ADD, or attention deficit disorder, affects between 3 and 7 percent of school aged children in the United States, according to estimates from the Centers for Disease Control and Prevention (CDC). Of those, approximately 56 percent, or 2.5 million children, are receiving drug therapy for the condition. The American Academy of Pediatrics (AAP) recommends medications as an important part of an ADD treatment plan, and a number of effective options are available. The term ADD was replaced by ADHD, or attention deficit/hyperactivity disorder, in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
Stimulant Medications
Stimulants are the most widely used medications for treating ADD. Available agents include methylphenidate, including Ritalin and Concerta; dextroamphetamine, includling Dexedrine; dexmethylphenidate, including Focalin; mixed amphetamine salts, including Adderall; and lisdexamfetamine, marketed as Vyvanse. Most are available in both long- and short-acting forms, and many are available as generics. Methylphenidate also is available in a patch, Daytrana.
Exactly how stimulants work to alleviate symptoms of ADD is not known. Patient variability is a key factor in efficacy, as one drug in the class may not work for a particular person, but another drug may be highly effective. Potential adverse effects include headache or stomachache, reduced appetite, difficulty sleeping, social withdrawal or feeling jittery.
In June 2009, the U.S. Food and Drug Administration (FDA) issued guidance to prescribers of stimulant medications, recommending they complete a thorough patient history and physical examination, with special attention to cardiovascular risks, prior to initiation of stimulant therapy. Any patient at risk for adverse cardiovascular outcomes should undergo further examination or testing prior to treatment.
Tricyclic Antidepressants
Tricyclic antidepressants, or TCAs, are second-line agents for the treatment of ADD, according to AAP guidelines. Imipramine and desipramine are the most studied agents. Both are dosed multiple times per day and have significant side effects, including sedation.
Bupropion
According to AAP guidelines, bupropion, or Wellbutrin, is also a second-line treatment for ADD. The drug, an antidepressant, is available in long- and short-acting dosage forms and can be given one to three times daily. Side effects include sleeping difficulties, agitation, dizziness and anxiety. Bupropion carries a serious warning concerning increased risk of suicidal thinking and behavior in children, adolescents and young adults. The drug also can increase the risk of seizures.
Atomoxetine
Atomoxetine, marketed as Strattera, is FDA-approved for treatment of ADD in children over age 6. The drug can be dosed once or twice daily. Atomoxetine is a non-stimulant and also carries a serious warning concerning suicidal thinking and behavior in children, adolescents and young adults. The most common side effects in children are nausea, vomiting, stomach upset, dizziness, tiredness, mood swings and slowing of growth.
Guanfacine
Guanfacine, marketed as Intuniv, is a non-stimulant medication indicated for treatment of ADD. The drug is taken once daily, and common side effects include sedation, dizziness, nausea, stomachache, decreased appetite, headache, dry mouth and constipation.
References
- Centers for Disease Control and Prevention: ADHD Data and Statistics
- American Academy of Pediatrics: Clinical Practice Guideline: Treatment of the School-Aged Child With Attention Defecit/Hyperactivity Disorder
- U.S. Food and Drug Administration: Communication about an Ongoing Safety Review of Stimulant Medications used in Children with Attention Deficit/Hyperactivity Disorder (ADHD)
- Lilly U.S.: How Strattera Can Help
- Shire U.S.: Intuniv
