Around the Practice: Management of Adult with Attention Deficit/Hyperactivity Disorder (ADHD) - Episode 4

Unmet Needs in the Treatment of Adult ADHD

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Craig Chepke, MD, FAPA, and Andrew J. Cutler, MD, discuss unmet needs in adults with ADHD.

Stephen Faraone, PhD: Let's move on, Doctor Chepke, what are current unmet needs in adults with ADHD?

Craig Chepke, MD, FAPA: There's quite a few of them, the first one that I would mention would be the under diagnosis or misdiagnosis of ADHD, but we've covered that very well already, so far here. But then, even once the ADHD is diagnosed in adults, then having it under treatment of it what I think is a significant problem, I mean, I practice in the southern part of the United States and sometimes I say that ADHD around here isn't treated with stimulants, it's treated with a hickory switch. And that tends to persist until adulthood too, that there's this stigma, is the biggest unmet need is combatting the stigma, because there's the belief that the person is just lazy, that they just need to work harder, they just need to pick themselves up by their bootstraps and do it, similar to what we hear in many different diagnosis in psychiatry, and having the acceptance of this diagnosis and the treatments for it is a significant unmet need. But then also, just the treatments that we have themselves. Although we have dozens, literally, of stimulants, and we have some non-stimulants as well, we still don't have enough treatment. One aspect is the small range of molecules that we have, we only have a few molecules despite the dozens of stimulants, and then of the non-stimulants as well, and each one of those has certain pharmacokinetic limitations, and we could get, we could have a very long discussion about that but, really, when it comes to the stimulants, you have to match the pharmacokinetics to the person, and I find that I need all the dozens of stimulants for each individual person, because everyone's day is a little bit different, and they have different needs.

Andrew J. Cutler, MD: Yes, I would add, one of the unmet needs is, more effective non-stimulants, we only have 2, as of now, that are FDA approved, non-stimulants, that is, and there's a lot of adults that I'm concerned about abuse or diversion, or I don't want to use a stimulant because, as we talked about earlier, maybe they have hypertension or cardiovascular issues, and medications that help us address the comorbidities, because those comorbidities are so common, depression, anxiety, substance abuse, as we talked about, bipolar disorder as well.

Transcript edited for clarity