It is estimated that attention deficit hyperactivity disorder (ADHD) affects between 5 and 8% of the child population, being more common in boys than in girls, according to data from the World Health Organization (WHO). ). As its name indicates, it is characterized by excessive activity, impulsivity and difficulties maintaining attention, which often continue during adolescence and even into adulthood, so those affected need medical follow-up, as well as taking medications, with the side effects that this entails.
Now a review of various clinical trials whose results have been published in the scientific journal The Lancet Psychiatry has compared different pharmacological and non-pharmacological treatments to manage ADHD in adults. Researchers have proven that only stimulants and atomoxetine effectively reduce symptoms after 12 weeks, but they have warned that the medications are not well tolerated by all patients, that they did not find evidence that they improve quality of life and that their Long-term effects are unclear.
To carry out the analysis, its authors searched for published and unpublished randomized clinical trials in various databases until September 6, 2023. Studies that compared treatments with a control group or other active therapies in people over 18 years of age were included. who had been diagnosed with ADHD.
Pharmacological treatments had to be adjusted to the maximum doses recommended by international guidelines and trials with a minimum duration of one week for medications, at least four sessions for psychological therapies and any duration considered appropriate for neurostimulation therapies were included. In the case of medications, cognitive training or neurostimulation, only double-blind trials were accepted, which are those in which neither the participants nor the researchers know what treatment is being administered or whether it is a placebo.
Stimulants and atomoxetine reduced ADHD symptoms in the short term
From a total of 32,416 records, 113 unique trials were selected that included 14,887 participants (45.6% women, 51.3% men and 3.1% without gender data) with the aim of determining the reduction of the main symptoms of ADHD at 12 weeks. The results showed that atomoxetine and stimulants proved to be more effective than placebo based on both self-report and physician-rated scales. For example, stimulants showed a more pronounced improvement on clinical scales.
Non-pharmacological therapies, such as cognitive-behavioral, cognitive remediation, mindfulness, psychoeducation and transcranial stimulation, were more effective than placebo, but only when symptoms were evaluated by professionals. Most treatments had dropout rates similar to placebo, except atomoxetine and guanfacine, which were accepted improvements and had a lower dropout rate.
The authors conclude in their article that stimulants and atomoxetine were the only treatments that demonstrated clear short-term benefits in reducing ADHD symptoms, as assessed by both patients and physicians. However, atomoxetine was less accepted due to more dropouts.
“The ideal we aspire to in ongoing research is ‘precision psychiatry’, where treatment is tailored to the individual not only based on their symptoms, but also biological ‘markers’”
Regarding non-pharmacological therapies, the results were more variable and depended on who had performed the evaluation. Furthermore, no clear benefits were found in other important aspects, such as quality of life, and its long-term effects still need to be proven. This analysis provides the most comprehensive evaluation to date of treatments for ADHD in adults and will serve as the basis for future clinical guidelines.
Jon Jureidini, research leader in Critical and Ethical Mental Health (CEMH), at the Faculty of Medicine of the University of Adelaide (Australia), who has not participated in the research, explained in statements collected by SMC Spain that “the findings Significant findings from this study are that, for adults diagnosed with ADHD, commonly used medications (stimulants and atomoxetine) have a very low to moderate impact on short-term symptoms; they do not have a positive impact on the results after one year of follow-up; and have not been shown to improve quality of life, a measure more important than symptomatic improvement.
And he adds that “the authors correctly point out that the quality of the evidence is poor, that there are harms associated with the medication and that more research is needed on the significant benefits beyond symptomatic improvement, the relevance of which is questionable.” For all this, he concludes that “the study reinforces the need for doctors to go beyond simplified symptomatic diagnoses to seek to understand why each individual experiences some combination of inattention, hyperactivity and impulsivity, since simply diagnosing and treating ADHD will have dubious benefits.”
For his part, Anthony Hannan, research leader of the Mental Health Mission at the Florey Institute of Neuroscience and Mental Health, has stated in statements to the same medium that “the key message for mental health clinicians and researchers is that some existing treatments are effective, but we can do much better to make them more effective and with fewer side effects. The ideal we aspire to in ongoing research is ‘precision psychiatry’ (as part of ‘precision medicine’), where treatment is tailored to the individual not only based on their symptoms, but also ‘markers’. biological. “This requires much more research to understand the causes of ADHD and identify new approaches for innovative therapies.”
