Farmakologisk långtidsbehandling vid ADHD : Hur skiljer sig substanserna metylfenidat, lisdexamfetamin och atomoxetin?
Sammanfattning: Attention Deficit Hyperactivity Disorder (ADHD) is a neuropsychiatric disability characterised by difficulties in paying attention, excessive activity and actions without thinking about the consequenses. Symptoms vary among different individuals in how the disability expresses. Symptoms also vary among different age groups. The cause of ADHD is not yet known, but the main theory seems to be due to disturbed dopaminergic transmisson in the regions of the brain that controlls attention, activity control and impulses. Clinical studies show that there seems to be a connection between the etiology of the disability and genetic- and environmental factors. ADHD can’t be cured but a multimodal treatment has been proven to be effective in symptom reduction. The multimodal treatment consist of psychoeducation, psychotherapy and medical treatment. In Sweden methylphenidate is the first choise of drug and if it is not tolerated well by patients in terms of respons or side effects lisdexamfetamine or atomoxetin is choosen. The mechanism of action for these three substances is not completly known but in general they presume to block the reuptake of dopamine and norepinephrine in the presynaptic neurons. This leads to an enhanced transmission at the dopaminergic neurons that in turn stimulates the executive funtions that seem to be deficient in ADHD patients. The aim of this literature study is to investigate how the three substances methylphenidate, lisdexamfetamine and atomoxetine differ in therapeutic effects and side effects profile during long-term treatment for ADHD. Five scientific articles were choosen from the database Pubmed, which analysed the therapeutic effects and side effects of the above choosen drugs during a period of atleast 24 weeks. Participants in the selected studies had a definite diagnosis of ADHD and the participants included were children, adolescents and also adults. Therapeutic efficiency of selected drugs was measured by using different diagnostic scales such as ADHD-RS-IV, CAARS-Inv:SV, AISRS, CGI-S or CGI-I. Therapeutic efficiency was measured by the total reduction of the mean value in the rating scale from start to end of the study. Safety was measured at each follow up session by evaluating the side effects profile and measurements of vital parameters. These studies show statistically significant symptom reductions for all three selected drugs. The results also show differences in therapeutic effects among different drugs. Participants treated with lisdexamfetamine showed greater symptom reduction and thereby the greatest effect. There may be a difference in therapeutic effect between methylphenidate and atomoxetine but more studies are needed to conclude the results. The adverse effects were similar between lisdexamfetamine and methylphenidate but more serious effects were found during treatment with lisdexamfetamine.
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