![]() In adults, there was no data for guanfacine and clonidine. But teachers only rated methylphenidate and modafinil as more effective than placebo (there was no data for teacher ratings of amphetamines and clonidine). Symptom rating came from teachers and clinicians for children, and for adults these were given by clinicians.īased on clinician ratings in children and adolescents, all drugs were more effective than placebo in controlling ADHD symptoms. Drug effectiveness was reviewed in 10068 children and adolescents and in 8131 adults, while side effects were evaluated in 11018 children and adolescents and 5362 adults. Of these, 89 randomised controlled trials included unpublished data or were completely unpublished. Of the 133 randomised clinical trials included, 81 were in children and adolescents, 51 were in adults and one trial was in both. It also studied the drugs’ side effects (including blood pressure and weight loss), and acceptability was assessed according to how many people dropped out of trials for any reason. This study compared the available drugs based on how effectively they reduce ADHD symptoms and improve general functioning over 12 weeks of treatment. Other guidelines in Europe recommend psychostimulants as first-line treatment without any distinction between methylphenidate and amphetamines being made. Over the past few decades, prescriptions for drugs for ADHD have increased in the USA and other countries, but treatment guidelines are inconsistent as there are a few head-to-head comparisons of ADHD drugs available.Ĭurrently, the UK National Institute for Health and Care Excellence (NICE) recommends methylphenidate as first-line drug treatment in children and adolescents (with lisdexamfetamine as the second option, and atomoxetine or guanfacine recommended as third-line drugs), and recommend methylphenidate and lisdexamfetamine as first choices in adults. Treatment breaks are occasionally recommended to assess whether the medication is still needed, but the treatment for ADHD can be taken for periods longer than 12 weeks. The annual costs associated with ADHD are substantial in many countries, including US$143-266 billion in the USA.ĪDHD medications are not a permanent cure for ADHD but may help patients concentrate better, be less impulsive, feel calmer, and learn and practice new skills. The disorder is characterised by age-inappropriate levels of inattention, hyperactivity or impulsivity, or all of these. Environmental modifications – such as changes made to minimise the impact of ADHD in day-to-day living – and non-pharmacological therapies should be considered first in ADHD treatment, but for people who require drug treatments, our study finds that methylphenidate should be the first drug offered for children and adolescents, and amphetamines should be the first drug offered for adults.”ĪDHD is estimated to affect 5% of school-age children and 2.5% of adults worldwide. More research is needed into the long-term effects of medication. Prof Cipriani says: “It’s important to note that the data available only allow us to compare the effectiveness at 12 weeks, when we know that both children and adults can be on these medications for longer. Prof Andrea Cipriani, Department of Psychiatry, University of Oxford Medication can be an important tool for people with ADHD, and our study illustrates that in the short term, these can be effective and safe treatment options for children, adolescents and adults. The study also does not include psychological therapies used for ADHD, but the authors say that these should be regularly discussed with people with ADHD and their family members or carers, and possibly offered before ADHD medications, if appropriate, especially for children and adolescents. However, more research to confirm longer term effects of ADHD medications is urgently needed.Īlthough they are commonly prescribed for people with ADHD, the study did not include antipsychotic drugs or antidepressants as they do not treat ADHD core symptoms. ![]() The study, which was led by Prof Andrea Cipriani, compared the effectiveness and side effects of amphetamines (including lisdexamfetamine), atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil with each other or with placebo over 12 weeks of treatment. ![]() Of the drugs available for attention-deficit hyperactivity disorder (ADHD), the most effective and safe for short-term treatment is methylphenidate for children, and amphetamines for adults, according to the most comprehensive evidence yet from a network meta-analysis and systematic review comparing the effectiveness and safety of seven ADHD drugs against placebo, published in The Lancet Psychiatry journal.
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