■兴奋剂,包括哌醋甲酯和安非他明,是成人ADHD的一线药物治疗。然而,在对兴奋剂无反应或耐受性差的患者中,通常推荐非兴奋剂药物。
■作者对成人多动症非兴奋剂治疗的文献进行了叙述性综述,包括对成人样本进行的对照和观察性临床研究。阿托莫西汀已被广泛研究并在治疗成人ADHD方面显示出显著疗效。与剂量有关的问题,治疗持续时间,安全,并总结了在精神病合并症中的应用。在其他用于成人ADHD的化合物中,抗抑郁药共享至少一种去甲肾上腺素能或多巴胺能成分,包括三环化合物,安非他酮,还有维洛嗪,已显示出可证明的功效。抗高血压药也有证据,尤其是胍法辛,以及美金刚,美他多辛,和情绪稳定剂,虽然加兰他敏出现了负面发现,抗精神病药,和大麻素。
■根据临床指南,托莫西汀可能是成人多动症患者唯一的二线选择,根据合并症和ADHD特征,为了个性化治疗,其他几种非兴奋剂化合物也可有效使用.然而,需要进一步的研究来确定和测试针对ADHD成人的更多个性化治疗策略.
UNASSIGNED: Stimulants, including methylphenidate and amphetamines, are the first-line pharmacological treatment of ADHD in adults. However, in patients who do not respond or poorly tolerate stimulants, non-stimulant medications are usually recommended.
UNASSIGNED: The authors provide a narrative review of the literature on non-stimulant treatments for adult ADHD, including controlled and observational clinical studies conducted on adult samples.
Atomoxetine has been extensively studied and showed significant efficacy in treating adult ADHD. Issues related to dosing, treatment duration, safety, and use in the case of psychiatric comorbidity are summarized. Among other compounds indicated for ADHD in adults, antidepressants sharing at least a noradrenergic or dopaminergic component, including tricyclic compounds, bupropion, and viloxazine, have shown demonstratable efficacy. Evidence is also available for antihypertensives, particularly guanfacine, as well as memantine, metadoxine, and mood stabilizers, while negative findings have emerged for galantamine, antipsychotics, and cannabinoids.
UNASSIGNED: While according to clinical guidelines,
atomoxetine may serve as the only second-line option in adults with ADHD, several other nonstimulant compounds may be effectively used in order to personalize treatment based on comorbid conditions and ADHD features. Nevertheless, further research is needed to identify and test more personalized treatment strategies for adults with ADHD.