Atomoxetine and Adult Attention-Deficit/Hyperactivity Disorder: The Effects of Comorbidity
Abstract
OBJECTIVE: The objective of this study was to determine if measures of broad clinical psychopathology or neuropsychological performance could aid in the prediction of therapeutic response to the highly selective norepinephrine transporter inhibitor, atomoxetine, among adults with attention-deficit/hyperactivity disorder (ADHD). METHOD: We analyzed data from 2 double-blind, placebo-controlled, parallel design studies of adult patients (Study I, N = 280; Study II, N = 256) with DSM-IV-defined ADHD who were recruited by referral and advertising. Subjects were randomly assigned to 10 weeks of treatment with atomoxetine or placebo and were assessed with Conners' Adult ADHD Rating Scales (CAARS), the General Well-Being Schedule (GWB), the Sheehan Disability Scale, the Stroop Color-Word Test (SCWT), and the Structured Clinical Interview for DSM-IV (SCID) before and after treatment. RESULTS: Therapeutic improvement on atomoxetine as evidenced by reduced CAARS scores was reliably predicted by the presence of a lifetime comorbid diagnosis of depression or post-traumatic stress disorder at baseline, while improvement on subscales of the GWB and Sheehan Disability Scale were predicted by these and other SCID endorsements, such as alcohol and substance use, as well as demographics such as age and gender. In light of the exploratory nature of this work and the many comparisons that were examined in the corresponding regression models, these findings should be regarded as tentative pending replication and extension in another dataset. CONCLUSION: From these findings, we conclude that the variable responsiveness of individuals to atomoxetine cannot be largely accounted for by differences in broad-spectrum psychopathology or neuropsychological indicators of attentional capacity.
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The co-occurrence of ADHD and SUD complicates diagnosis and treatment of both disorders.
“which complicates diagnosis and treatment”
From Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review (2021) · cites this paper as [25]
The co-occurrence of ADHD and SUD is associated with poor treatment outcomes.
“and is associated with poor treatment outcomes”
From Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review (2021) · cites this paper as [25]
Risk of bias was low in the randomized studies of Findling et al. (2011), Newcorn et al. (2017b), and Spencer et al. (2006), and high in all other studies.
“We rated the risk of bias as low in the randomized studies of Findling et al. (2011) [42], Newcorn et al. (2017b) [34], and Spencer et al. (2006) [25], and as high in all other studies (Table 2).”
From Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review (2021) · cites this paper as [25]
Many studies have reported improvements in comorbid psychiatric symptoms when ADHD is effectively treated.
“Many studies have reported improvements in comorbid psychiatric symptoms when ADHD is effectively treated.”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [112]
Atomoxetine has been associated with improvements in comorbid depressive symptoms.
“For instance, atomoxetine has been associated with improvements in both ADHD and comorbid anxiety [111] and depressive [112] symptoms.”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [112]
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“Children with ADHD frequently co-occur with mood disorders, anxiety disorders, and conduct disorders (3).”
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- Authors
- Spencer, T. J., Faraone, S. V., Michelson, D., Adler, L. A., Reimherr, F. W., Glatt, S. J., & Biederman, J.
- Affiliations
- Harvard University (US)
- SUNY Upstate Medical University (US)
- Eli Lilly (United States) (US)
- New York University (US)
- University of California San Diego (US)
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2006-03-15
- Volume
- 67
- Issue
- 03
- Pages
- 415-420
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2010693980
- Cited by
- 94
- References
- 0
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 5 · 2023: 1 · 2022: 4 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 2 · 2017: 4 · 2016: 3 · 2015: 8 · 2014: 5 · 2013: 5 · 2012: 9
- FWCI
- 4.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- atomoxetine, adult ADHD, treatment response prediction, norepinephrine transporter inhibitor, comorbid depression, post-traumatic stress disorder, alcohol and drug use, psychopathology, neuropsychological performance, attentional capacity, Stroop task, Conners' Adult ADHD Rating Scale, Sheehan Disability Scale, General Well-Being Schedule
- MeSH terms
- Atomoxetine Hydrochloride, Adult, Age Factors, Attention Deficit Disorder with Hyperactivity, Mental Disorders, Depressive Disorder, Double-Blind Method, Female, Health Status, Humans, Male, Neuropsychological Tests, Placebos, Propylamines, Psychiatric Status Rating Scales, Risk Factors, Stress Disorders, Post-Traumatic, Comorbidity, Treatment Outcome, Adrenergic Uptake Inhibitors, Diagnostic and Statistical Manual of Mental Disorders, Norepinephrine Plasma Membrane Transport Proteins
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