Present and future pharmacotherapeutic options for adult attention deficit/hyperactivity disorder

Attention deficit/hyperactivity disorder (ADHD) is often a lifelong condition. When untreated or undertreated, it appears to have a deleterious impact upon the daily functioning of the majority of adults that were diagnosed with this condition during childhood. Effective treatment, under the best circumstances, is multi-modal. The recent MTA study staged by the United States government confirmed the primary role of psychostimulants for children with this condition. The findings from this study have been generalised to adults that also have ADHD, particularly in cases where there is a well-defined longitudinal history dating back to early childhood. Psychostimulants remain a viable first-choice strategy for adults with ADHD. There are idiosyncratic differences in response to the various psychostimulants for any given individual with ADHD. Furthermore, the emergence of long-acting, once daily psychostimulant medications is likely to improve the calibre of care for adults with ADHD. A number of alternative pharmacotherapies have been studied, or are being developed, for adults with ADHD. These pharmacotherapies include antidepressant medications that affect dopaminergic and noradrenergic bioavailability, as well as cholinergic agents. In addition, agents that manipulate histaminergic and glutaminergic receptors are being studied as possible non-stimulant alternatives in the management of adult ADHD. More information is needed before any definitive statements can be made concerning the feasibility and utility of these non-stimulant medication approaches.