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Ask the Mental Health Expert Archives 2001-2004

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Alternatives to Ritalin

Q. I am doing research for my Master thesis and investigating alternative treatments to Ritalin that is standard in ADHD (attention deficit hypertension disorder). Are you familiar with any scientific, randomized, placebo controlled experiments written up about this subject? I am having a hard time locating this. Editorials and anecdotals just won't be accepted in the parameters in which I am working. Can you help?

A. It's a bit hard to know how to answer your question, since the terms "alternative" and "standard" can mean a variety of things. For example, do you mean alternative pharmacological treatment, psychosocial treatment, or both? Does "standard" mean having FDA-approved labeling for use in ADHD, or simply that many practitioners believe the treatment is useful?

Notwithstanding these questions, it's certainly fair to say that several medications besides Ritalin have been shown effective in controlled studies of ADHD. Not all of these have been randomized or utilized a placebo, however. There are controlled studies showing that besides methylphenidate (Ritalin), Adderal XR (a mixture of amphetamine salts), atomoxetine (Straterra), and bupropion have all proved useful in this condition, to some degree, compared with placebo [see Biederman et al, Pediatrics 2002 Aug;110(2 Pt 1):258-66; Michelson et al, Pediatrics 2001 Nov;108(5):E83; and Wilens et al, Am J Psychiatry 2001 Feb;158(2):282-8].

Less rigorous studies have also shown some efficacy for venlafaxine and clonidine. Older studies have shown efficacy for tricyclic antidepressants, which are less commonly used nowadays owing to cardiac toxicity. It has been more difficult to show that psychosocial treatment alone is effective in ADHD, though some controlled data point toward the usefulness of behavioral or cognitive-behavioral approaches.

Most studies suggest that psychosocial intervention alone is not especially effective for the core symptoms of ADHD, but may augment the effects of medication on certain measures of improvement in ADHD. For details on these studies, see Jensen et al, J Dev Behav Pediatr 2001 Feb;22(1):60-73; Kolko et al, J Am Acad Child Adolesc Psychiatry 1999 May;38(5):578-86; and Barkley et al, J Consult Clin Psychol 2001 Dec;69(6):926-41. Good luck with your thesis!

April 2003

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