Top Treatments for Attention Deficit Hyperactivity Disorder (ADHD) in Adults

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects millions of adults worldwide. An estimated 8.7 million adults in the US have ADHD. The core symptoms of inattention, hyperactivity, and impulsivity can significantly impact daily functioning, productivity, and overall quality of life.

Untreated ADHD in adulthood can lead to a cascade of negative consequences, including academic or occupational difficulties, strained relationships, low self-esteem, and an increased risk of comorbid conditions such as anxiety and depression.

Despite the substantial burden, many adults with ADHD struggle to find effective treatment options that address their unique needs and challenges.

Fortunately, a growing body of research has shed light on various pharmacological and non-pharmacological interventions that can effectively manage ADHD symptoms in adults. From psychostimulants and non-stimulant medications to cognitive-behavioral therapies, mindfulness-based approaches, and novel techniques like neurofeedback, a range of treatment options are available to help adults with ADHD regain control over their lives and reach their full potential.

1. Psychostimulants

Psychostimulants are among the most commonly prescribed medications for ADHD, such as:

• Methylphenidate
• Dexamphetamine
• Mixed amphetamine salts
• Lisdexamfetamine

Methylphenidate is a cornerstone treatment for ADHD in adults. It is available in immediate-release (IR) and sustained-release (SR) formulations. Methylphenidate works by increasing the levels of dopamine and norepinephrine in the brain, which helps improve attention and focus while reducing hyperactive and impulsive behaviors.

Amphetamine derivatives, such as dexamphetamine, mixed amphetamine salts, and lisdexamfetamine, are also effective in treating ADHD. These medications function similarly to methylphenidate by enhancing dopamine and norepinephrine activity in the brain.

Studies have demonstrated the efficacy of psychostimulants in reducing the core symptoms of ADHD in adults. These medications are significantly more effective than placebo in improving attention, reducing hyperactivity, and controlling impulsivity. The degree of efficacy is variable, but generally speaking, psychostimulants can provide substantial clinical benefits.

While psychostimulants are effective, they are associated with various side effects that can affect their tolerability and long-term use. Common side effects include:

• Insomnia
• Decreased appetite
• Weight loss
• Increased heart rate
• Elevated blood pressure

2. Non-stimulants

Non-stimulant treatments for ADHD offer viable alternatives to psychostimulants, particularly when the latter are ineffective or poorly tolerated, such as:

• Atomoxetine
• Viloxazine Extended Release
• Alpha-2 Adrenergic Agonists
• Bupropion
• Tricyclic Antidepressants
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Atomoxetine (ATX) is the first FDA-approved non-stimulant for ADHD, indicated for both children and adults. It selectively inhibits norepinephrine reuptake, increasing synaptic norepinephrine in multiple brain regions and dopamine levels in the prefrontal cortex. Common side effects include sedation, nausea, vomiting, decreased appetite, weight loss, and increased heart rate and blood pressure.

Viloxazine ER, approved in 2021, is a norepinephrine reuptake inhibitor with activity at several post-synaptic serotonin receptors. It has shown efficacy in treating ADHD symptoms in children and adolescents, with comparable response rates across various doses. Side effects include somnolence, decreased appetite, and headache.

Clonidine Extended Release (XR) and Guanfacine XR are alpha-2 adrenergic agonists approved for ADHD treatment. These medications are particularly effective in reducing hyperactive and impulsive symptoms and are often used when behavioral overarousal, aggression, or tics are present. Both medications are effective as monotherapy or in combination with stimulants, helping to extend the duration of symptom control.

Other medications used off-label for ADHD include bupropion, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Bupropion, a dopamine and norepinephrine reuptake inhibitor, has shown efficacy in treating ADHD, particularly in patients with comorbid mood disorders. Tricyclic antidepressants like desipramine are effective but limited by cardiovascular side effects. SNRIs such as venlafaxine and duloxetine have been studied with mixed results. Investigational compounds like centanafadine and mazindol XR show promise in early trials but require further research to establish their efficacy and safety profiles.

3. Combination of Medication and Behavioral Therapies for ADHD

Combining medication with behavioral therapies such as Cognitive Behavioral Therapy (CBT) has been found to enhance treatment outcomes.

One study demonstrates that the combination of CBT with medication results in greater improvements in ADHD symptoms, organizational skills, and self-esteem compared to CBT alone. The study involved 88 adults who received 12 manualized group CBT sessions, with 42 participants also receiving medication.

The results showed that the combined approach was superior to CBT alone during the treatment phase. However, the differences diminished over time as the CBT alone group improved post-treatment.

Another study found that combining CBT with medication for adults with ADHD resulted in greater improvements in executive functions compared to medication alone. Although both treatment groups showed significant improvements in core ADHD symptoms, emotional symptoms, and social functional outcomes, the addition of CBT provided broader benefits, particularly in executive functioning. This supports the use of a multimodal treatment approach for ADHD to enhance overall treatment effectiveness.

A combination approach is often advocated in ADHD therapies. This approach leverages the strengths of both pharmacological and psychological treatments, offering a comprehensive strategy to manage ADHD symptoms and improve overall functioning. Medication helps stabilize the core symptoms of ADHD, providing a foundation upon which behavioral therapies can build to address organizational skills, self-esteem, and other related issues.

4. Novel Approaches

Novel approaches such as Mindfulness-Based Cognitive Therapy (MBCT) and mindfulness interventions are showing promise.

One research study highlights that MBCT, often combined with treatment as usual, effectively reduces ADHD symptoms and improves executive functioning in adults. MBCT integrates mindfulness practices with cognitive behavioral techniques, helping individuals develop greater awareness and control over their thoughts and behaviors.

Another innovative treatment involves a combination of cognitive and dialectical behavior therapy, which has been shown to reduce symptoms and improve mental health outcomes with lasting effects. A study was conducted involving 18 adults with ADHD who underwent a 14-week program combining cognitive and dialectical behavior therapy. The results indicated significant reductions in ADHD symptoms, depression, perceived stress, and anxiety, with these improvements remaining stable for six months post-treatment.

5. Non-Pharmacological Treatments

Alternative non-pharmacological treatments, such as neurofeedback and treatments focusing on circadian rhythms, are also being explored. Neurofeedback using slow cortical potential (SCP) feedback and near-infrared spectroscopy (NIRS) shows potential as a valuable alternative treatment for ADHD.

One research study describes how these neurofeedback techniques help individuals learn to regulate their brain activity, potentially reducing ADHD symptoms and improving cognitive functioning.

Similarly, melatonin has been found effective in advancing the circadian rhythm and reducing ADHD symptoms in adults with Delayed Sleep Phase Syndrome. Research highlights that melatonin administration helps synchronize sleep patterns, leading to reductions in ADHD symptoms and improvements in overall daily functioning.

Final Words

Effective treatment cannot be overstated in addressing adult ADHD. The evidence highlights psychostimulants, non-stimulant medications, and the combined approach of medication with behavioral therapies as vital treatment pillars. Directly targeting core ADHD symptoms through these methods can transform the lives of millions. Novel mindfulness and neurofeedback techniques also show great promise as complementary interventions.

Adults struggling with ADHD must be proactive in seeking out these research-backed treatment options. It is advised to consult with a medical professional, explore available therapies, and commit to a comprehensive management plan.

FAQs About ADHD Treatment for Adults

What are the risks associated with stimulant medications in the treatment of adult ADHD?

Decades of research have found no major negative health effects from taking stimulant medications for a long time. Some studies have suggested that children who keep taking stimulants into adulthood may grow up slightly shorter. But other studies have found no link between medication use and adult height.

How should ADHD be treated in adults with comorbid substance use disorders?

In treating patients with ADHD and comorbid substance use, psychostimulants may be a useful pharmacologic ADHD alternative treatment. However, the risks of such treatment with high-risk populations must be considered alongside potential benefits.

Are there special considerations for treating ADHD in adults over 50?

Treating ADHD in adults over 50 requires careful consideration of age-related cognitive changes, comorbid psychiatric and medical conditions, and potential polypharmacy. Traditional DSM-5 criteria may not adequately capture ADHD's manifestation in this age group, making clinical interviews crucial for a comprehensive diagnosis. Neuropsychological testing is less reliable in older adults for diagnosing ADHD. Additionally, treatment plans should carefully consider medication interactions and prioritize psychotherapy to improve organizational skills, behavioral changes, and self-esteem, especially for those diagnosed later in life.