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Am Fam Physician. 1999;59(6):1630-1631

Diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults is difficult. Some evidence indicates that most children outgrow this disorder by adulthood, but other evidence shows that some adults may continue to have at least residual symptoms of ADHD. Higgins reviewed the literature to assess the efficacy of antidepressants compared with stimulants in adults who presented with attention deficits.

A Medline search yielded 20 studies that reported on antidepressant or stimulant treatment in adults with attention deficits. These studies were reviewed to determine the type of medication used and the percentage of patients who were responders. Of the nine studies of stimulants, only five were placebo-controlled double-blind studies. Three of these reported significant improvement in patients taking the stimulant compared with placebo; the other two studies showed no difference between the two.

Only three of the 11 studies of antidepressants were placebo-controlled. One study evaluated the use of a monoamine oxidase inhibitor and showed no difference between the active treatment and placebo. The other two studies (using desipramine and tomoxetine, a medication that is not available in the United States) found that 68 percent and 52 percent of patients responded, respectively, compared with none and 2 percent of those in the placebo group. Non–placebo-controlled studies of bupropion and venlafaxine found good response in adults with attention deficits.

Further studies, including those comparing antidepressants, stimulants and placebo, are needed to determine the best treatment in adults with ADHD. However, the author notes that using an antidepressant in adequate dosages may be a satisfactory alternative to prescribing a controlled substance (i.e., a stimulant) in these patients.

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Copyright © 1999 by the American Academy of Family Physicians.

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