Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder in Adults

A history of childhood attention-deficit/hyperactivity disorder (ADHD) is a mandatory prerequisitefor the diagnosis of adult type ADHD, for which no DSM criteria exists. Since the diagnosis mustbe made retroactively, tentative criteria have been designed to establish the presence of the childhooddisorder. In the 1970s, I advanced the hypothesis that "minimal brain dysfunction" (as ADHD wascalled) might be produced by decreased catecholaminergic function. A total of over 300 ADHD patientshave been included in treatment studies, including 224 patients who received stimulants in fourdouble-blind, placebo-controlled trials: three of methylphenidate (N = 176) and one of pemoline(N = 48). An additional 79 patients have been included in open-label trials of pargyline, selegiline,bupropion, levodopa, phenylalanine, and tyrosine. Altogether, these studies have demonstrated theefficacy of methylphenidate, pemoline, and monoamine oxidase-B (MAO-B) inhibitors when administeredto adult ADHD patients; a robust response was produced in 60% of the patients. Bupropionand selegiline were effective in the open-label studies and should be systematically evaluated. A longtermstudy is being conducted with methylphenidate maintenance; patients have been followed for aslong as 5 years, and little, if any, drug tolerance has been observed. Treatment of adult patients whohave ADHD is symptomatic, not curative, but the combination of medication and psychotherapy mayoffer life-changing opportunities to individuals who suffer from the disorder.