A long-acting stimulant should be initiated first because of the advantage of a simpler dosing regimen as compared with immediate-
release stimulant formulations.2 SSRIs are not indicated for ADHD. Because this patients symptoms are interfering with her day-to-day activities, reassurance and clinical monitoring is not appropriate. The patient should be advised about potential side effects of stimulant treatment, including anorexia, dry mouth, insomnia, and headache.3,4
- Trial of a long-acting amphetamine given once in the morning.
2. Stein MA. Treating adult ADHD with stimulants. CNS Spectr 2008;13(9 Suppl 13):8–11.
3. Biederman J, Spencer TJ, Wilens TE, et al; SLI381.304 Study Group. Long-term safety and effectiveness of mixed amphetamine salts extended release in adults with ADHD. CNS Spectr 2005;10(12 Suppl 20):16–25.
4. Weisler RH, Biederman J, Spencer TJ, et al. Mixed amphetamine salts extended-release in the treatment of adult ADHD: a randomized, controlled trial. CNS Spectr 2006;11:625–39.
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Seminars in Medical Practice
Hospital Physician Board Review Manuals
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Updated 4/16/09 nvf