Nonstimulant treatment of adult attention-deficit/hyperactivity disorder.

A substantial literature supports the viability of nonstimulant treatments for ADHD. Despite their chemical differences, the various compounds with documented anti-ADHD activity share a common noradrenergic/dopaminergic activity. Although TCAs are established alternative treatments forADHD, particularly the more noradrenergic secondary amines (DMI and nortriptyline), their narrow therapeutic index and potential for cardiovascular toxicity have limited their use. The atypical mixed noradrenergic/dopaminergic antidepressant bupropion also has been documented to be effective in treating adults with ADHD in a controlled clinical trial. Recent work with the novel noradrenergic specific agent, atomoxetine, has produced convincing evidence of substantial efficacy, tolerability, and safety in children and adults. Despite these advances, more work is needed to further document the short- and long-term safety and efficacy of stimulants and alternative agents for treating adults with ADHD. It also is hoped that advances in the understanding of the underlying neurobiology of ADHDwill lead to the development of a new generation of safe and effective treatments for this disorder. Such developments have the promise of improving the quality of life of the millions of affected patients and their families worldwide.