Methylphenidate helps ease adult ADHD

By Larry Hand

NEW YORK (Reuters Health) - In adults with attention-deficit/hyperactivity disorder (ADHD), group therapy did not outperform individual psychological treatment, but each intervention worked better when combined with methylphenidate, researchers say.

"The combination of psychological treatment with methylphenidate is more effective than psychological treatment. Specific group psychotherapy (under investigation) is not superior to individual clinical management," Dr. Alexandra Philipsen, of the University of Oldenburg School of Medicine and Health Sciences in Germany, told Reuters Health by email.

But, she added, in this study "the psychological interventions combined with placebo (also) displayed improvements after one year (which cannot be automatically expected in a lifetime condition). Thus, in some patients with contraindications (or reservations) against methylphenidate, both clinical management and group psychotherapy might be worth trying," she said.

Dr. Philipsen and colleagues recruited adults with ADHD, ages 18 to 58, from seven German treatment centers.

The final analysis covered 419 patients randomly assigned to group psychotherapy with methylphenidate or placebo, or individual counseling plus methylphenidate or placebo.

Methylphenidate was started at 10 mg/d and titrated up to 60 mg/d over six weeks. Maximum dosage reached 1.3 mg/kg of body weight.

Group psychotherapy consisted of 12 weekly sessions followed by 10 monthly sessions over a year. In the control arms, participants received nonspecific counseling sessions of 15-20 minutes each.

After three months, the ADHD Index all-group baseline mean of 20.6 improved to adjusted means of 17.6 for group therapy and 16.5 for individual counseling, with no significant difference between groups, according to the article online November 4 in JAMA Psychiatry.

However, symptoms decreased significantly at 12 weeks in patients who received methylphenidate instead of placebo, with ADHD Index score differences amounting to -1.7 and -0.4, respectively, (p=0.003).

Treatment effects remained stable at one year.

Researchers found no significant differences in depression among all four arms.

As for Clinical Global Impression (CGI) scores, group psychotherapy performed better than individual management but the difference was significant only at one year.

Although individual counseling appeared to be better than group psychotherapy after three months, "CGI global assessments of effectiveness of the interventions were significantly better for (group therapy) at all measurement times. This is remarkable because this scale represents more general measures of well-being (e.g., improved acceptance, self-esteem, coping skills), which were the focus of (group therapy)," the researchers wrote.

The researchers acknowledge that their results "may not be generalizable to routine care settings in which comorbidities are not excluded and patients may have more psychosocial impairments or difficulties meeting the time and effort requirements for this trial."

"We cannot answer what this really means for patients in their daily life," Dr. Philipsen told Reuters Health. "Further studies should have a closer look on the effects of treatments on daily life functioning. A relevant part of patients could not be reached with treatments offered in our outpatient services."

"Lower-threshold treatment options, such as home visits and phone/web assisted interventions, should be investigated. We haven't finished data analysis. Now we want to find out whether a particular patient with ADHD benefits from a particular treatment," she said.

The German Federal Ministry of Research and Education funded this research.

SOURCE: http://bit.ly/1kaISGq

JAMA Psychiatry 2015.

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