Nonstimulants May Be an Appropriate Alternative to Stimulants for Treating ADHD

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The meta-analysis comprised 15 randomized controlled trials identified via several databases, including 4648 child participants diagnosed with ADHD.
The meta-analysis comprised 15 randomized controlled trials identified via several databases, including 4648 child participants diagnosed with ADHD.

Both stimulant and nonstimulant therapies were satisfactory treatments of attention-deficit/hyperactivity disorder (ADHD) in youth, according to the findings of a study published in the Journal of Child and Adolescent Psychopharmacology.

The meta-analysis comprised 15 randomized controlled trials identified via several databases, including 4648 children (mean age 11.06) diagnosed with attention-deficit/hyperactivity disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. These trials investigated either stimulant or nonstimulant medications and reported Attention-Deficit/Hyperactivity Disorder-Rating Scale-IV scores as the primary outcome. Some also reported treatment-emergent adverse effects as a secondary outcome. All trials lasted ≥3 weeks with a mean duration of 5.28 weeks.

Overall, both treatments reduced rating scale scores with a standardized mean difference of −0.70 (95% CI −0.85 to −0.55), or −0.83 (95% CI, −1.11 to −0.54) for stimulants and −0.58 (95% CI, −0.69 to −0.46) for nonstimulants as determined by subgroup analyses.

As expected, each group exhibited varying treatment-emergent adverse effects. Participants taking stimulants were more likely to report decreased appetite (28.6% vs 14.2%), while participants taking nonstimulants were more likely to report drowsiness (34.1% vs 4.4%). However, the frequency of adverse effects did not vary between groups and no significant change in heart rate was noted for either medication.

A limitation of the meta-analysis was its fairly small size and the use of studies with uniform outcome measures; it is possible that heterogeneity was higher than reported. It was also unknown whether the participants in these trials were taking any medication in addition to stimulants or nonstimulants.

Previous research has suggested that stimulants are significantly more effective than nonstimulants in treating childhood attention-deficit/hyperactivity disorder. While the findings of the meta-analysis corroborated that stimulants may have a greater overall effect size, the difference was not statistically notable, and suggested that nonstimulants may be an appropriate alternative in cases in which co-occurring conditions might prevent the administration of stimulants.

Reference

Cerrillo-Urbina A, García-Hermoso A, Pardo-Guijarro M, et al.  The effects of long-acting stimulant and nonstimulant medications in children and adolescents with attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials [published online June 13, 2018]. J Child Adolesc Psychopharmacol. doi:10.1089/cap.2017.0151

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