Selegiline in Comparison with Methylphenidate in Treatment of Adults with Attention Deficit Hyperactivity Disorder: A Double-Blind, Randomized Trial

Article excerpt

Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common mental disorders in childhood and it continues to adulthood without proper treatment. Stimulants have been used in treatment of ADHD for many years and the efficacy of methylphenidate (MPH) in the treatment of adults with ADHD has been proven to be acceptable according to meta-analysis studies. However, there are some concerns about stimulants. Finding other effective medications for the treatment of adult ADHD seems necessary. We tried a monoamine oxidase inhibitor, Selegiline, as there are some theoretical and experimental evidences for the efficacy of this medication .

Method: Forty patients were randomized to receive Selegiline or methylphenidate in an equal ratio for an 8-week double-blind clinical trial. Each patient filled the CAARS self report screening form before starting to take the medication and in weeks 2-4-6 and 8. Patients were also assessed by a psychiatrist at the baseline and on each 14 days up to the 8 weeks period.

Results: The mean score of the two groups- receiving Selegiline or methylphenidate- decreased over the 8 weeks. There was not a significant difference between the two groups. The most prevalent side-effect of methylphenidate was decrease of appetite and for Selegiline change in sleep pattern .

Conclusion: Selegiline is as effective as methylphenidate in the treatment of adults with Attention-Deficit/Hyperactivity Disorder. Selegiline can be an alternative medication for the treatment of adult ADHD If its clinical efficacy is proven by other larger studies .

Keywords: Adult, Attention deficit disorder with hyperactivity, Methylphenidate, Selegiline,

Iran J Psychiatry 2009; 4:126-130

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common mental disorders in childhood. It affects 3-6% of school-age children (1, 2). Some recent evaluations report the prevalence of 5.3% in childhood (3). The disorder is characterized by symptoms of hyperactivity, impulsivity and inattention. ADHD continues into adolescence and adulthood without treatment in about 60% of the cases. Therefore, the prevalence of the disorder among adults is at least 1-3% (4). Even some studies report the prevalence to be 1.2-7.3%. The estimated prevalence of DSM-IV adult ADHD over ten countries around the world was 3.4%. Prevalence estimates were significantly higher than this average in France (7.3%), U.S (5.2%) and Netherlands (5%); and significantly lower in Colombia (1.9%), Lebanon (1.8%), Mexico (1.9%) and Spain (1.2%) (5).

The following disabilities were found in 30-day functioning associated with adult attention-deficit hyperactivity disorder diability in: self-care, mobility and cognition. The clinical presentation of ADHD often changes with increase in age as the patient moves from childhood to adulthood. The symptoms of inattention and impulsivity are more likely to persist into adulthood than symptoms of hyperactivity. The diagnosis of ADHD in adults might be debatable because before the publication of the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the disorder seemed to apply only to children (6). In addition, the diagnosis of ADHD is dependent on the clinician's experience. Some physicians aren't still well-informed of the manifestations and importance of this disorder in adulthood.

Comorbidity is common among patients with ADHD. In children and especially in adolescents, comorbid disorders are often difficult to recognize ,but the existence of a comorbid condition is correlated with greater likelihood that the symptoms will persist into adulthood. In adults with ADHD, comorbidity of several other psychiatric diagnoses is common and requires broader and more comprehensive treatment goals (7).

Diagnosis of adult ADHD is a longitudinal process requiring the documentation of ADHD symptoms with onset at not older than 7 years of age (pervasive as demonstrated in a variety of settings and severe enough to interfere with school) and occupation and social functioning. …