ADHD MEDS/NYC

Information on ADHD medications for adults by Dr. Nicholas Schwartz.  Dr. Schwartz is a graduate of the Yale School of Medicine and runs a private practice in Manhattan specializing in adult ADHD.  The site reviews important aspects of medications, issues of medication tolerance, and books on ADHD.  There is also contact information for those wishing to consult with Dr. Schwartz

ADHD research

This page includes some of the more interesting, recent papers relating to ADHD.  Click on the title to download the complete article in PDF. If readers have suggestions for papers that I haven't included, please send me the title of the article and I will review it.

Predictors of Atomoxetine response - CNS Drugs 2016
Summary: the researcher set out to identify factors that might predict which adult patients would respond favorably to Atomoxetine. They didn't, but the more interesting finding was the very low overall success rate of the drug. Fewer than 1/3 of patients got any benefit. This matches what most clinicians have found, but is much lower than previously reported success rates.

Early antibiotic use and late childhood psychiatric symptoms - Acta Paediatrica 2017
Summary: This study followed a large group of children in New Zealand from birth to early adolescence. They found that children who had received antibiotics within the first year of life were more likely to have behavioral difficulties and symptoms of depression later in childhood. They hypothesized that this might be due to disruption of intestinal bacteria ("microbiome"), an aspect of our biology that has been identified as important in a variety of ways recently. However, the authors were careful to point out that they found an association, but not causation, as this was an initial study.

Neurofeedback as a treatment for adults with ADHD - Clinical Neurophysiology 2016
Summary: the first paper (to my knowledge) to describe benefit of this treatment in adults. It included only 24 patients and it's the first paper on the topic, so it may be premature to recommend the treatment for adults yet. However, it offers promise, especially for those who would prefer non-medicinal therapy.

Patterns of Dopamine release in ADHD patients - PLoS one 2015
Summary: a rather technical paper that supports the idea that the disruption in dopamine neurotransmission in ADHD may not be as simple as "not enough dopamine". Other papers have been published recently that have found that the dysregulation of dopamine in ADHD patients spans the range from "too little" to "too much", depending on the individual.

Electro-encephalogram (EEG) may aid in accurate diagnosis of borderline cases of ADHD - Brain and Behavior 2015
Summary: Because other psychiatric illnesses may cause attention symptoms which mimic ADHD, it can sometimes be difficult to distinguish patients with true ADHD vs. patients with alternative attention-disrupting diagnoses. This paper examines the use of EEG in increasing diagnostic accuracy.

Adult ADHD may not be related to childhood ADHD as we had thought - American Journal of Psychiatry 2015
Summary: This study examined a population over time and found that many individuals diagnosed with ADHD as adults did not meet criteria as children, but only developed the disease in later years. This undermines our current understanding of Adult ADHD as a continuation of childhood-onset disease. This is a single study, however, and needs to be replicated before we renounce our current paradigm.

Excessive Daytime Sleepiness in ADHD Patients - Journal of Clinical Psychiatry 2015
Summary: Patients with ADHD have have more daytime sleepiness and perform poorly on driving test (which require alertness).

Pesticides and ADHD - The FASEB Journal 2015
Summary: In this animal model, low doses of pyrethroid pesticides (such as those used for household pests) were administered to pregnant mice. The offspring demonstrated both behavioral signs of ADHD and neurobiological findings similar to human ADHD patients compared to controls.

Phthalates and ADHD - Psychological Medicine 2015
Summary: Phthalates, a groups of chemicals released from soft plastics that are often used in food storage, are found in higher concentrations in children with ADHD, especially boys.

Phthalates in IV Tubing is a Risk Factor for Later ADHD Development - Intensive Care Medicine 2016
Further evidence of the association between childhood exposure to phthalates and later development of ADHD. This paper looked at the risk conferred by phthalates transmitted by IV tubing in the pediatric intensive care unit. The comparison of children exposed to unexposed, healthy children found a much higher incidence of ADHD in exposed.

Nerve Stimulation as a Treatment for ADHD - Brain Stimulation 2015
Summary: in this pilot study examining feasibility and safety, stimulating the trigemminal nerve (a nerve in the face) seemed to be safe and effective for improving ADHD symptoms in children. The authors caution that this is preliminary data and needs further investigation before the treatment can be recommended broadly.

Stimulants Activate the Inferior Frontal Cortex - Biological Psychiatry 2014
Reviews the neurobiology of stimulants effects on the brain.

ADHD Medications Do Not Produce Cardiac Complications in Adults - JAMA 2011
Summary: Previous studies have suggested an increased incidence of adverse cardiovascular events in people taking stimulants (heart attack, sudden cardiac death, stroke.) In this large patient sample spanning almost 20 years, they found no increased risk of these three measures in patients taking amphetamines (Adderall, Dexedrine, etc.), Methylphenidate (Ritalin, Concerta, Focalin, etc.), and Strattera.

Increased Emotional Difficulties in ADHD - Psychological Medicine 2014
Summary: As compared with non-ADHD controls, individuals with ADHD have more frequent episodes of feeling angry or irritable. This appears to be mediated by both an increased incidence of adverse events as well as a greater sensitivity to these emotional states. Once in a negative emotional state, the ADHD individuals took longer to return themselves to a state of feeling better than the non-ADHD participants.

Ritalin in Pregnancy - Journal of Clinical Psychiatry 2016
Summary: Children born to mothers who had used Ritalin during pregnancy did not have a higher incidence of birth defects. In this case birth defects were defined as major structural abnormalities. It did not assess for whether the children had a higher incidence of psychiatric disorders.

Irritability with Stimulant Use - Journal of Clinical Psychiatry 2017
Summary: This meta-analysis found that amphetamine preparations were associated with higher degrees of irritability in children compared to placebo. Ritalin was associated with lower irritability scores than placebo.

Ritalin Effects in Children vs Adults - JAMA Psychiatry 2016
Summary: in this randomized, controlled study, Ritalin was associated with increased blood flow to brain regions believed to be associated with attention problems in children, but not adults. This, in conjunction with the irritability study listed above, supports what many clinicians have noted in practice, which is that Ritalin seems to work better in children and ampthetamines better in adults.