A new candidate for ADHD medication: Amantadine and the rise of non-stimulants

It is well known that ADHD diagnoses and substance abuse problems are closely associated. It is estimated that substance abuse problems including dependence are up to twice as common among individuals with ADHD, which is not surprising given the impulsivity factor involved in ADHD. The problem is that until recently, most medications for ADHD have belonged to the stimulant category and as many, including us, have written before it is probably not the best idea ever to give drugs that have a relatively large abuse probability to people who are relatively likely to develop substance abuse problems. Right?

We’ve already written about atomoxetine and bupropion, two drugs with relatively low abuse potential (since patients don’t actually feel “high” from them) that are being successfully used in treating ADHD. But there is little doubt that the type of effect seen among patients who are using stimulants (like adderall, ritalin, etc.) isn’t being observed among patients taking non-stimulant medications. All of this means that patients on non-stimulants are getting less bang but with less risk. A dopamine agonist by the name of amantadine might change all of that according to a recent study.

Amantadine versus stimulants for ADHD treatment

Fourty children between the ages of 6 and 14 were enrolled in the study conducted in a psychiatric hospital in Iran. The kids were randomized into two groups a methylphenidate (ritalin) and amantadine group. Over a six week period the kids were assessed four times – at intake and then every two weeks -using an instrument that parents and teachers (who didn’t know what medication the kids were getting) would use to rate the child’s behavior on the 18 ADHD symptoms listed in the DSM-IV.

Amantadine may soon offer a new non-stimulant medication option for ADHD treatmentThe final findings were very encouraging (see picture): The kids in both conditions improved greatly over the 6 weeks of the study and no difference was found between the two medications. the children in the amantadine condition actually suffered less side effects and significantly so when looking at side effects common to stimulant medication such as decrease in appetite and restlessness. While more studies are obviously needed, this randomized trial shows that amantadine is not only safe, but it may be safer than at least some stimulant medications while also providing the same effect on ADHD symptoms. Given that approximately 30% of patients don’t respond well to stimulants and that some families are afraid of giving stimulant medications to their children, at least partially because of the risk of substance abuse issues, non-stimulant medications can be an attractive alternative, and it seems like amantadine can deliver.

Final thoughts from Dr. Jaffe on ADHD medications and amantadine

One of the main reservations I have about the notion of using this medication for ADHD is that NMDA receptors are very important in learning, so it may be that we’re helping to resolve attention problems but making it more difficult to actually create memories that are crucial for learning. More research is necessary to see if these decreases in impulsivity are accompannied by improvements, and not reductions, in learning ability.

So, if you’re considering medicating a child who has been diagnosed with ADHD, I strongly support the notion given the difference that medication has made in my own life. However, I urge you to be educated and to consider non-stimulant options, especially as more are researched and as that treatment option becomes more available, less costly, and less likely to lead to abuse of the drug. With prescription drug abuse one of the fastest growing problems in the U.S., being careful is just sound advice.

Citation:

Mohammad-Reza Mohammadi, Mohammad-Reza Kazemi, Ebtehal Zia, Shams-Ali Rezazadeh, Mina Tabrizi, Shahin Akhondzadeh (2010) Amantadine versus methylphenidate in children and adolescents with attention deficit/hyperactivity disorder: a randomized, double-blind trial. Human Psychopharmacology.

Some parkinson work showing effect of amantadine: http://www.springerlink.com/content/76r5wxux8wn52rq5/fulltext.pdf

Monitoring the Future by NIDA: Teen alcohol and drug use data from a national survey

Teen drug useOne of the perks of being an alcohol, drug use, and addiction researcher, as well as of writing for a website like this and Psychology Today, is that sometimes we get to talk to people that most can’t reach or to receive information that others might not have access to. NIDA‘s Monitoring the Future, a national survey of about 50,000 teens between 8th and 12th grades is a huge annual undertaking the results of which will be released tomorrow for general consumption.

But we got a little sneak peek before everyone else.

If you follow this sort of stuff, you know that teen alcohol and drug use is always shifting as new drugs become more popular and others lose favor with that group of Americans that can’t make up their minds. This year seems to give us more of the same.

Monitoring the future: Early alcohol and drug use results

  1. Daily marijuana use, after being on the decline for a short while is apparently rising once again among teens, following last year’s continuing trend of a reduction in teens’ perceptions of marijuana harmfulness – We’ve written on A3 about some of the specific issues relevant to marijuana use including writing about Marijuana’s addictive potential and its medical benefit. There’s no doubt that the national marijuana debate will continue but the idea of 8th graders smoking weed doesn’t seem to be part of anyone’s plan.
  2. Among some groups of teens drug use is proving more popular than smoking cigarettes – I guess this could be taken as evidence of the effectiveness of anti-smoking campaigns, though until we see the full numbers I’m not going to comment any further on that.
  3. While Vicodin use among high-school seniors (12th graders) is apparently down, non-medical use of prescription medications is still generally high among teens, continuing a recent upward trend – Abuse of prescription stimulants has been on the rise for a number of years as the number of prescriptions for ADHD goes up, increasing access. It is interesting to see Vicodin use go down though the data I’ve received says nothing about abuse of other prescription opiate medications such as oxycontin, so I’m not sure if the trend has to do with a general decrease in prescription opiate abuse among teens.
  4. Heroin injection rates up among high-school seniors (12th graders) – I think everyone will agree that this is a troubling trend no matter what your stance on drug use policy. The associated harms that go along with injecting drugs should be enough for us to worry about this, but again, I’ll reserve full judgment until I actually see the relevant numbers. I’m also wondering if this is a regional phenomenon or a more general trend throughout the United States.
  5. Binge drinking of alcohol is down – As we’ve written before, the vast majority of problems associated with the over consumption of alcohol (binge drinking) among high-school students has to do with the trouble they get themselves in while drunk (pregnancies, DUI accidents, and the likes), so this is an encouraging trend though hopefully it isn’t simply accounting for the above mentioned increases in marijuana and heroin use.

Some general thoughts on NIDA’s annual Monitoring the Future results

I am generally a fan of broad survey information because it gets at trends that we simply can’t predict any other way and gives us a look at the overall population rather than having to make an educated guess from a very small sample in a lab. NIDA‘s annual MTF survey is no different although until I get to see all of the final numbers (at which point there will probably be a follow-up to this article) it’s hard to make any solid conclusions. Nevertheless, I am happy to see binge drinking rates among teens going down and if it wasn’t for that pesky increase in heroin injection rates I would say that overall the survey makes it look like things are on the right tracks.

I’ve written about it before and will certainly repeat it again – I personally think that alcohol and drug use isn’t the problem we should be focusing on exclusively since it’s chronic alcohol and drug abuse and addiction that produce the most serious health and criminal problems. Unfortunately, drug use is what we get to ask about because people don’t admit to addiction and harmful abuse because of the inherent stigma. Therefore, I think that it’s important for us to continue to monitor alcohol and drug use while observing for changes in reported abuse and addiction patterns. Hopefully by combining these efforts we can get a better idea of what drugs are causing increased harm and which are falling by the wayside or producing improved outcomes in terms of resisting the development of abuse problems.