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Effects of Atomoxetine and Methylphenidate on Sleep in Children With ADHD
Abstract
STUDY OBJECTIVES: This study compared the effects of atomoxetine and methylphenidate on the sleep of children with attention-deficit/hyperactivity disorder (ADHD). This study also compared the efficacy of these medications for treating ADHD in these children. DESIGN: Randomized, double-blind, crossover trial. SETTING: Two sleep disorders centers in the United States; 1 in a private-practice setting and 1 in a hospital setting. PATIENTS: 85 children diagnosed with ADHD. INTERVENTIONS: Twice-daily atomoxetine and thrice-daily methylphenidate, each for approximately 7 weeks. MEASUREMENTS AND RESULTS: Relative to baseline, the actigraphy data indicated that methylphenidate increased sleep-onset latency significantly more than did atomoxetine (39.2 vs 12.1 minutes, p < .001). These results were consistent with the polysomnography data. Child diaries indicated that it was easier to get up in the morning, it took less time to fall asleep, and the children slept better with atomoxetine, compared with methylphenidate. Parents reported that it was less difficult getting their children up and getting them ready in the morning and that the children were less irritable, had less difficulty getting ready for bed, and had less difficulty falling asleep with atomoxetine, compared with methylphenidate. There were no significant differences between medications using the main measures of efficacy for ADHD treatment. Atomoxetine was superior on some secondary ADHD treatment-efficacy measures, based on parent reports. The only significant differences in treatment-emergent adverse events were greater incidence of decreased appetite and greater incidence of insomnia with methylphenidate. CONCLUSIONS: Patients receiving twice-daily atomoxetine had shorter sleep-onset latencies, relative to thrice-daily methylphenidate, based on objective actigraphy and polysomnography data. Although both medications decreased nighttime awakenings, the decrease was greater for methylphenidate.
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“However, a review of scientific studies comparing medicated and unmedicated children describes inconsistent outcomes, both for polysomnographic measures and for parental reports [123].”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [123]
In the citing paper
“In a randomized, double-blind, cross-over study comparing the effect of methylphenidate (given thrice daily) and atomoxetine (given twice daily) on the sleep of children with ADHD, methylphenidate increased sleep-onset latency significantly more than did atomoxetine, both considering actigraphic and polysomnographic data [123].”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [123]
In the citing paper
“Both medications decreased night-time awakenings, but the decrease was greater for methylphenidate.”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [123]
In the citing paper
“Moreover, both childrens’ diaries and parents’ reports indicated a better quality of sleep (in terms of “getting ready in the morning”, “getting ready for bed”, “falling asleep”) with atomoxetine, compared with methylphenidate.”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [123]
In the citing paper
“When data on standard deviations were missing, study authors were contacted to provide missing data [18] or it was calculated using the standard error of subgroups or confidence intervals [19-21].”
In the citing paper
“Nine randomized trials comparing methylphenidate and atomoxetine, with a total of 2762 participants were included.”
In the citing paper
“The outcome in three of these trials favoured atomoxetine suggesting that higher doses of atomoxetine administered twice daily may be more effective.”
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A primer on sleeping, dreaming, and psychoactive agents
Csiernik, R., & Pirie, M. (2023) · Journal of Social Work Practice in the Addictions · doi:10.1080/1533256x.2023.2199045
“Unfortunately, the use of even minor amphetamines such as methylphenidate (Ritalin and Concerta) typically given to children and youth diagnosed with ADHD can delay and reduce REM sleep periods (Sangal et al., 2006).”
Nie, T. (2023) · Drugs & Therapy Perspectives · doi:10.1007/s40267-023-01013-0
“However, atomoxetine significantly improved early morning functioning versus methylphenidate IR in a crossover trial [17] and versus baseline in two open-label trials [18] (Table 2).”
BackgroundADHD By Night: Sleep Problems and ADHD Medications
Stein, M. A., Weiss, M. D., & LEVENTHAL, B. L. (2024) · The ADHD Resource Hub · doi:10.1521/adhdhub.2024.2.1.5
Attention Deficit, Hyperactivity, and Sleep Disorders
Wang, G., Bogan, C., Lenker, K. P., Calhoun, S. L., Luebbert, J. F., & Chervin, R. D. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-75566-5.00014-9
Psychotropic Substances and Sleep
Silva, V. (2024) · Springer eBooks · doi:10.1007/978-3-031-72219-6_23
Metadata
- Authors
- Sangal, R. B., Owens, J., Allen, A. J., Sutton, V., Schuh, K., & Kelsey, D.
- Affiliations
- Rhode Island Hospital (US)
- Eli Lilly (United States) (US)
- Corresponding author
- Schuh, Kory
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-12
- Volume
- 29
- Issue
- 12
- Pages
- 1573-1585
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- OpenAlex
- W10589707
- Cited by
- 214
- References
- 0
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 5 · 2023: 4 · 2022: 8 · 2021: 8 · 2020: 7 · 2019: 6 · 2018: 10 · 2017: 10 · 2016: 13 · 2015: 17 · 2014: 7 · 2013: 12 · 2012: 11
- FWCI
- 10.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- SLEEP (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- atomoxetine, methylphenidate, attention deficit hyperactivity disorder, children, sleep latency, actigraphy, polysomnography, insomnia, nocturnal awakenings, adverse events, appetite loss
- MeSH terms
- Atomoxetine Hydrochloride, Adolescent, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Dose-Response Relationship, Drug, Double-Blind Method, Electrophysiology, Female, Humans, Male, Methylphenidate, Propylamines, Sleep, REM, Cross-Over Studies, Adrenergic Uptake Inhibitors
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