title: Effectiveness of one-year pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD): an open-label prospective study of time in treatment, dose, side-effects and comorbidity.
abstract: How to generalize from randomized placebo controlled trials of ADHD drug treatment in adults to 'real-world' clinical practice is intriguing. This open-labeled prospective observational study examined the effectiveness of long-term stimulant and non-stimulant medication in adult ADHD including dose, side-effects and comorbidity in a clinical setting. A specialized ADHD outpatient clinic gave previously non-medicated adults (n=250) with ADHD methylphenidate as first-line drug according to current guidelines. Patients who were non-tolerant or experiencing low efficacy were switched to amphetamine or atomoxetine. Primary outcomes were changes of ADHD-symptoms evaluated with the Adult ADHD Self-Report Scale (ASRS) and overall severity by the Global Assessment of Functioning (GAF). Secondary outcomes were measures of mental distress, and response on the Clinical-Global-Impressions-Improvement Scale. Data at baseline and follow-ups were compared in longitudinal mixed model analyses for time on-medication, dosage, comorbidity, and side-effects. As results, 232 patients (93%) completed examination at the 12 month endpoint, and 163 (70%) remained on medication. Compared with the patients who discontinued medication, those still on medication had greater percentage reduction in ASRS-scores (median 39%, versus 13%, P<0.001) and greater improvement of GAF (median 20% versus 4%, P<0.001) and secondary outcomes. Continued medication and higher cumulated doses showed significant associations to sustained improvement. Conversely, psychiatric comorbidity and side-effects were related to lower effectiveness and more frequent termination of medication. Taken together, one-year treatment with stimulants or atomoxetine was associated with a clinically significant reduction in ADHD symptoms and mental distress, and improvement of measured function. No serious adverse events were observed.
authors.affiliation: Division of Mental Health and Addiction, Vestfold Hospital Trust, N-3101 Tønsberg, Norway; University of Oslo, N-0318 Oslo, Norway. Electronic address: mats.fredriksen@siv.no.
authors.forename: Mats
authors.initials: M
authors.lastname: Fredriksen
authors.affiliation: University of Oslo, N-0318 Oslo, Norway; Department of Oncology, Oslo University Hospital, Radiumhospitalet, N-0424 Oslo, Norway. Electronic address: a.a.dahl@ibv.uio.no.
authors.forename: Alv A
authors.initials: AA
authors.lastname: Dahl
authors.affiliation: University of Oslo, N-0318 Oslo, Norway; Clinic of Mental Health and Addiction, Oslo University Hospital, N-0514 Oslo, Norway. Electronic address: e.w.martinsen@medisin.uio.no.
authors.forename: Egil W
authors.initials: EW
authors.lastname: Martinsen
authors.affiliation: University of Oslo, N-0318 Oslo, Norway; Clinic of Mental Health and Addiction, Oslo University Hospital, N-0514 Oslo, Norway. Electronic address: ole.klungsoyr@medisin.uio.no.
authors.forename: Ole
authors.initials: O
authors.lastname: Klungsøyr
authors.affiliation: Department of Biomedicine, University of Bergen, N-5009 Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, N-5009 Bergen, Norway. Electronic address: Jan.Haavik@abm.uib.no.
authors.forename: Jan
authors.initials: J
authors.lastname: Haavik
authors.affiliation: Department of Psychiatry, Akershus University Hospital, Grorud Outpatient Clinic, N-1478 Lørenskog, Norway. Electronic address: dawn.peleikis@vikenfiber.no.
authors.forename: Dawn E
authors.initials: DE
authors.lastname: Peleikis
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000661:Amphetamine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D001523:Mental Disorders / Q000150:complications; D008774:Methylphenidate / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D011437:Propylamines / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013315:Stress, Psychological / Q000150:complications / Q000188:drug therapy; D013997:Time Factors; D055815:Young Adult
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D011437:Propylamines; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride; D000661:Amphetamine
keywords: ADHD; ADHD medications; Comorbidity; Psychopharmacology; Psychostimulants; Side effects