Ni Hsing-Chang, Hwang Gu Shoou-Lian, Lin Hsiang-Yuan, Lin Yu-Ju, Yang Li-Kuang, Huang Hui-Chun, Gau Susan Shur-Fen
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taiwan.
Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
J Psychopharmacol. 2016 May;30(5):459-67. doi: 10.1177/0269881116632377. Epub 2016 Feb 23.
Intra-individual variability in reaction time (IIV-RT) is common in individuals with attention-deficit/hyperactivity disorder (ADHD). It can be improved by stimulants. However, the effects of atomoxetine on IIV-RT are inconclusive. We aimed to investigate the effects of atomoxetine on IIV-RT, and directly compared its efficacy with methylphenidate in adults with ADHD.
An 8-10 week, open-label, head-to-head, randomized clinical trial was conducted in 52 drug-naïve adults with ADHD, who were randomly assigned to two treatment groups: immediate-release methylphenidate (n=26) thrice daily (10-20 mg per dose) and atomoxetine once daily (n=26) (0.5-1.2 mg/kg/day). IIV-RT, derived from the Conners' continuous performance test (CCPT), was represented by the Gaussian (reaction time standard error, RTSE) and ex-Gaussian models (sigma and tau). Other neuropsychological functions, including response errors and mean of reaction time, were also measured. Participants received CCPT assessments at baseline and week 8-10 (60.4±6.3 days).
We found comparable improvements in performances of CCPT between the immediate-release methylphenidate- and atomoxetine-treated groups. Both medications significantly improved IIV-RT in terms of reducing tau values with comparable efficacy. In addition, both medications significantly improved inhibitory control by reducing commission errors.
Our results provide evidence to support that atomoxetine could improve IIV-RT and inhibitory control, of comparable efficacy with immediate-release methylphenidate, in drug-naïve adults with ADHD. Shared and unique mechanisms underpinning these medication effects on IIV-RT awaits further investigation.
反应时的个体内变异性（IIV-RT）在注意力缺陷多动障碍（ADHD）患者中很常见。兴奋剂可改善这种情况。然而，托莫西汀对IIV-RT的影响尚无定论。我们旨在研究托莫西汀对IIV-RT的影响，并直接将其与哌甲酯对成年ADHD患者的疗效进行比较。
对52名未服用过药物的成年ADHD患者进行了一项为期8-10周的开放标签、头对头、随机临床试验，这些患者被随机分为两个治疗组：速释哌甲酯组（n=26），每日三次（每次剂量10-20mg）；托莫西汀组（n=26），每日一次（0.5-1.2mg/kg/天）。源自康纳斯连续作业测试（CCPT）的IIV-RT由高斯模型（反应时标准误差，RTSE）和前高斯模型（sigma和tau）表示。还测量了其他神经心理功能，包括反应错误和反应时均值。参与者在基线以及第8-10周（60.4±6.3天）接受CCPT评估。
我们发现速释哌甲酯治疗组和托莫西汀治疗组在CCPT表现上有相当的改善。两种药物在降低tau值方面均显著改善了IIV-RT，疗效相当。此外，两种药物均通过减少执行错误显著改善了抑制控制。
我们的结果提供了证据支持，在未服用过药物的成年ADHD患者中，托莫西汀可改善IIV-RT和抑制控制，其疗效与速释哌甲酯相当。这些药物对IIV-RT产生作用的共同和独特机制有待进一步研究。
