A randomised, double-blind, placebo-controlled trial of dexamphetamine in adults with attention deficit hyperactivity disorder

Objective: The aim of this paper is to determine the efficacy of dexampheta mine in adult attention deficit hyperactivity disorder (ADHD) in a naturali stic setting. Method: A randomised, double-blind, placebo-controlled study of dexamphetam ine was conducted by two psychiatrists in private practice who saw a total of 68 consecutive referrals of patients thought to have ADHD by their refer ring general practitioners. Patients were admitted to the study if their cu rrent level of ADHD symptoms satisfied DSM-IV criteria (modified for use in adults), and were not currently comorbid for major mood disturbance or sub stance abuse. Response to medication was assessed by repeated administratio n of these modified DSM-IV criteria, self- and relatives' rating, as well a s clinician rating using the Clinical Global Impressions Scale. More genera l outcome measures included the Brief Symptom Inventory and a patient satis faction questionnaire. Medication side effects were recorded, including mon itoring blood pressure and weight change. Urinalysis monitored concurrent s ubstance usage and compliance. Results: Dexamphetamine had a significant therapeutic response exceeding th e placebo response (p = 0.045). The response was similar in both genders an d across the age range. it was detected by patients, their relatives and th e two clinicians. The only significant side effect was weight loss. One pat ient on dexamphetamine discontinued the trial because of an event possibly related to the medication. Conclusions: In the short term, dexamphetamine appears to be efficacious in treating adult ADHD. As this is the first study in the literature, the res ult requires replication. Given that stimulant medication use in adult ADHD appears to be long-term, studies of long-term efficacy need to be carried out.