[Stimulant and non-stimulant medication in current and future therapy for ADHD].

Abstract

! The current pharmacotherapy for attention-deficit hyperactivity disorder (ADHD) is mainly based on the stimulant methylphenidate and to a small extent on amphetamines which are not approved in Germany. The only approved non-stimulant so far is atomoxetin (Strattera ® ), a norepinephrine reuptake inhibitor. There is no approved pharmacotherapy for adults. The aim of the available medication is a reduction of impulsivity, hyperactivity, and attention deficits. Neu-robiological correlates of these effects are still not fully understood, however, a functional implication of dopaminergic and noradrenergic systems is known. To date there is no disease-modifying therapy. The currently available substances have limitations due to the short half-life of stimulants, the unknown pathomechanisms, and the use of stimulants in developing brains with possible long-term side-effects. Moreover, the abuse potential of stimulants is still controversially discussed. The recently developed Lisdexamfetamin and SPD-465 have stimulant effects, too. A number of different developmental substances in preclinical and clinical phases show other mechanisms: SPD-503 represents an α 2 A-adrenozeptoragonist, ABT-089 and ABT-418 have partial agonistic effects to the α 4 β 2 -subtype of nicotinic acetylcholinre-ceptors, CX-717, -1739, -1942 and -1796 are glutamatergic α -amino-3-hydroxy-5-methyl-4- isoxazolepropionic acid (AMPA)-receptor agonists and PF-3654746 exhibits antagonistic properties to histaminergic