Non-stimulant medications in the treatment of ADHD

Banaschewski, Dr. T.
Roessner, V.
Dittmann, R. W.
Janardhanan Santosh, P.
Rothenberger, A.

¹Child and Adolescent Psychiatry, University of Göttingen, von-Siebold-Str. 5, 37075, Göttingen, Germany.
²Lilly Deutschland GmbH, Bad Homburg, Germany.
³Psychosomatic Department, Children's Hospital, University of Hamburg, Hamburg, Germany.
⁴Dept. of Psychological Medicine, Hospital for Children, Great Ormond Street, London, UK.

European Child & Adolescent Psychiatry 13:p i102-i116, July 2004. | DOI: 10.1007/s00787-004-1010-x

Abstract

Background

Stimulants are the first-line medication in the psychopharmacological treatment of attention-deficit hyperactivity disorder (ADHD). However, 10 to 30% of all children and adults with ADHD either do not respond to or do not tolerate treatment with stimulants.

Objective

To describe alternative treatment approaches with various non-stimulant agents, especially atomoxetine.

Method

General review of empirically based literature concerning efficacy and safety of the substances.

Results

A large and still increasing body of data supports the usefulness of atomoxetine, a once daily dosing, and new selective noradrenalin reuptake inhibitor, with few side effects. Atomoxetine has been licensed in the US for use in ADHD across the lifespan, and is currently under consideration in Europe. Other non-stimulant substances, such as tricyclic antidepressants (TCAs) and alpha-2-adrenergic agonists, which are used to treat ADHD, are also reviewed. TCAs have been well studied and shown to be efficacious in the treatment of ADHD, but are limited by side effects. The number of studies documenting the efficacy of alpha-2-adrenergic agonists is still limited. Some experimental studies support a potential role of cholinergic drugs such as acetylcholinesterase inhibitors (tacrine, donepezil) as well as novel nicotinic analogues (ABT-418).

Conclusion

Non-stimulant agents have been shown to be effective in treatment of ADHD. Especially, atomoxetine seems promising and newline drugs are in development.