Atomoxetine for the Treatment of Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder

Abstract

This study confirms previous findings that patients with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder show statistically and clinically significant improvement in attention-deficit/hyperactivity disorder symptoms and global clinical functioning when treated with atomoxetine. It remains uncertain, however, whether atomoxetine exerts a specific and enduring effect on oppositional defiant disorder symptoms.

Effect of atomoxetine on quality of life and family burden: results from a randomized, placebo-controlled, double-blind study in children and adolescents with ADHD and comorbid oppositional defiant or conduct disorder

“…While previous studies have used other generic instruments such as the Child Health Questionnaire (CHQ) or the parent-rated Child Health and Illness Profile-Child Edition (CHIP-CE) to measure QoL [3,6,22,23,[40][41][42][43][44], this is the first placebo-controlled study that has used the KINDL-R for this purpose. In this sample, QoL was clearly impaired at baseline as determined by KINDL-R scores (Table 3) [26].…”

“…Both short-and long-acting methylphenidate (MPH) formulations are effective in ADHD patients with concomitant ODD or related aggressive behavior [14,[18][19][20][21]. In contrast, only a few studies have investigated the effect of treatment with atomoxetine on comorbid ODD or CD [22,23]. Therefore, this study was conducted to evaluate the efficacy and tolerability of atomoxetine in children and adolescents with ADHD and comorbid ODD or CD.…”

Atomoxetine for the treatment of attention-deficit/hyperactivity disorder in children and adolescents: a review

“…45 The frequency of suicidal ideation in patients taking atomoxetine was 0.37% vs 0% in a placebo group. Frequencies between atomoxetine and methylphenidate groups did not differ.…”

Guanfacine Extended Release Adjunctive to a Psychostimulant in the Treatment of Comorbid Oppositional Symptoms in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

“…However, there were no significant differences between atomoxetine and placebo as measured by the CPRS-R:S oppositional subscale (Kaplan et al 2004). In contrast, a randomized controlled study that also examined a population of children with diagnoses of both ADHD and ODD (n = 226) found significantly greater changes from baseline on the ODD subscale of the Swanson, Nolan, and Pelham Rating Scale-Revised with atomoxetine than with placebo in an overall repeated-measures analysis ( p = 0.01), although a last-observationcarried-forward analysis found no significant difference between atomoxetine-treated and placebo-treated groups (Bangs et al 2008). The results of additional studies of the effects of atomoxetine on oppositional symptoms in patients with ADHD are similarly inconsistent (Dell'Agnello et al 2009;Hazell et al 2009;Waxmonsky et al 2010;Dittmann et al 2011;Waxmonsky et al 2011;van Wyk et al 2012).…”

“…Historically, monotherapy studies of psychostimulants and of atomoxetine for the treatment of oppositional symptoms have yielded mixed efficacy results (Kaplan et al 2004;Spencer et al 2006;Bangs et al 2008;Lopez et al 2008;Dell'Agnello et al 2009;Hazell et al 2009;Waxmonsky et al 2010;Dittmann et al 2011;Marchant et al 2011;Waxmonsky et al 2011;van Wyk et al 2012). For example, in a randomized, double-blind, parallelgroup, placebo-controlled study conducted in children and adolescents with ODD with or without coexisting ADHD (n = 308), in the overall study population, mixed amphetamine salts (extended release) were associated with significant improvements in parent and teacher ratings on the ODD subscale of the Swanson, Nolan, and Pelham-IV ( p < 0.05) (Spencer et al 2006).…”