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.
"I think the Wilens' study is a good study, although further work is needed," Edward D. Levin, PhD, of Duke University Medical Center in Durham, N.C., tells WebMD. "Our findings are quite similar. We've done a few studies looking at the effects of the nicotine skin patch on attentiveness in adults with ADHD, schizophrenia, and Alzheimer's patients and found significant improvement in attentional performance in all those groups."
Levin says that nicotine stimulates the release of dopamine, which may mean that nicotine's effects may be similar to that of Ritalin or amphetamine, which has also been used to treat ADHD. Dopamine is a chemical in the brain that is responsible for aiding in the transmission of nerve impulses and has been identified as one of the important chemicals in ADHD. Evidence suggesting a role for nicotine in ADHD comes from studies which show that the smoking rate for adults with ADHD is double that seen in the general population and that people with ADHD smoke at an early age. "They may be smoking to self-medicate their symptoms of inattentiveness," says Levin.
"In no way am I recommending that any one take up or keep smoking. ... Actually, providing some nicotinic therapy might help prevent these people from taking up smoking for self-medication," Levin tells WebMD. "Nicotine has gotten a bad name in terms of being the drug in tobacco which underlies tobacco addiction. Nicotine itself or some of these nicotinic agonists hold great promise for therapeutics."
Wilens' research was funded by Abbott Laboratories, the nicotine patch manufacturer.
- For adults who suffer from moderate ADHD, the nicotine patch could be an alternative treatment to Ritalin or antidepressants.
- The nicotine patch will not ever replace these other drug options, but further study is needed to determine who could benefit and what the dosage should be.
- The rate of smoking among people with ADHD is double that of the general population, leading one researcher to suggest they may be attempting to self-medicate.