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    Trouble Concentrating? A Patch on the Arm Could Help

    WebMD Health News

    Dec. 2, 1999 (New York) -- The nicotine patch -- workhorse of the stop-smoking movement -- may have earned a new job title. The patch may also provide an alternative to Ritalin in treating disorganized, distracted, forgetful adults who have moderate symptoms of Attention Deficit Hyperactivity Disorder (ADHD), according to a report in the December issue of the American Journal of Psychiatry.

    Until now, stimulants like Ritalin and antidepressants have been the standard treatment for ADHD. However, those who take Ritalin can experience abdominal pain and, because the drug can suppress appetite, it often causes weight loss. The most common adverse side effects of the nicotine patch were dizziness, skin irritation, nausea, and headaches.

    "This is the first clinical study of a very different class of [drugs] for this disorder," lead author Timothy E. Wilens, MD, of Massachusetts General Hospital/Harvard Medical School in Boston, tells WebMD. "Since most adults come in for treatment of the cognitive ["attention-related" symptoms] aspects of the disorder, this treatment shows promise," he adds.

    The study involved 32 adults between the ages 19 and 60 -- all diagnosed with ADHD dating back to childhood -- and all with moderate-to-severe levels of impairment. In the study, patients received two patches every morning containing either the nicotine compound or a placebo. The patches were removed at night. There were two 3-week treatment periods separated by a weeklong break without patches.

    The investigators found that 47% of patients responded to the nicotine treatment compared to 22% of the subjects on placebo -- and those with less severe symptoms responded best to the nicotine treatment. All of the nine symptoms of inattention and six of nine symptoms of hyperactivity/impulsivity were significantly improved following treatment with the nicotine patch, compared with five of 18 symptoms that improved with the placebo.

    While the patch won't be a substitute for Ritalin and other ADHD treatments "simply because it's not as robust a response," it provides an alternative, says Wilens. "It may be added to other agents or may be used for subtypes of individuals with ADHD."

    The study was limited by its relatively small size and short duration, Wilens adds. He suggests that future investigations should utilize higher doses, more flexible dosing, and longer treatment trials, especially because people were still continuing to improve at the end of his study.

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