title: A head-to-head randomized clinical trial of methylphenidate and atomoxetine treatment for executive function in adults with attention-deficit hyperactivity disorder.
abstract: Results regarding the effects of methylphenidate and atomoxetine on executive functions were inconsistent and no study has directly compared the efficacy of these two medications in improving executive functions in adults with attention-deficit hyperactivity disorder (ADHD). We conducted an 8-10 wk, open-label, head-to-head, randomized clinical trial involving adults with a clinical diagnosis of ADHD confirmed by psychiatric interview. The two treatment arms were immediate-release methylphenidate (IR-methylphenidate) (n = 31) and atomoxetine once daily (n = 32). Executive functions were assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB), including spatial working memory, spatial span, intra-extra dimensional set shifts, rapid visual information processing and Stockings of Cambridge (SOC). In addition to the symptom assessments at baseline (week 0), visit 2 (week 4-5) and visit 3 (week 8–10), they received CANTAB assessments at baseline and visit 3 (60.4 ± 6.3 d). Compared to baseline, adults treated with atomoxetine showed significant improvement in spatial working memory, spatial short-term memory, sustained attention and spatial planning at visit 3; adults treated with IR-methylphenidate showed significant improvement in spatial working memory at visit 3. Comparing the magnitude of improvement in executive functions between these two medications, the effect was generally similar for the two groups, although atomoxetine might have significantly greater efficacy than IR-methylphenidate in terms of improving spatial planning (SOC). Our results provide evidence to support that both IR-methylphenidate and atomoxetine improved various executive functions in adults with ADHD with greater improvement in atomoxetine than IR-methylphenidate in spatial planning.
authors.affiliation: Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hsing-Chang
authors.initials: HC
authors.lastname: Ni
authors.forename: Chi-Yung
authors.initials: CY
authors.lastname: Shang
authors.forename: Susan Shur-Fen
authors.initials: SS
authors.lastname: Gau
authors.forename: Yu-Ju
authors.initials: YJ
authors.lastname: Lin
authors.forename: Hui-Chun
authors.initials: HC
authors.lastname: Huang
authors.forename: Li-Kuang
authors.initials: LK
authors.lastname: Yang
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000328:Adult; D000069445:Atomoxetine Hydrochloride; D001288:Attention / Q000187:drug effects; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use*; D056344:Executive Function / Q000187:drug effects*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008570:Memory, Short-Term / Q000187:drug effects; D008774:Methylphenidate / Q000627:therapeutic use*; D009483:Neuropsychological Tests; D011437:Propylamines / Q000627:therapeutic use*; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D014796:Visual Perception / Q000187:drug effects
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D018765:Dopamine Uptake Inhibitors; D011437:Propylamines; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride