COMMENTARY

ADHD: We Finally Know Which Drugs to Use

Charles P. Vega, MD

Disclosures

August 31, 2018

Hello. I'm Dr Charles Vega, and I am a clinical professor of family medicine at the University of California at Irvine. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

A new systematic review and meta-analysis based on 133 double-blind, randomized controlled trials has concluded that methylphenidate is the best first-line medication choice for the treatment of ADHD in kids and teens.

In what researchers call the most comprehensive comparison to date of seven common oral medications for ADHD, all treatment options were more effective than placebo in the short term in children and adolescents. Methylphenidate was only slightly less effective than amphetamines in this group but much better tolerated. In contrast, amphetamines were more effective and better tolerated in adults.

This conclusion comes with some important caveats. Outcomes beyond 12 weeks were not assessed in many of the trials, so no conclusions can be drawn about the long-term effects of these drugs. There was significant heterogeneity between studies, but the researchers found that the comparison between methylphenidate and amphetamine was at least of moderate quality.

The principal conclusion of this research is that methylphenidate offers advantages in the treatment of ADHD in children and adolescents, while amphetamines may be considered superior to treat ADHD in adults. This general guideline should not outweigh shared decision-making with the individual patient.

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