Shared and drug-specific effects of atomoxetine and methylphenidate on inhibitory brain dysfunction in medication-naive ADHD boys
Open accessAbstract
The stimulant methylphenidate (MPX) and the nonstimulant atomoxetine (ATX) are the most commonly prescribed medications for attention deficit hyperactivity disorder (ADHD). However, no functional magnetic resonance imaging (fMRI) study has as yet investigated the effects of ATX on inhibitory or any other brain function in ADHD patients or compared its effects with those of MPX. A randomized, double-blind, placebo-controlled, crossover pharmacological design was used to compare the neurofunctional effects of single doses of MPX, ATX, and placebo during a stop task, combined with fMRI within 19 medication-naive ADHD boys, and their potential normalization effects relative to 29 age-matched healthy boys. Compared with controls, ADHD boys under placebo showed bilateral ventrolateral prefrontal, middle temporal, and cerebellar underactivation. Within patients, MPX relative to ATX and placebo significantly upregulated right ventrolateral prefrontal activation, which correlated with enhanced inhibitory capacity. Relative to controls, both drugs significantly normalized the left ventrolateral prefrontal underactivation observed under placebo, while MPX had a drug-specific effect of normalizing right ventrolateral prefrontal and cerebellar underactivation observed under both placebo and ATX. The findings show shared and drug-specific effects of MPX and ATX on performance and brain activation during inhibitory control in ADHD patients with superior upregulation and normalization effects of MPX.
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In the authors' four fMRI studies comparing single dosages of methylphenidate and atomoxetine versus placebo on brain activation in children and adolescents with ADHD, reduced activation in frontal, parietal, temporal, and insular-striatal regions during cognitive tasks can be increased (and even normalized) by both stimulant and non-stimulant medications.
“Thus, in our four fMRI studies comparing the effects of single dosages of methylphenidate and atomoxetine versus placebo on brain activation in children and adolescents with ADHD (45, 85–87), we found that reduced activation in frontal, parietal, temporal, and insular-striatal regions during cognitive tasks can be increased (and even normalized) by both stimulant and non-stimulant medications.”
From Differential effects of a single dose of Lisdexamfetamine and Guanfacine on cognitive function in children with ADHD (2025) · cites this paper as [85]
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Experimental — accuracy not yet measuredAcute methylphenidate normalized the underactivation in right IFC in ADHD patients under placebo compared with healthy control subjects during inhibition and timing processes.
“Furthermore, acute methylphenidate normalized the underactivation in right IFC that was observed in ADHD patients under placebo compared with healthy control subjects during inhibition and timing processes [see also 23, 24], which has also been observed previously during interference inhibition (17), motor inhibition 18, 23, WM (72), and TD (4) (Table S2 in Supplement 1).”
From Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis (2014) · cites this paper as [23]
The Discussion reports that methylphenidate normalized right ventrolateral prefrontal cortex (right inferior frontal cortex) underactivation in ADHD boys relative to healthy controls during a motor-inhibition task. The Methods describe a stop task, not a timing-process task, so this source does not support the timing portion of the claim. Page numbers are not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe active compared to the control group showed significantly enhanced activation in rIFC in the Stop task after fMRI-NF training compared to before, comparable to rIFC upregulation effects previously observed with stimulant medication during the same task.
“Furthermore, the active compared to the control group showed significantly enhanced activation in rIFC in the Stop task after the fMRI-NF training compared to before, comparable to the rIFC upregulation effects we have previously observed with stimulant medication during the same task (Rubia et al., 2011b, 2014b; Cubillo et al., 2014).”
From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Cubillo et al., 2014
ROI fMRI studies found methylphenidate significantly enhanced right IFC activation during motor inhibition.
“but significantly enhanced right IFC activation during motor inhibition (23)”
From Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis (2014) · cites this paper as [23]
The ACC/SMA cluster reduction in the stop task analysis was partly due to increased deactivation with methylphenidate (more activation during the go condition).
“However, a similar cluster in our stop task analysis (Table 3) was partly due to increased deactivation with methylphenidate (i.e., more activation during the go condition) (Figure S4 in Supplement 1), which was also observed in the ROI analysis (23) and other studies 19, 20, 74.”
From Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis (2014) · cites this paper as [23]
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Liddle (2001) · doi:10.1002/1097-0193(200102)12:2
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“and timing processes [see also (23,24)], which has also been observed previously during interference inhibition (17), motor inhibition (18,23), WM (72), and TD (4) (Table S2 in Supplement 1).”
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Self-citation
- Authors
- Cubillo, A., Smith, A. B., Barrett, N., Giampietro, V., Brammer, M. J., Simmons, A., & Rubia, K.
- Affiliations
- King's College London (GB)
- Corresponding author
- Rubia, Katya
- Venue
- Cerebral Cortex
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-10-09
- Volume
- 24
- Issue
- 1
- Pages
- 174-185
- ISSN
- 1047-3211 (ISSN-L)
- 1460-2199
- PMC
- PMC3862268
- OpenAlex
- W2141333481
- Cited by
- 116
- References
- 92
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 8 · 2023: 7 · 2022: 6 · 2021: 7 · 2020: 8 · 2019: 6 · 2018: 11 · 2017: 8 · 2016: 10 · 2015: 11 · 2014: 16 · 2013: 9
- FWCI
- 8.18
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Cerebral Cortex (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by-nc)
- Funders
- National Institute for Health and Care Research
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- atomoxetine, methylphenidate, attention deficit hyperactivity disorder, inhibitory control, stop-signal task, ventrolateral prefrontal cortex, cerebellum, brain activation
- MeSH terms
- Atomoxetine Hydrochloride, Adolescent, Central Nervous System Stimulants, Analysis of Variance, Attention Deficit Disorder with Hyperactivity, Brain, Catecholamines, Child, Data Interpretation, Statistical, Double-Blind Method, Humans, Image Processing, Computer-Assisted, Inhibition, Psychological, Intelligence Tests, Magnetic Resonance Imaging, Male, Methylphenidate, Movement, Neuropsychological Tests, Propylamines, Psychomotor Performance, Case-Control Studies, Prefrontal Cortex, Cross-Over Studies, Adrenergic Uptake Inhibitors
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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