Attention deficit disorder with or without the hyperactivity (ADD, ADHD) is an extremely prevalent condition that affects both children and adults. As many as 10% of children may have it, and according to World Health Organization estimates, around 5% of adults do as well.
Treatment for ADHD typically consists of medication of the stimulant class. There are two main categories of stimulant – the amphetamine based (Adderall, Dexedrine, Vyvanse) and the methylphenidate based (Ritalin, Concerta, Focalin).
What advances have there recently been in the treatment of ADHD?
The vast majority of improvement and change in the psychopharmacology of ADHD has consisted in improvement in delivery and efficacy. Much of this has been due to advances in the understanding of mechanism of action for the underlying medications.
The past 10 years have also seen great advances in the treatment of ADHD with non-stimulatory medications.
In both amphetamine and methylphenidate, certain mirror forms of the molecule may be more effective. With methylphenidate, it is possible that the l form is entirely inactive and even acts to block the action of the d form. This insight led to the development of Focalin, which consists solely of the d form.
A similar thing occurred with the amphetamines. Research indicates that the d form of amphetamine causes slightly different activity than the l form, and this is especially noticed in the realm of unwanted side effects. Because of this, the recent amphetamine based medication Vyvanse is purely the d form.
Other innovation takes place in terms of drug delivery. Vyvanse uses advanced digestion-based release that has unmatched duration of effect, helping treat ADHD symptoms for up to 14 hours. Competing extended release treatments have effect for only 8-12 hours. The release mechanism Vyvanse uses is also superior regarding variability of release.
Daytrana is the first and only treatment that is in the form of a patch. While the demand for such release is limited, this is an innovation that may help treat certain populations.
The first true non-stimulant was recently approved for use in ADHD – Intuniv. It works by stimulating alpha-2 receptors that act to regulate blood pressure and may play a role in attention and motivation. Intuniv works decently well although is still a step below the stimulants. Non-stimulant therapy is important as roughly 30% of people with ADHD can not tolerate or do not respond to stimulant therapy.
Strattera was also recently hailed as an effective non-stimulant for ADHD but it has proven to be disappointing in clinical practice. Additionally, its mechanism of action was ultimately as a stimulatory agent.
Future directions of treatment in ADHD remain open. Because of how profitable the field is (medications must be taken daily for years), there is a great deal of motivation for drug companies to find better treatments that can be big sellers.
About the author:
David loves blogging about health topics! Recently he wrote an analysis of Intuniv for ADHD, Side Effects. He is proud of his investigative journalism such as in covering Prozac, Paxil, Zoloft Weight Gain.
