Drug relieves persistent daydreaming, fatigue, and brain sluggishness in adults with ADHD

Early results from clinical trials of a medication known to increase brain activity have shown that it is effective in decreasing symptoms of slow cognitive tempo in 38 men and women with attention deficit hyperactivity disorder (ADHD). As a combination of symptoms that include persistent daydreaming, tiredness, and slow-working speed has been the topic of dispute as to whether it is a component of, or a distinct condition from, attention deficit hyperactivity disorder (ADHD).

The stimulant lisdexamfetamine (available under the brand name Vyvanse) was shown to decrease by 30 percent self-reported symptoms of slow cognitive tempo, according to the study’s lead researchers from NYU Grossman School of Medicine and Icahn School of Medicine at Mount Sinai. Moreover, it reduced symptoms of ADHD by more than 40% while also substantially improving deficiencies in executive brain function, as shown by fewer bouts of procrastination, improvements in remembering things, and improved prioritizing abilities. Researchers reported their findings in the Journal of Clinical Psychiatry, which was published online on June 29. They also discovered that one-quarter of the overall improvements in sluggish cognitive tempo, such as feelings of boredom and difficulty staying alert, as well as signs of confusion, were due to improvements in symptoms of ADHD. As a result of this finding, the researchers concluded that reductions in ADHD-related episodes of physical restlessness, impulsive behavior, and/or times of not paying attention were associated with some, but not all, improvements in sluggish cognitive pace.

As the lead study investigator and psychiatrist Lenard Adler, MD, explains, “Our findings add to the growing evidence that slowed cognitive tempo can be distinguished from attention deficit hyperactivity disorder and that the stimulant lisdexamfetamine can effectively treat both conditions in adults, as well as when they occur in conjunction.” As of right now, stimulants have only been proven to help slow cognitive tempo symptoms in children with ADHD, according to Dr. Adler, who heads the adult ADHD program at NYU Langone Medical Center. He goes on to say that the results of the NYU Langone-Mount Sinai collaboration are the first to demonstrate that such therapies are effective in adults. Adler, who is a professor in the Departments of Psychiatry and Child and Adolescent Psychiatry at New York University Langone Medical Center, believes that sluggish cognitive tempo is likely a subset of symptoms that are commonly seen in some patients with attention deficit hyperactivity disorder (ADHD) and other psychiatric disorders. In contrast, it is still uncertain if slowing down of the cognitive processing speed is an independent mental health disease and whether stimulant medicines may enhance sluggish cognitive processing speed in individuals who do not have ADHD.

Sluggish cognitive tempo has been proposed as a separate condition by some experts, while opponents argue that additional study is required to resolve the debate. Dr. Adler states that the results “underscore the significance of evaluating patients’ complaints of slow cognitive tempo and executive brain function when they are first diagnosed with ADHD.” The research was sponsored by the medication maker Takeda Pharmaceuticals of Cambridge, Massachusetts, and included several dozen volunteers who were randomly assigned to receive daily doses of either lisdexamfetamine or a sugar tablet as a placebo for one month. On a weekly basis, the researchers closely monitored their mental health by administering standardized tests for indications and symptoms of slow cognitive tempo, attention deficit hyperactivity disorder (ADHD), as well as other indicators of brain function. Once this was accomplished, researchers had participants swap roles: half of those who had been taking the placebo began taking daily doses of lisdexamfetamine, while the other half of those who had been receiving the medication throughout the study’s initial phase began taking the placebo. Sunovion Pharmaceuticals, Enymotec, Shire Pharmaceuticals (now part of Takeda), Otsuka, and Lundbeck have all provided Adler with grants and/or research assistance throughout the course of his career. Additionally, in addition to Bracket, SUNY, the National Football League, and Major League Baseball, he has worked as a paid consultant for a number of other businesses. Since 2004, he has also earned royalties from New York University for products related to adult ADHD diagnostics and training. New York University Langone Medical Center’s rules and procedures are being followed in the management of all of these partnerships.

Journal Reference : Lenard A. Adler et al. A Placebo-Controlled Trial of Lisdexamfetamine in the Treatment of Comorbid Sluggish Cognitive Tempo and Adult ADHDJournal of Clinical Psychiatry, 2021 [abstract]

Categories: Clinical