIM-10 or CIM -1) criteria. Therefore, Central, medline, clinicals.gov databases. EU and WHO study registers as well as the websites of regulatory authorities and pharmaceutical companies were consulted until September 6, 2023. The main objectives of studies were: to assess the effectiveness (evolution of the main symptoms according to patients and/or doctors. 12 weeks after the start of treatment) tolerance, measured by the proportion of treatment interruptions.

Results

• 113 randomized studies for 14,887 subjects (51.3 % men) were analyzed. In 55.8 % of studies, drugs were evaluated, 24.8 % were psychological interventions and 8.8 % were neurostimulant interventions or neurofeedback (including 194 only in 10 studies). Control groups were also included in 85.8 % of studies.
• Reduction of main symptoms after 12 weeks has been quantified on the basis of the standardized average difference (SMD) compared to placebo. In this case, atomoxetine and stimulants were effective in self -report as in clinical evaluation (SMD -0.38 / -0.51 and -0.39 / -0.61).
• The results were also better than those of the placebo, but only in the context of clinical evaluation:
  • Cognitive therapy (SMD = -0.76),
  • Cognitive remediation (-1.35),
  • Mindfulness training (-0.79),
  • Psychoeducation (-0.77),
  • DC transcranial stimulation (-0.78).
• For most treatments, acceptance was similar to that obtained with placebo. The only exceptions were atomoxetine and guanfacin (Chances report or 1.43 resp. 3.70).

Funding

UK National Institute for Health and Care Research.

Clinical impact

Among the numerous interventions adhd adults: drugs psychotherapy? evaluated. only atomoxetine and stimulants have brought a short-term improvement in the symptoms of ADHD both in self-assessment and in clinical evaluation, the first being less well accepted.

Positive effects have also shown several psychological interventions, but only in clinical evaluation. In addition. the authors note that the drugs have not improved the quality of life and that the longer -term evidence of all the procedures have been insufficiently studied. They consider their own work as ” The best convincing database available to date to develop the next recommendations so that they take into account the advantages. disadvantages of the interventions available for ADHD in adults ».

This article was initially published on Univadis.de. It has been translated, using several editorial tools, including AI, as part of the process. The translation was reviewed and adapted by the editorial staff adhd adults: drugs psychotherapy? before publication.