New ADHD Drugs -- New Problems
"Untreated ADHD has a bad outcome. We should be treating it aggressively," he adds. "There is a problem with overdiagnosing ADHD, but a bigger problem is undertreatment. If the ads are educational, that is good. If they say that one treatment is right for everybody, that is a problem."
Stein says he gets lots of questions from parents who are scared of stimulant drugs -- but who are quite willing to try unregulated herbs and alternative medicines. Nearly half of parents use one of these types of medicine, he says, which are often are marketed as ADHD treatments.
In any case, Swanson says, if there is a rush by parents to get brand-name ADHD drugs, he hasn't seen it.
"Parents aren't willy-nilly putting kids on drugs, that is not my experience at all," he says. "Most parents don't want medications, they want to try something else first. Most parents opt for 10 weeks of behavioral therapy before even trying medications."
Swanson has been deeply involved in clinical trials of many of the new ADHD drugs now approved or still in the final stages of testing. He notes that while Ritalin and other stimulant drugs are effective, they wear off after a few hours, and because the drugs can be abused, they must be locked in the principal's office.
Kids needing a second dose often are embarrassed by having to report to the office for dosing. Another problem is that multiple dosing doesn't give a smooth effect, so the drugs may not be most active when a child needs them. A once-a-day drug smoothes out these peaks and valleys and works evenly throughout the school day.
Here's Swanson's list of new and up-and-coming ADHD medicines:
- Concerta. Already approved and advertised, Concerta pills actually contain a pumping mechanism to deliver measured doses of Ritalin. Each dose lasts 12 hours.
- Metadate-CD. Also approved and advertised, these pills contain Ritalin in special time-release beads. Each dose lasts 8 hours.
- Ritalin-LA. Not yet approved, these pills use a different time-release method for delivering Ritalin. Each dose lasts 8 hours.
- Adderall-XR. Adderall, currently used to treat ADHD, is a mixture of four different types of amphetamine, a powerful type of stimulant. The new XR (extended release) formulation will increase the time of action from 6 to 12 hours.
- Modafinil is a drug now used to treat narcolepsy -- uncontrollable fits of falling asleep. Because the drug improves alertness, it is being explored as an ADHD treatment. The idea is promising -- before being used to treat ADHD, Ritalin was also used to treat narcolepsy.
- Atomoxetine, formerly called tomoxetine. Manufacturer Eli Lilly and Co. hopes this non-stimulant drug will gain approval in 2002. Like Ritalin, it blocks the action of a scavenger that removes a needed chemical from the brain. Unlike Ritalin, it seems to have no abuse potential.
- In an even earlier stage of development is a drug that acts on a completely different part of the brain that is involved in ADHD. The non-stimulant drug, under development by a firm called Gliatech, blocks a brain molecule known as histamine 3. Early studies show that blocking this molecule increases alertness.