Tricyclic antidepressants, clonidine, venlafaxine, and modafinil for the treatment of attention-deficit/hyperactivity disorder in adults

Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder with inappropriate levels of inattention, hyperactivity, and impulsivity manifesting in childhood and continuing into adulthood, resulting in functional impairment in academic, family and social settings. The prevalence of ADHD in the general population is approximately 3% to 4% while it affects approximately 4.4 percent of American adults. Stimulants such as methylphenidate and amphetamine are first line agents and a major component of pharmacotherapy in children and adults with ADHD, but the addictive character of stimulants and the chronic nature of ADHD can lead to abuse potential and side effects in many organs including the cardiovascular system. Approximately 10 to 30% of patients do not respond optimally to stimulant therapy due to adverse events, lack of efficacy or non-adherence to treatment. Non-stimulant therapy with atomoxetine, tricyclic antidepressants (TCAs), clonidine, and venlafaxine has been used as an alternative approach in the treatment of ADHD. A novel non-traditional stimulant, wakefulness-promoting compound modafinil, has also been used in the treatment of ADHD with low-abuse potential. This report aims to review to clinical effectiveness of non-stimulants (TCA, clonidine, venlafaxine) and modafinil for the treatment of adults with ADHD.