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Authors' reply

Published online by Cambridge University Press:  02 January 2018

Joanna Moncrieff
Affiliation:
Department of Mental Health Sciences, University College London, UK, email: j.moncrieff@ucl.ac.uk
Sami Timimi
Affiliation:
Lincolnshire Partnership NHS Foundation Trust, Sleaford, Lincolnshire, UK
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Abstract

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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2012

In response to Tyrie & Knibbs, positive accounts of improvement and recovery from any disorder or difficulties are important and inspiring, but they cannot be taken as evidence for the efficacy of a particular treatment. The efficacy of treatments can only be established by randomised controlled trials, and these demonstrate that people taking stimulants for adult attention-deficit hyperactivity disorder do only slightly better than those taking a placebo in the short term and do no better in the long term. The effectiveness of a drug is then judged by balancing the gains against placebo, if there are any, with the adverse effects associated with the drug, as well as other considerations. Stimulants do have effects, of course. They are not inert. Low-dose stimulants modify behaviour in animals and humans alike, improving attention and focus on mundane tasks. Reference Arnste1 Animal studies also show that this effect is accompanied by a reduction in spontaneous exploratory behaviour, interest in the environment and social interaction. Reference Arakawa2,Reference Hughes3 Moreover, any initial effects may decline due to tolerance, which, although little investigated in the case of therapeutic stimulant use, is known to occur in response to most psychoactive substances.

References

1 Arnste, AF. Stimulants: therapeutic actions in ADHD. Neuropsychopharmacol 2006; 31: 2376–83.Google Scholar
2 Arakawa, O. Effects of methamphetamine and methylphenidate on single and paired rat open-field behaviors. Physiol Behav 1994; 55: 441–6.Google Scholar
3 Hughes, RN. Methylphenidate induced inhibition of exploratory behaviour in rats. Life Sci 1972; 11: 161–7.Google Scholar
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