Non-stimulant medications in the treatment of ADHD.
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.


METHODS
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).


CONCLUSIONS
Non-stimulant agents have been shown to be effective in treatment of ADHD. Especially, atomoxetine seems promising and newline drugs are in development.
Child and Adolescent Psychiatry, University of Göttingen, von-Siebold-Str. 5, 37075 Göttingen, Germany. tbanasc@gwdg.de
Tobias
T
Banaschewski
Veit
V
Roessner
Ralf W
RW
Dittmann
Paramala Janardhanan
PJ
Santosh
Aribert
A
Rothenberger
D000929:Antidepressive Agents, Tricyclic / Q000145:classification / Q000627:therapeutic use; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D002648:Child; D004347:Drug Interactions; D004361:Drug Tolerance; D006801:Humans; D009638:Norepinephrine / Q000037:antagonists & inhibitors*; D011437:Propylamines / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*
D000929:Antidepressive Agents, Tricyclic; D011437:Propylamines; D000069445:Atomoxetine Hydrochloride; D009638:Norepinephrine