CNS Spectrums

Review Articles

Psychopharmacology and psychotherapy for the treatment of adults with ADHD—a systematic review of available meta-analyses

Tais S. Moriyamaa1a2a3 c1, Guilherme V. Polanczyka1a3, Fernanda S. Terzia3, Kauy M. Fariaa3 and Luis A. Rohdea1a4

a1 National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil

a2 Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil

a3 Divison of Child and Adolescent Psychiatry, Department of Psychiatry, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil

a4 Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

Abstract

Objective/Introduction Attention-deficit/hyperactivity disorder (ADHD) in adult life is a prevalent condition. We systematically reviewed the literature available by searching for meta-analyses assessing pharmacological and psychosocial interventions for adults with ADHD.

Methods Using wide-ranging search terms, we retrieved 191 titles from the PubMed and Cochrane databases. Two independent evaluators judged all abstracts. Only meta-analyses about the treatment of adults with ADHD were included. Information from meta-analyses found was systematically extracted by 3 independent evaluators.

Results Eight meta-analyses were identified. Results from those meta-analyses suggest that stimulants are effective in decreasing ADHD symptoms on a short-term basis with a medium to large effect size (ES). Short-acting stimulants might be superior to long-acting stimulants, but no data on difference in adherence are available for the comparison of these two types of formulation. Bupropion is superior to placebo but less effective than stimulants. No conclusions about the impact of psychosocial interventions can be drawn based on meta-analyses so far.

Discussion The efficacy of stimulants in reducing ADHD symptoms for adults is well documented in meta-analyses, but there is a concerning lack of meta-analysis about other treatment interventions.

Conclusion The available meta-analytic literature does not cover questions of essential clinical relevance for adults with ADHD.

(Received January 13 2013)

(Accepted April 08 2013)

(Online publication June 06 2013)

Key words

  • ADHD;
  • adults;
  • inattention;
  • stimulants;
  • treatment

Correspondence

c1 Address for correspondence: Tais S. Moriyama, Instituto Nacional de Psiquiatria do Desenvolvimento, Rua Dr. Ovídio Pires de Campos 785, 3° andar, CEAPESQ, sala 09, CEP 05403-010 - São Paulo, SP, Brazil. (Email taismoriyama@gmail.com)

Footnotes

  Dr. Tais S. Moriyama receives financial support from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil.

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