COMMENTARY

Efficacy and Safety of Amphetamines in ADHD

Peter M. Yellowlees, MBBS, MD

Disclosures

April 14, 2016

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This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees. Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric conditions affecting children and adolescents. Amphetamines are among the most commonly prescribed medications to manage ADHD, yet despite their addictive potential, we really don't know how safe or efficacious they are.

A team of investigators from the University of Alberta, Canada, have used standard Cochrane methodology to evaluate the safety and efficacy of amphetamines for ADHD in children and adolescents.[1] They included 23 trials with 2675 children aged 3-17 years, comparing amphetamines with placebo. Study durations ranged from 14 days to 365 days, with the majority lasting less than 6 months. The researchers found that many of the trials were of poor quality, and while amphetamines did seem efficacious at reducing the core symptoms of ADHD in the short term, they were associated with a greater number of adverse events, such as decreased appetite, insomnia, abdominal pain, nausea, headaches, and anxiety. They found no evidence that supported any one specific amphetamine derivative over another, and the review did not reveal any differences between long-acting and short-acting amphetamine formulations.

So where does this leave us clinicians? We need to prescribe amphetamines carefully, using the minimum effective dosage, and with drug holidays if possible. We need to carefully monitor for side effects and effectiveness, and we need to combine these medications with standard cognitive behavioral techniques involving both children and their families. The evidence confirms that amphetamines have an established role in the treatment of ADHD in children and adolescents, but from a clinical perspective they should be part of a wider, individually customized biopsychosocial treatment plan.

Thank you for listening to this Medscape Psychiatry Minute. Do enjoy your practice.

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