Immediate-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults
Tamir Epstein1, Nikolaos A Patsopoulos, Mark Weiser
1Department of Psychiatry, The Chaim Sheba Medical Center, Affiliated to the Tel-Aviv University,, Sackler School of Medicine,, Tel Hashomer, Israel, 52621.
The Cochrane Database of Systematic Reviews
|September 19, 2014
Summary
Immediate-release methylphenidate effectively treats adult attention deficit hyperactivity disorder (ADHD) symptoms, including hyperactivity, impulsivity, and inattentiveness. While generally safe, potential side effects like appetite loss warrant consideration in short-term treatment.
Area of Science:
- Clinical Psychiatry
- Pharmacology
- Evidence-Based Medicine
Background:
- Attention deficit hyperactivity disorder (ADHD) symptoms often persist into adulthood, leading to significant functional difficulties.
- Adult ADHD is associated with a high comorbidity of psychiatric issues and challenges in academic, social, and occupational functioning.
- Limited research exists on the efficacy of immediate-release methylphenidate in adults, with varying results.
Purpose of the Study:
- To evaluate the efficacy and tolerability of immediate-release methylphenidate compared to placebo in adult ADHD treatment.
- To synthesize evidence from randomized controlled trials on methylphenidate for adult ADHD.
Main Methods:
- Systematic search of multiple databases (CENTRAL, MEDLINE, EMBASE, PsycINFO, DARE) and trial registers up to November 2013.
- Inclusion of all randomized trials comparing immediate-release methylphenidate with placebo in adults (≥18 years) diagnosed with ADHD.
- Independent data extraction and risk of bias assessment by two reviewers, with efforts to obtain missing data.
Main Results:
- Immediate-release methylphenidate demonstrated significant improvement in core ADHD symptoms: hyperactivity (SMD -0.60), impulsivity (SMD -0.62), and inattentiveness (SMD -0.66).
- Overall clinical improvement in adults with ADHD was observed, with a standardized mean difference (SMD) of -0.72.
- Most studies were high-quality evidence, though inattentiveness data had moderate quality. Adverse effects were generally mild, with loss of appetite being most common; cardiovascular effects were not clinically significant.
Conclusions:
- Randomized controlled trials indicate that immediate-release methylphenidate is effective for treating adult ADHD symptoms and improving overall clinical condition.
- Adverse effects associated with immediate-release methylphenidate in adults with ADHD do not appear to be of serious clinical significance.
- The short duration of included studies may limit definitive conclusions on long-term adverse effects, such as weight loss.
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