Short-term use of amphetamines can improve ADHD symptoms in adults, review finds

ScienceDaily (July 28, 2011) — Giving amphetamines to adults with Attention Deficit Hyperactivity Disorder (ADHD) can help them control their symptoms, but the side effects mean that some people do not manage to take them for very long. These conclusions were drawn by a team of five researchers working at Girona and Barcelona Universities in Spain, and published in a new Cochrane Systematic Review.

Attention Deficit Hyperactivity Disorder (ADHD) is a childhood onset disorder, but half of people with it find that the symptoms of hyperactivity, mood instability, irritability, difficulties in maintaining attention, lack of organization and impulsive behaviours persist into adulthood. "We wanted to see whether amphetamines could reverse the underlying neurological problems that feature in ADHD, and so improve ADHD symptoms," says Xavier Castells, who led the study and works in the Unit of Clinical Pharmacology at University of Girona.

After searching through medical literature, they identified seven studies, which had enrolled a total of 1091 participants in clinical trials. The three amphetamine based medicines they considered (dextroamphetamine, lisdexamphetamine and mixed amphetamine salts (MAS)) all reduced ADHD symptoms, although there was no evidence that higher doses worked better than lower ones.. The researchers did not find any difference between in effectiveness between formulations that release the amphetamines rapidly, and those that have a sustained-release.

While there was evidence that people taking amphetamines drop out of treatment due to adverse events slightly more than those on placebo controls, the researchers were keen to point out that only 9% of people taking amphetamines withdrew from treatment. Looking at the different formulations of amphetamines, those on MAS had lower drop-out rates than those on other versions of the drug. Furthermore, most studies had a duration of between 2 and 7 weeks, therefore precluding the possibility of drawing conclusions regarding amphetamine's efficacy and safety in the long-term.

In many clinical trials, doctors randomly allocate some patients to 'treatment group' and give them the active medication, while others are placed in a 'control group' and receive a placebo -- a treatment that looks and feels like the real thing, but has no active ingredient in it. The idea is that the patient doesn't know which one they are on. This helps researchers determine how much of any apparent treatment effect is actually due to the therapy, and how much is due to other factors unrelated to drug effects such as the person believes regarding the efficacy of the intervention or the natural history of the disease. This experimental system only works, though, if the patients have no idea which group they are in. "One of the problems with trying to make sense of this research is that you cannot do a properly controlled study because the amphetamines have such a distinct set of effects.. Patients instantly know whether they are on the treatment or the placebo, so you have to be more cautious about the way you interpret the data," says Castells.

"Given that other drugs, like atomoxetine or methylphenidate, have also been shown to reduce ADHD symptoms in adults, it would be of great interest to compare the efficacy of amphetamines to these interventions," says Castells.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Wiley-Blackwell, via AlphaGalileo.

Journal Reference:

Xavier Castells, Josep Antoni Ramos-Quiroga, Rosa Bosch, Mariana Nogueira, Miguel Casas. Amphetamines for Attention Deficit Hyperactivity Disorder (ADHD) in adults. Cochrane Database of Systematic Reviews, 2011; 6: CD007813 DOI: 10.1002/14651858.CD007813.pub2

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Short-term use of amphetamines can improve ADHD symptoms in adults, review finds

ScienceDaily (July 28, 2011) — Giving amphetamines to adults with Attention Deficit Hyperactivity Disorder (ADHD) can help them control their symptoms, but the side effects mean that some people do not manage to take them for very long. These conclusions were drawn by a team of five researchers working at Girona and Barcelona Universities in Spain, and published in a new Cochrane Systematic Review.

Attention Deficit Hyperactivity Disorder (ADHD) is a childhood onset disorder, but half of people with it find that the symptoms of hyperactivity, mood instability, irritability, difficulties in maintaining attention, lack of organization and impulsive behaviours persist into adulthood. "We wanted to see whether amphetamines could reverse the underlying neurological problems that feature in ADHD, and so improve ADHD symptoms," says Xavier Castells, who led the study and works in the Unit of Clinical Pharmacology at University of Girona.

After searching through medical literature, they identified seven studies, which had enrolled a total of 1091 participants in clinical trials. The three amphetamine based medicines they considered (dextroamphetamine, lisdexamphetamine and mixed amphetamine salts (MAS)) all reduced ADHD symptoms, although there was no evidence that higher doses worked better than lower ones.. The researchers did not find any difference between in effectiveness between formulations that release the amphetamines rapidly, and those that have a sustained-release.

While there was evidence that people taking amphetamines drop out of treatment due to adverse events slightly more than those on placebo controls, the researchers were keen to point out that only 9% of people taking amphetamines withdrew from treatment. Looking at the different formulations of amphetamines, those on MAS had lower drop-out rates than those on other versions of the drug. Furthermore, most studies had a duration of between 2 and 7 weeks, therefore precluding the possibility of drawing conclusions regarding amphetamine's efficacy and safety in the long-term.

In many clinical trials, doctors randomly allocate some patients to 'treatment group' and give them the active medication, while others are placed in a 'control group' and receive a placebo -- a treatment that looks and feels like the real thing, but has no active ingredient in it. The idea is that the patient doesn't know which one they are on. This helps researchers determine how much of any apparent treatment effect is actually due to the therapy, and how much is due to other factors unrelated to drug effects such as the person believes regarding the efficacy of the intervention or the natural history of the disease. This experimental system only works, though, if the patients have no idea which group they are in. "One of the problems with trying to make sense of this research is that you cannot do a properly controlled study because the amphetamines have such a distinct set of effects.. Patients instantly know whether they are on the treatment or the placebo, so you have to be more cautious about the way you interpret the data," says Castells.

"Given that other drugs, like atomoxetine or methylphenidate, have also been shown to reduce ADHD symptoms in adults, it would be of great interest to compare the efficacy of amphetamines to these interventions," says Castells.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Wiley-Blackwell, via AlphaGalileo.

Journal Reference:

Xavier Castells, Josep Antoni Ramos-Quiroga, Rosa Bosch, Mariana Nogueira, Miguel Casas. Amphetamines for Attention Deficit Hyperactivity Disorder (ADHD) in adults. Cochrane Database of Systematic Reviews, 2011; 6: CD007813 DOI: 10.1002/14651858.CD007813.pub2

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here

Trend in young adults' dating habits, committed relationships may not lead to marriage

ScienceDaily (July 25, 2011) — Changes in relationship formation and dissolution in the past 50 years have revealed new patterns in romantic relations among young adults. The U.S. Census indicates that young people are choosing to marry later and cohabitating more often than past generations. Now, a University of Missouri researcher has found that people in their 20s are redefining dating by engaging in "stayover relationships," spending three or more nights together each week while maintaining the option of going to their own homes.

"Instead of following a clear path from courtship to marriage, individuals are choosing to engage in romantic ties on their own terms -- without the guidance of social norms," said Tyler Jamison, a researcher in the Department of Human Development and Family Studies (HDFS). "There is a gap between the teen years and adulthood during which we don't know much about the dating behaviors of young adults. Stayovers are the unique answer to what emerging adults are doing in their relationships."

Jamison found that "stayover relationships" are a growing trend among college-aged couples who are committed, but not interested in cohabiting. However, little is known about the effects of stayovers on future commitment decisions or marriage.

"A key motivation is to enjoy the comforts of an intimate relationship while maintaining a high degree of personal control over one's involvement and commitment," said Larry Ganong, professor in HDFS. "We see this interest in personal control nationally in more single adult households, and in the growing phenomenon of 'living apart together' (middle-aged and older monogamous couples who maintain their own households). It may also help explain why marriage is on the decline, particularly among young adults."

Jamison conducted interviews among college-educated adults who were in committed, exclusive relationships. She found that although living together before marriage has become less taboo, many young adults want to avoid the potential negative social consequences of cohabitation.

"As soon as couples live together, it becomes more difficult to break up," Jamison said. "At that point, they have probably signed a lease, bought a couch and acquired a dog, making it harder to disentangle their lives should they break up. Staying over doesn't present those entanglements."

Jamison found that couples who had a stayover routine were content in their relationships, but did not necessarily plan to get married or move in together.

"Many college-aged adults are students who will soon be facing a transition point in their lives," Jamison said. "Most students do not have a definite plan for where they will live or work after graduation, and stayovers are a way for couples to have comfort and convenience without the commitment of living together or having long-term plans."

The study, "We're not living together: Stayover relationships among college-educated emerging adults," is in the current issue of the Journal of Social and Personal Relationships. Jamison recommends future research to determine the effect of stayovers on marriage and divorce rates. Her follow-up research is focused on stayover relationships in unmarried parents. She is a doctoral candidate in the MU College of Human Environmental Sciences.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Missouri-Columbia.

Journal Reference:

T. B. Jamison, L. Ganong. ''We're not living together:'' Stayover relationships among college-educated emerging adults. Journal of Social and Personal Relationships, 2010; 28 (4): 536 DOI: 10.1177/0265407510384897

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Depression: Not just for adults

ScienceDaily (June 2, 2011) — From a distance, Callie (not her real name) appears to be a normal if quiet 5-year-old girl. But when faced with a toy that blows large soap bubbles -- an activity that makes the vast majority of kindergarteners squeal and leap with delight -- she is uninterested in popping the bubbles or taking a turn with the gun herself. When offered dolls or other toys, she is equally unmoved. When groups of children congregate to play, Callie does not join them. Even at home, she is quiet and withdrawn. While Callie's mother explains this lack of interest in play as simple "shyness," researchers are now discovering that children as young as 3 years of age can meet the clinical criteria for major depressive disorder (MDD). What's more, they demonstrate patterns of brain activation very similar to those seen in adults diagnosed with the disorder.

Brain changes in pre-school depression

Joan Luby, director of the early emotional development program at Washington University in St. Louis, has been studying pre-school depression for almost two decades. Developmental psychologists have argued that young children did not have the emotional or cognitive competence to experience depression, but Luby's clinical experience contradicted the party line.

"When you think about it, most of the core symptoms of depression are developmentally broad," says Luby. "Sadness and irritability can occur at any age from infancy to very old age. But symptoms like anhedonia were thought to be adult problems because it's often talked about as decreased libido. That, obviously, doesn't occur in young children. But when you developmentally translate it to an absence of joyfulness, especially when joyfulness is the dominant mood state of young children, you have a pretty robust clinical marker."

Depressed pre-schoolers do not just show synonymous clinical symptoms to adult depression -- they also show similar patterns of brain activity when scanned using a functional magnetic resonance imaging (fMRI) techniques. In a study published in the March 2011 issue of the Journal of Affective Disorders, Luby and colleagues scanned 11 depressed children with an average age of 4.5 years while they viewed faces with different expressions of emotion. The group found that there was a significant correlation between the severity of the depression and increased activity in the right amygdala, the same pattern of activity viewed in adults with depression.

"There is something about the experience of depression in very early childhood that seems to leave an enduring mark on the brain -- these kids are more likely to be depressed as adults, too," she says. "So these results suggest that there may be very early markers of a depressed brain that can be picked up in kids as early as age 4 or 5 and may open the door to much earlier intervention."

Risk factors for early childhood depression

Daniel Klein, a psychologist at Stony Brook University, is investigating potential factors in early childhood that may predict later chronic depression.

"When clinicians ask a depressed person when they first started feeling depressed, they'll often report having been depressed their entire lives," he says. "It's not clear when the onset is so I study pre-school age children with the intent of trying to identify behavioral and emotional precursors that will later evolve into chronic depression."

He is currently following more than 600 families from the local community sample in a longitudinal study. Though preliminary, a few factors appear to play a large role in the onset of depression later in life.

"In terms of temperament, a lack of exuberance and joy in situations where most kids get very excited about and then a lot of feelings of fearfulness and sadness stand out," he says. "These kids tend to have parents who have a history of depression and we're seeing some abnormalities in electrical activity when we take EEGs. There's some evidence now that these patterns predict not necessarily clinical depression but more depressive symptoms three or four years later."

Treating children with depression

While understanding the origins of MDD is of great biological interest, parents of depressed pre-schoolers are more interested in viable treatment options than brain scans. While anti-depressants have been used with some success in the adult population, there is wide concern about whether they should be used in children, let alone children of such a young age whose brains are going through critical periods of development.

"Certainly, with kids, there are all kinds of concerns particular to their age and level of neurological and physical development when we're talking about drug treatments," says Michael Yapko, a former clinical psychologist and author of Depression is Contagious. "Despite those concerns, the Food and Drug Administration estimates that 7% of antidepressants are still being prescribed to children."

While Luby does not dismiss the idea of a pharmacological treatment in the future, Luby's lab is currently testing a unique early intervention called dyadic play therapy. Children work with their primary caregivers, who are coached via an earpiece by a therapist, on emotional regulation and development.

"So far, the treatment appears promising," she says. "We are just now writing up the results of a small randomized, controlled trial suggesting there may be large effect sizes with this intervention."

Both Luby and Klein emphasize that our biological understanding of pre-school depression is still very preliminary. And while there is no one treatment option for these children at this point, Luby offers this advice to parents -- especially parents who have a child like Callie.

"Be attentive. If you have a child who is persistently irritable, persistently sad, who does not brighten in play or when fun and exciting things happen, that's every bit as much of a concern as a child who is disruptive in pre-school," says Luby. "We don't tend to pay as much attention to it but it is every bit as much of a concern. And treating it early may make all the difference."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by DANA Foundation. The original article was written by Kayt Sukel.

Journal Reference:

Michael S. Gaffrey, Andy C. Belden, Joan L. Luby. The 2-week duration criterion and severity and course of early childhood depression: Implications for nosology. Journal of Affective Disorders, 2011; DOI: 10.1016/j.jad.2011.04.056

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here