Amphetamine was first synthesised in 1889 by Edeleano. The
benzedrine inhaler, which contained 250 mg of amphetamine sulphate,
was introduced as a nasal and bronchial decongestant in 1932 by the
Smith Kline and French pharmaceutical company. These inhalers
unsurprisingly became very popular and were frequently misused.
Amphetamine was first produced in tablet form in 1935, at which
time it was marketed as a treatment for narcolepsy. In 1937,
Charles Bradley published his paper "The behaviour of children
receiving benzedrine". In it, he described his serendipitous
observations that stimulant medications could ameliorate a range of
symptoms that we now recognise as the core symptoms of ADHD.
His paper makes interesting reading and has been helpfully
reprinted as an appendix to a recent book (
Solanto et al, 2001). There are now two
stimulants, methylphenidate and dexamphetamine, licensed for the
treatment of ADHD in the UK and a further two, adderall and
pemoline, approved for use in the USA. No entirely new
psychostimulant has been licensed in the past 20 years. There have
been advances in recent years, however, with the licensing of
several effective modified release stimulant preparations in the US
and one (Concerta-XL) in the UK.
Several nonstimulant preparations have been used to treat
ADHD. These include the tricyclic antidepressants, buproprion
clonidine and guanfacine (
Biederman
& Spencer, 2000). Other drugs that have some limited
support for use are the monoamine oxidase inhibitors, buspirone and
venlafaxine. The SSRIs and typical and atypical antipsychotics are
not useful in treating ADHD. When each of these drugs is mentioned,
there should be a hyperlink to the relevant part of the drug-based
information (these would obviously be entered in the processing
phase for the website).
Several new non-stimulant preparations have been trailed for
use in ADHD recently;
- Atomoxetine (a specific noradrenaline reuptake inhibitor which,
as tomoxetine, failed trials as an antidepressant) has been shown
to be effective and safe in treating both adults (Spencer et al, 1998) and
children (Michelson et
al, 2001; Spencer et
al, 2001) with ADHD and also to have a low abuse
potential.
- There has also been recent work exploring the effects of
nicotinic drugs in adult ADHD.
- A small open trial of nicotine patches (Conners et al, 1996; Levin et al, 1998) and
- An exploratory RCT of ABT-418 a CNS nicotinic agonist, also
delivered via a transdermal system (Wilens et al, 1999), both
reported positive results.
It therefore seems likely that in the next few years, several
non-stimulant options for treating ADHD may become available.