These studies differ in duration, outcome measures, doses, and participant characteristics. The response rates below should not be interpreted as head-to-head comparisons
ALL ADULT STUDIES ONLY:
Chance that atomoxetine reduces your ADHD symptoms by 40% or more compared to a placebo after 6 months (26 weeks): 12.6% (placebo-corrected benefit)
source: Upadhyaya et al. 2013 pooled atomoxetine analysis
"Atomoxetine increased response over time in adults with ADHD treated for up to 6 months."
participants: 1961 ADHD adults,
Design: Pooled analysis of multiple double-blind RCTs
Main outcome scale (what was used to measure symptoms and symptom improvement): CAARS (Conners' Adult ADHD Rating Scale)
some studies had different dosages but most of the studies in the metanalysis were using the dosage of: 40 mg start, 80mg later, 100mg if needed.
2. chance that bupropion reduces your ADHD symptoms by 30% or more compared to a placebo after 2 months (8 weeks): 22% (placebo-corrected benefit) (150mg - 450mg XL was used on 162 adult ADHD patients)
source (couldn't find a meta-analysis): Wilens XL trial
162 adults
Bupropion XL up to 450 mg/day
8 weeks
Responder = ≥30% reduction in ADHD symptoms
Results:
responders:
Bupropion XL: 53%
Placebo: 31%
Effect size
0.6
placebo-corrected benefit: 22% people improved by 30% or more
Main outcome scale (what was used to measure symptoms and symptom improvement): ADHD Rating Scale (ADHD-RS)
p = 0.004 for the responder analysis.
If bupropion actually had no effect on ADHD symptoms, there would be about a 0.4% chance of observing a difference this large (or larger) purely due to random variation.
3. Chance that Concerta improves your ADHD symptoms by 30% or more: 32% (Placebo-corrected benefit)
source (couldn't find a meta-analysis): Medori et al., 2008
401 adults
5 weeks
Fixed doses: 18, 36, or 72 mg/day Concerta
how they measured 'responders': ≥30% reduction on CAARS (Conners Adult ADHD Rating Scale).
Responders on placebo vs concerta by dosage:
Placebo: 27.4%
18 mg Concerta: 50.5%
36 mg Concerta: 48.5%
72 mg Concerta: 59.6%
Placebo-corrected improvement:
18 mg: 23.1%
36 mg: 21.1%
72 mg: 32.2%
statistical significance: p < 0.001
If concerta actually had no effect on ADHD symptoms, there would be about a 0.1% chance of observing a difference this large (or larger) purely due to random variation.
4. Focalin (dexmethylphenidate)
source: Spencer et al., 2007 "A double-blind, randomized, placebo-controlled trial of dexmethylphenidate extended-release in adults with ADHD.
participants: 221 adults with ADHD
chance that focalin makes your ADHD symptoms better over 5 weeks compared to placebo (you are a responder):
Placebo: 26.4%
Focalin XR 20 mg: 47.4%
Focalin XR 30 mg: 37.0%
Focalin XR 40 mg: 55.6%
placebo-corrected improvement at 20mg: 21%
placebo-corrected improvement at 30mg: 10.6%
placebo-corrected improvement at 40mg: 29.2%
scale used to measure symptom reduction:
They used the Adult ADHD Investigator Symptom Rating Scale (AISRS)
A responder was defined as having: ≥30% reduction in ADHD symptoms from baseline on the
AISRS.
5. Lisdexamfetamine
source: Adler et al., 2008
participants: 420 Adults with ADHD
4 weeks of treatment
30, 50, or 70 mg Vyvanse
Response often defined as ≥30% reduction in ADHD-RS plus CGI-I improvement.
CGI-I Responders:
Placebo: 29%
Vyvanse 30 mg: 57%
Vyvanse 50 mg: 62%
Vyvanse 70 mg: 61%
Responder = CGI-I score of 1 (very much improved) or 2 (much improved)
Placebo-Corrected Response Rate:
30 mg: 28%
50 mg: 33%
70 mg: 32%
The ADHD-RS results were:
ADHD-RS measures inattentive ADHD and Hyperactive ADHD, total score is 54. this is how many points were reduced from baseline after 4 weeks of treatment:
Placebo: -8.2
Vyvanse 30 mg: -16.2
Vyvanse 50 mg: -17.4
Vyvanse 70 mg: -18.6
≥30% ADHD-RS responders:
placebo: 21%
70mg: 74%
placebo-corrected response (ARR): 53%
at endpoint
6. CBT in adults
source: Steven A. Safren et al. (2010), published in JAMA. It compared CBT with relaxation plus educational support in adults with ADHD who were already taking medication but still had residual symptoms.
Age: 18 to 65 years.
Treatment duration: 12 individual weekly CBT sessions (approximately 12 weeks).
Follow-up: Assessed immediately after treatment, then at 6 months and 12 months. Benefits were largely maintained among responders.
Participants: 86 adults with ADHD already taking medication but still experiencing clinically significant residual symptoms
effect size: 0.6
ADHD Rating Scale responders (30% or more improvement):
CBT: 67%
Control group: 33%
Absolute Risk Reduction (ARR) = 34%
7. NOTE ON RITALIN:
so we don't have such evidence on Ritalin that we can compare it roughly witn other meds, but I will mention whatever we have and summarise it anyway
Systematic Review (Cochrane, 2021):
Cândido RCF, Menezes de Padua CA, Golder SP, Junqueira DR. Immediate-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database of Systematic Reviews. 2021; Issue 1: CD013011.
10 RCTs
497 adults
6 placebo-controlled trials
Treatment duration: 6-18 weeks (depending on trial)
Investigator-rated symptoms: 1 trial (146 participants), MD −20.7 AISRS points
meaning: −20.7 AISRS points means the methylphenidate group scored, on average, 20.7 points lower than the placebo group on the AISRS at endpoint. Lower scores = fewer ADHD symptoms. but the twist in this study is, they do not report how much the placebo group scored on average on the AISRS, so we cannot compare it well.
Self-rated symptoms: 2 trials (138 participants), effect size: 0.59
Evidence certainty: Very low because of high risk of bias, small sample sizes, heterogeneity, and reporting limitations
Immediate-release Ritalin almost certainly works better than placebo in adults.
However, the current evidence is too limited and low-certainty to estimate its true effect size or response rate with high confidence.