(Part 3 of 4)
In this video, Psych Congress 2020 cochair Vladimir Maletic, MD, MS, discusses emerging treatments and mechanisms of action for attention deficit/hyperactivity disorder (ADHD). Dr. Maletic is Clinical Professor of Psychiatry, University of South Carolina School of Medicine, Greenville, and spoke at the Psych Congress 2020 psychopharmacology preconference on "ADHD Across the Lifespan: How Neurobiology Informs Our Treatment Choice."
Read the transcript:
A very interesting question: treatments for ADHD that are on the horizon. There are several more recent developments in treatment of ADHD, and those are stimulants. They tend to be more long‑acting and cover 12 to 16 hours.
Beyond those, there is an agent that is about to have an FDA review. It scheduled in this fall, in November, I believe. The agent is viloxazine extended‑release formulation. It is medication that in addition to being norepinephrine uptake inhibitor, is also a serotonin 2C agonist, and serotonin 2B antagonist, so this is medication that modulates both norepinephrine and serotonin.
What may be an advantage? It remains to be proven, but you would wonder, in children who have comorbid anxiety, who have comorbid depression, or prominent emotional dysregulation in ADHD, might an agent like this be of help?
In addition to that, it's important to appreciate that serotonin itself has a significant role in ADHD. There have been studies both looking at peripheral metabolites of serotonin, as well as cerebrospinal fluid metabolites of serotonin. They have found association between these markers of serotonin transmission and irritability, hostility, aggression, impulsivity, and hyperactivity in ADHD.
Will presence of ability to modify serotonin in some way provide a different profile of ADHD treatment, relative to currently available agents?
Finally, there is an agent that is so‑called triple‑action modulator, a norepinephrine, dopamine, serotonin modulator that is. They have published data in phase 2B out in the market.
It seems that the focus is now looking at agents that are capable of modulating norepinephrine and dopamine akin to stimulants, but also may engage serotonin transmission, hopefully providing a wider spectrum of symptom relief.