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A network meta-analysis published in the Lancet looks at pharmacological, psychological, and neurostimulatory interventions for ADHD in adults.
Prof Philip Shaw, Director, King’s Maudsley Partnership for Children and Young People, and Professor, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, said:
“There are several take home points from this study, which used a very clever approach to pool and contrast different types of ADHD treatments. First, the study shows that there are effective interventions for adults living with ADHD who are looking for ways to reduce any unwanted impact from symptoms. The clearest benefit was seen for medications, both as experienced by the individual and as observed by a clinician. The downside was that some medications had troublesome side effects, though this wasn’t the case for psychostimulants, which are the most widely used medication. There were benefits from other approaches, such as therapies that boost cognitive skills or mindfulness, but these were more apparent to the clinician than the individual.
“The study highlights three big gaps in our knowledge. Most of the treatment trials considered lasted less than 3 months: so, it’s hard to be sure about how long benefits might last. The study also didn’t look at combined approaches, for example, where medication is used alongside cognitive treatments. The last gap is mentioned in the study: we don’t yet know how to match the best treatment to the individual. We can only make this major advance if we identify the underlying features that explain why individuals differ in how they respond to different treatment approaches. This would allow a more ‘personalized’ treatment approach.”
Prof Roi Cohen Kadosh, Head of School of Psychology and Professor of Cognitive Neuroscience, University of Surrey, said:
“This paper is a valuable contribution to the literature, shedding light on both the scarcity of neurostimulation research and the limited exploration of combined treatment approaches for ADHD. While novel neurostimulation methods linked to neuroplasticity—such as those we have demonstrated to be superior in children with ADHD—were not covered here, they have shown promising and lasting benefits. In contrast, research in adults remains relatively underdeveloped. Moving forward, greater emphasis on innovative, tolerable, personalised, and sustainable neurostimulation approaches is essential to meet the unmet clinical needs of adults with ADHD”
Prof Katya Rubia, Professor of Cognitive Neuroscience, Kings College London, said:
“This study is the first large network meta-analysis comparing medication and non-medication treatments for adult ADHD showing conclusive beneficial effects for medication treatments only.
“However, it needs to be taken into account that far more studies were available for medication (63 studies) than for non-pharmacological treatments. For example, for neurostimulation, only 10 studies were included and on very heterogenous stimulation methods. The evidence on the efficacy of neurostimulation is therefore hardly conclusive and more studies are needed to establish their efficacy.
“It is also important to stress that the network meta-analysis shows only evidence for short-term efficacy of medications, while longer-term efficacy cannot be established as yet because it is under-researched.
“Last, from the perspective of individual patients, these are group statistics on small number of studies in the case of non-pharmacological treatments and individual patients may benefit from some of the non-pharmacological treatments or prefer treatments with less side effects even if they have smaller effects. More research is needed on which treatments work for who.”
Dr Celso Arango, Director at the Institute of Psychiatry and Mental Health and Chair of the Department of Child and Adolescent Psychiatry at Hospital General Universitario Gregorio Marañon, said:
“This is the first network meta-analysis (NMA) to compare pharmacological, psychological, and neurostimulatory interventions for ADHD in adults, including more than 14,500 participants. The methodology employed in this component NMA is robust, though, as with any meta-analysis, its validity depends on the quality of the included studies.
“The analysis highlights a clear shortage of research on ADHD in adulthood, particularly regarding medium-term (beyond 12 weeks) and long-term treatment outcomes. Consequently, the findings are applicable only to short-term treatment. Notably, the study is highly relevant, as it was co-developed with individuals who have lived experience of ADHD.
“The results suggest that pharmacological treatments are more efficacious than psychological or neurostimulatory interventions alone when compared to placebo, especially when assessed by patients themselves. However, in terms of acceptability, atomoxetine and guanfacine demonstrated less favorable profiles.
“One significant limitation is that the combined approach of pharmacological treatment plus psychological or other interventions was not assessed.”
‘Comparative efficacy and acceptability of pharmacological, psychological, and neurostimulatory interventions for ADHD in adults: a systematic review and component network meta-analysis’ by Ostinelli et al. was published in Lancet Psychiatry at 23:30 UK time on Tuesday 17th December.
Declared interests
Prof Philip Shaw None
Prof Katya Rubia “I have a grant from TAKEDA.”
Dr Celso Arango “Dr. Arango has been a consultant to or has received honoraria or grants from Abbot, Acadia, Ambrosetti, Angelini, Biogen, BMS, Boehringer, Carnot, Gedeon Richter, Janssen Cilag, Lundbeck, Medscape, Menarini, Minerva, Otsuka, Pfizer, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion, Takeda and Teva. None of these honoraria or grants is related to ADHD.”
For all other experts, no reply to our request for DOIs was received.