BARCELONA – Adults with attention-deficit/hyperactivity disorder who undergo treatment for their most intrusive symptoms also might benefit by having their driving improve.
Most adults with attention-deficit/hyperactivity disorder (ADHD) do not seek treatment because of their driving; most usually want their disorder to intrude less into their work life, education, or relationships. However, a poor driving record is common among ADHD patients. In addition, driving performance improved significantly during treatment with atomoxetine in a controlled study with 43 patients.
These are the first study results to show that atomoxetine treatment can improve driving performance in real traffic in adults with ADHD, Dr. Esther Sobanski said at the annual congress of the European College of Neuropsychopharmacology.
Dr. Esther Sobanski
Atomoxetine, which is approved in the United States and in Europe for treating ADHD in adults and children, also has shown efficacy in controlled studies for treating patients with ADHD and social anxiety disorder (Depress. Anxiety 2009;26:212-21), and partial efficacy for patients with ADHD and alcohol-use disorder (Drug Alcohol Depend. 2008;96:145-54). The drug probably is similar in efficacy and safety to methylphenidate but without methylphenidate’s long clinical track record, Dr. Sobanski said.
"We are trying to figure out whom to treat with atomoxetine and whom to treat with methylphenidate," she said in an interview. "There is no evidence base now, so we are trying to figure out" whether certain types of ADHD patients respond better to one drug or the other.
The study enrolled adults diagnosed with ADHD at an outpatient mental health clinic in Mannheim, Germany, who were 18-50 years old and had a valid German driver’s license. After a 4-week tapering-dosage washout of entry medications, patients underwent baseline testing and then randomized to 18 mg/day atomoxetine or placebo. The atomoxetine dosage gradually ramped up over 4 weeks to 80 mg/day, which continued for 8 weeks until follow-up testing occurred. Enrolled patients averaged about 35 years old.
After 8 weeks of full treatment, the 22 atomoxetine patients showed statistically significant reductions in their average rates of false reactions for three different measures: orientation to traffic, attention to traffic, and driver skills. For each of these, the rate of false reactions fell by more than half, compared with the baseline rate, reported Dr. Sobanski, a psychiatrist at the Central Institute of Mental Health in Mannheim. False reactions by a fourth measure, risk-related self-control, also fell by more than half, but this trend was not statistically significant. In contrast, the placebo group showed virtually no change from baseline by all four measures. The rate of "critical traffic situations" recorded by participants in their daily diaries also fell by about half in the atomoxetine patients but not in the placebo group. Dr. Sobanski and her associates recently published their findings (Eur. Psychiatry 2013;28:379-85).
Prior research documented that adults with ADHD have three to four times more traffic accidents and double the traffic violations (especially speeding) than does the general adult population, Dr. Sobanski said. But driving problems usually are not what bring patients to treatment. "Most patients with ADHD get interventions for other reasons, but our findings show that their driving benefits, too."
The study was funded by Eli Lilly, which markets atomoxetine (Strattera). Dr. Sobanski said she has been an adviser to and received support from Eli Lilly and also from Medice, Shire, and Novartis.
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