New ADHD Medication Affects Sleep Less

Strattera May Be Better Treatment Option for Children With Tics

From the WebMD Archives

Oct. 23, 2003 -- In one of the first studies to compare Strattera, the first non-stimulant to treat ADHD, with the ADHD medication Ritalin, researchers found that Strattera caused fewer sleep disturbances. And Strattera may work better in kids who also have a tic disorder.

"Strattera is being used by people who don't want to even start on a stimulant, and also for children who haven't done well on them or have had side effects," Stephen Hinshaw, PhD, professor of psychology at the University of California at Berkley, tells WebMD. He was not involved in the current studies.

But new research suggests that it may be the best treatment option for some other patients as well.

Fewer Sleep Disturbances

As many as 40% of kids treated with a stimulant ADHD medication experience troubling side effects, says psychiatric drug expert Joseph Biederman, MD. Common problems include sleep disturbances, loss of appetite, and jitteriness.

Biederman is professor of psychiatry at Harvard Medical School and chief of the pediatric psychopharmacology research program at Massachusetts General Hospital. He was not involved in this study but has done other Strattera research funded by the drug's manufacturer, Eli Lilly and Company, a WebMD sponsor.

"Stimulants are very effective medications for ADHD, but for many people this comes at a high price," he tells WebMD.

A study presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry was one of the first to compare Strattera and Ritalin head to head. The study was funded by Lilly.

Once-daily Strattera was compared with Ritalin taken three times a day in 75 children aged 6 to 14. Each child took one of the ADHD medications for six weeks, followed by a two-week period with no medication, and then another six-week period of taking the other ADHD medication. Neither the researcher nor the study participants knew which medication the children were taking.

Both ADHD medications effectively controlled symptoms in a group of 75 children, but Strattera caused fewer sleep disturbances.

Researchers also concluded that Strattera "may have some advantages in controlling (ADHD) symptoms early in the morning."

A common complaint about Strattera is that it causes sedation, but Biederman says daytime sleepiness can usually be avoided by giving the drug at night.


ADHD Medications and Tics

Tic disorders are another troubling area when it comes to treating kids with ADHD medications. Between 10% and 30% of children with ADHD also have tic disorders, and as many as 60% of those with Tourette's syndrome -- a condition characterized by repeated, involuntary motor and verbal tics -- also have a diagnosis of ADHD.

In a second study, also presented at the child and adolescent psychiatry meeting, McCracken and colleagues reported on 148 children and teens with tic disorders and ADHD treated with either Strattera or placebo for 18 weeks. Strattera effectively relieved ADHD symptoms without worsening tics. The study was also sponsored by Lilly.

ADHD researcher James T. McCracken, MD, tells WebMD that the stimulants used to treat ADHD worsen tic symptoms in roughly a third of cases.

"These patients [with tics disorders and ADHD] have remained a challenging subgroup of patients to treat," McCracken says. "Stimulants can worsen tics, and the medications commonly prescribed to suppress tics don't do much to treat ADHD."

Alternative Treatment

It is estimated that between 3% and 7% of school-aged children and 4% of adults in the U.S. -- more than 8 million people -- have ADHD.

Biederman says many children are not receiving ADHD medication because their parents don't want to put them on stimulants, and many adults avoid treatment for the same reason.

Unlike Ritalin and other stimulants, Strattera is not a controlled drug and there is little potential for abuse. This makes it an obvious choice for treating patients with histories of drug abuse.

"Having an effective alternative to stimulants could make a big difference in the treatment of ADHD," Biederman says. "I would not switch patients who are doing well on Ritalin or the other stimulants, but I would certainly switch those who are struggling with them. And there is a large segment of the population who will not take stimulants or put their children on them no matter how effective they are."

Since its launch early this year, more than 2 million prescriptions have been written for Strattera, according to Lilly.


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SOURCES: 50th Anniversary Meeting of the American Academy of Child and Adolescent Psychiatry, Miami Beach, Fla., Oct. 14-19, 2003. Jeff Newcorn, MD, department of psychiatry, Mount Sinai Medical Center, New York. James McCracken, UCLA Neuropsychiatric Institute, Los Angeles. Joseph Biederman, MD, chief of clinical research, pediatric psychopharmacology, Massachusetts General Hospital; professor of psychiatry, Harvard Medical School.
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