Adult Attention-deficit–Hyperactivity Disorder – Safety Issues in Pharmacotherapy

Wolfgang Retz
European Psychiatric Review, 2009;2(2):39-42
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Abstract

It is now known that attention-deficit–hyperactivity disorder (ADHD) can affect not only children, but adults as well. In addition to diagnostic challenges, clinicians must consider co-morbidities and safety issues that exist in adults that are not problems when treating children. While stimulants such as methylphenidate and amphetamines have proved effective, substance abuse disorders and increased cardiovascular risk are of major concern and may limit this therapeutic option in adults. Careful screening and monitoring of older patients is therefore an important part of the treatment process. Novel extended-release formulations of stimulants can potentially help to reduce these risks, as well as improving compliance in patients. Non-stimulant and combination drug and behavioural therapy have also shown encouraging results and warrant further research.
Keywords
Adult attention-deficit–hyperactivity disorder (adult ADHD), Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), International Classification of Diseases and Related Health Problems, 10th edition (ICD-10), co-morbidity, substance use disorder, cardiovascular risk, stimulants, extended-release methylphenidate, atomoxetine, combination therapy
Disclosure Wolfgang Retz has received honoraria for lectures and counselling from Flynn Pharma, AstraZeneca and Medice, and royalties from Hogrefe and Kohlhammer for published diagnostic and psychotherapeutic issues.
Received: October 30, 2009 Accepted November 30, 2009
Correspondence: Wolfgang Retz, Assisstant Professor, Neurocentre – Saarland University Hospital, Bdg 90.3, D-66421 Homburg/Saar, Germany. E: wolfgang.retz@uks.eu

Attention-deficit–hyperactivity disorder (ADHD) is one of the most common psychiatric conditions in childhood, with approximately 6–9% of school-age children being affected.1 Despite widespread belief that symptoms of this disorder disappear over time, in many cases ADHD persists into adulthood. Studies have found that up to 60–65% of affected children continue to suffer from this disease as adults, with it becoming a chronic condition.2–6 A recent cross-national investigation involving Belguim, Colombia, France, Germany, Italy, Lebanon, Mexico, The Netherlands, Spain and the US estimated the average prevalence of adult ADHD to be approximately 3.4%, with higher-income countries showing a higher prevalence (4.2%) than lower-income countries (1.9%).7 Despite the high incidence of adult ADHD, more than 50% of adults with the disease have symptoms that go undiagnosed or untreated due to a limited number of available trained practitioners.8 Considering the incidence of adult ADHD and the negative impact its symptoms may have on the different domains of a patient’s life, it should be recognised as an important mental disorder requiring accurate identification and treatment.

Adults with ADHD tend to present with co-morbid mood and/or anxiety disorders, substance use disorders and personality disorders, making both diagnosis and treatment of the different diseases a clinical challenge.9 Despite the number of drugs that have been developed for the treatment of ADHD in children, there are still no approved pharmacological treatments for adults with ADHD in the EU. By contrast, a number of drugs, including several stimulants and the non-stimulant atomoxetine, are currently approved in North America for the treatment of adult ADHD. As adults are not the same as children, it is possible that older patients may react differently to various treatments and present with certain unique negative effects. As a result, particular safety issues that do not exist in children may potentially affect adults being treated for ADHD. In the context of older patients, co-morbidities and safety concerns specific to treating adults need to be carefully addressed to reduce the risk of any serious adverse events.

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