Selegiline in Comparison with Methylphenidate in Treatment of Adults with Attention Deficit yperactivity Disorder: A Double-blind, Randomized Trial
Abstract
Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common mental disorders in childhood and it continues to adulthood without proper treatment. Stimulants have been used in treatment of ADHD for many years and the efficacy of methylphenidate (MPH) in the treatment of adults with ADHD has been proven to be acceptable according to meta-analysis studies. However, there are some concerns about stimulants. Finding other effective medications for the treatment of adult ADHD seems necessary. We tried a monoamine oxidase inhibitor, Selegiline, as there are some theoretical and experimental evidences for the efficacy of this medication.
Method: Forty patients were randomized to receive Selegiline or methylphenidate in an equal ratio for an 8-week double-blind clinical trial. Each patient filled the CAARS self report screening form before starting to take the medication and in weeks 2-4-6 and 8. Patients were also assessed by a psychiatrist at the baseline and on each 14 days up to the 8 weeks period.
Results: The mean score of the two groups- receiving Selegiline or methylphenidate- decreased over the 8 weeks. There was not a significant difference between the two groups. The most prevalent side-effect of methylphenidate was decrease of appetite and for Selegiline change in sleep pattern.
Conclusion: Selegiline is as effective as methylphenidate in the treatment of adults with Attention-Deficit/Hyperactivity Disorder. Selegiline can be an alternative medication for the treatment of adult ADHD If its clinical efficacy is proven by other larger studies.
Goldman LS, Genel M, Bezman RJ, Slanetz PJ. Diagnosis and treatment of attention deficit/hyperactivity disorder in children and adolescents. JAMA 1998; 279: 1100- 1107.
Mercuglioano M. What is attention- deficit/hyperactivity disorder? Pediatr Clin North Am 1999; 46: 831– 843.
Polanczyk G, Rohde LA. Epidemiology of attention-deficit/hyperactivity disorder across the lifespan. Curr Opin Psychiatry 2007; 20: 386-392.
Spencer TJ, Biederman J, Wilens TE, Faraone SV. Overview and neurobiology of attention- deficit/hyperactivity disorder. J Clin Psychiatry 2002; 63: 3-9.
Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, et al. Cross- national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry 2007; 190: 402-409.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: APA; 2002.
Babcock T, Ornstein CS. Comorbidity and its impact in adult patients with attention- deficit/hyperactivity disorder: a primary care perspective. Postgrad Med 2009; 121: 73-82.
Murphy KR, Adler LA. Assessing Attention- Deficit/Hyperactivity Disorder in Adults: Focus on Rating Scales. J Clin Psychiatry 2004; 65: 12-17.
Dopheide JA, Pliszka SR. Attention-deficit- hyperactivity disorder: an update. Pharmacotherapy 2009; 29: 656-679.
Faraone SV, Spencer T, Aleardi M, Pagano C, Biederman J. Meta-Analysis of the Efficacy of Methylphenidate for Treating Adult Attention- Deficit/Hyperactivity Disorder. J Clin Psychopharmacol 2004; 24: 24-29.
Noorbala AA, Akhondzadeh S. Attention- deficit/hyperactivity disorder: etiology and pharmacotherapy. Arch Iranian Med 2006; 9: 374–380.
Kollins SH, MacDonald EK, Rush CR. Assessing the abuse potential of methylphenidate in nonhuman and human subjects. Pharmacol Biochem Behav 2001; 68: 611- 627.
Ernst M, Liebenauer LL, Tebeka D, Jons PH, Eisenhofer G, Murphy DL, et al. Selegiline in ADHD adults: plasma monoamines and monoamine metabolites. Neuropsychopharmacology 1997; 16: 276- 284.
Jankovic J. Deprenyl in attention deficit associated with Tourette’s syndrome. Arch Neurol 1993; 50: 268–286.
Heinonen EH, Anttila MI, Lammintausta RA. Pharmacokinetic aspects of l-deprenyl (selegiline) and its metabolites. Clin Pharmacol Ther 1994; 56: 742–749.
Boix F, Qiao SW, Kolpus T, Sagvolden T. Chronic L-deprenyl treatment alters brain monoamine levels and reduces impulsiveness in an animal model of attention deficit/hyperactivity disorder. Behav Brain Res 1998; 94: 153– 162.
Rubinstein S, Malone MA, Roberts W,Logan WJ. Placebo-controlled study examining effects of Selegiline in Children with Attention- Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2006; 16: 404-415.
Mohammadi MR, Ghanizadeh A, Alaghband- Rad J, Tehranidoost M, Mesgarpour B, Soori H. Selegiline in comparison with Methylphenidate in attention deficit hyperactivity disorder in children and adolescents in a double-blind, randomized clinical trial. J Child Adolesc Psychopharmacol 2004; 14: 418-425.
Akhondzadeh S, Tavakolian R, Davari-Ashtiani R, Arabgol F, Amini H. Selegiline in the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized trial. Prog NeuroPsychopharmacol Biol Psychiatry 2003; 27: 841-845.
Ernst M, Liebenauer LL, Jons PH, Tebeka D, Cohen RM, Zametkin AJ. Selegiline in adults with ADHD: clinical efficacy and safety. Psychopharmacol Bull 1996; 32: 327-334.
Conners CK, Erhardt D, Sparrow MA. Book Review. Conners' adult ADHD rating scales ( CAARS). Arch Clin Neuropsychol 2003; 18: 431–437.
World Medical Association Declaration of Helsinki Ethical principles for medical research involving human subjects 2000 available from URL: http://www.wma.net.
Murphy k. Psychosocial Treatments for ADHD in Teens and Adults: A Practice-Friendly Review. J Clin Psychol 2005; 61: 607–619.
Adler LA, Chua HC. Management of ADHD in adults. J clin psychiatry 2002; 63: 29-35.
Kurscheidt JC, Peiler P, Behnken A, Abel S, Pedersen A, Suslow T, et al. Acute effects of methylphenidate on neuropsychological parameters in adults with ADHD: possible relevance for therapy. J Neural Transm 2008; 115: 357-362.
Spencer TJ, Biederman J,Wilens TE. Efficacy and tolerability of long-term, open-label, mixed amphetamine salts extended release in adolescents with ADHD. CNS Spectr 2005; 10: 14-21.
Turner DC, Blackwell AD, Dowson JH, McLean A, Sahakian BJ. Neurocognitive effects of methylphenidate in adult attention- deficit/hyperactivity disorder. Psychopharmacology 2005; 178: 286-295.
Bangs ME, Hazell P, Danckaerts M, Hoare P, Coghill DR, Wehmeier PM, et al. Atomoxetine for the Treatment of Attention- Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder. Pediatrics 2008; 121: 314- 320.
Amiri S, Mohammadi MR, Mohammadi M, Nouroozinejad GH, Kahbazi M, Akhondzadeh S. Modafinil as a treatment for ADHD in children and adolescents: a double blind, randomized clinical trial. Prog NeuroPsychopharmacol Biol Psychiatry 2008; 32: 145–149.
Banaschewski T, Roessner V, Dittmann RW, Santosh PJ, Rothenberger A. Non-stimulant medications in the treatment of ADHD. Eur Child Adolesc Psychiatry 2004; 13: 102-116.
Mohammadi MR, Akhondzadeh S. Pharmacotherapy of attention-deficit hyperactivity disorder: nonstimulant medication approaches. Expert Rev Neurotherapeutics 2007; 7: 195-201.
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Issue | Vol 4 No 4 (2009) | |
Section | Articles | |
Keywords | ||
Adult Attention deficit disorder with hyperactivity Methylphenidate Selegiline |
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