Two-year outcome of treatment with central stimulant medication in adult attention-deficit/hyperactivity disorder: a prospective study.
BACKGROUND
Given that adults with ADHD continue to use stimulants for extended periods of time, studies on the long-term effectiveness and adverse events are warranted. The aims of this study were to investigate factors associated with persistence in treatment in an exploratory manner and to document side effects and reasons for discontinuation.


METHODS
The current study describes the systematic follow-up of 133 psychiatric patients with DSM-IV-diagnosed ADHD treated with central stimulants at a specialized outpatient unit between January 1, 2001, and August 31, 2006. A standardized questionnaire, derived from the Targeted Attention-deficit Disorder Symptoms Rating Scale, was used in order to measure improvement of the following target symptoms: hyperactivity, impulsivity, irritability, distractibility, structure/organization problems, inattention, and restlessness.


RESULTS
Eighty percent of the patients were successfully treated with stimulants at the 6- to 9-month follow-up. Fifty percent remained in treatment after 2 years or more. Forty-five percent were treated for comorbid anxiety and/or depression during the study period. Only 15% dropped out because of lack of efficacy. The amount of clinical response over the first 6 to 9 months (but not at 6 weeks) predicted adherence to treatment at 2 years. The patients' heart rate increased from a least squares mean ± SE of 70 ± 2.2 to 80 ± 2.1 bpm (P = .00003) while blood pressure remained unchanged at the ≥ 2-year follow-up. Severe side effects or drug abuse were not detected in this cohort.


CONCLUSIONS
The long-term treatment outcome shows that stimulants are effective in adult ADHD and side effects tend to be mild.
Bejerot
Susanne
S
Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden. susanne.bejerot@sll.se
Rydén
Eleonore M
EM
Arlinde
Christina M
CM
D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D001288:Attention / Q000187:drug effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D001794:Blood Pressure / Q000187:drug effects; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007175:Impulsive Behavior / Q000188:drug therapy*; D007508:Irritable Mood / Q000187:drug effects*; D008297:Male; D010045:Outpatients; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000697:Central Nervous System Stimulants