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• W2029001805 abstract "Authors' replySir—None of the six patients with ADHD who we studied took psychotropic drugs for at least 1 month before the study. Four participants had been treated with psychostimulants previously and two had never been exposed to any psychotropic drug. The effects of psychostimulants are probably the result of immediate interactions of the drug with dopamine transporter—ie, alterations in neuronal gene expression do not appear to be necessary. Lastly, several lines of evidence support the contention that these findings are not drug-induced,1Madras BK Imaging and dopamine transporter: a window on dopamine neurons.in: Marwah J Teitelbaum H Advances in neurodegenerative disorders, volume 1. Parkinson's disease. Prominent Press, Scottsdale1998: 229-253Google Scholar including previous findings of dopaminergic abnormalities in patients with ADHD.2Ernst M Zametkin AJ Matochik JA et al.High midbrain [18F]DOPA accumulation in children with attention deficit hyperactivity disorder.Am J Psychiatry. 1999; 156: 1209-1215PubMed Google Scholar The statement made by Fred Baughman that the observed effects in our imaging study are a result of past stimulant use is grossly premature and devoid of any scientific basis. Nonetheless, although the differences we describe in our study may represent a phenotypic difference, this was a preliminary report of six patients and Baughman has addressed an important point that needs to be examined. Further studies are needed to clarify these issues and such investigations are underway.Lastly, Baughman states that “ADHD is yet to be validated as a disease”. Despite some controversy, an emerging body of scientific data3Faraone SV Biederman J Neurobiology of attention-deficit hyperactivity disorder.Biol Psychiatry. 1998; 44: 951-958Summary Full Text Full Text PDF PubMed Scopus (523) Google Scholar consisting of clinical, genetic, neuropsychological, imaging, and treatment studies strongly support not only the validity of the diagnosis of ADHD in adults,4Spencer T Biederman J Wilens T Faraone SV Adults with attention-deficit/hyperactivity disorder: a controversial diagnosis.J Clin Psychiatry. 1998; 59: 59-68PubMed Google Scholar but also syndromatic continuity with a paediatric condition.James Swanson raises two important points. First, he requests details regarding the differences in average binding potential between the two groups (table). The six patients with ADHD had a mean age-corrected binding potential of 3·00 (SD 0·51), whereas the 30 control participants had a mean age-corrected binding potential of 1·77 (0·53). An unpaired t test revealed a highly significant difference in age-corrected binding potential between the two study groups (t=5·25; p<0·001). As indicated by the graph in the original report, the binding potential of each patient with ADHD differed from the mean-age-corrected binding potential for age-matched control participants by at least 2 SDs. These data are presented in greater detail in the table shown here. Even for the single patient in the youngest age group, age-corrected binding potential was more than 2 SDs greater than the age-corrected mean for age-matched control participants (2·71 vs 2·12 [0·25]).Table123I-altropane binding potential in patients with ADHD and age-matched control groupGroupAge-range yearsBinding potentialADHD patients342·98452·34242·71532·33512·16413·51ADHDgroup (n=6)24–533·00 (0·51)Control group (n=30)19–601·77 (0·53)18–30 (n=6)2·12 (0·25)31–40 (n=9)1·90 (0·54)41–50 (n=8)1·58 (0·51)51–60 (n=7)1·50 (0·57) Open table in a new tab Second, Swanson asks about the sex ratio in the control group. This group of 30 participants comprised 14 women and 16 men. There was no significant difference in binding potential in the control participant data based on sex. The six patients with ADHD included four women and two men. Given the small sample size, we do not believe any generalisations can be made regarding effects of sex. However, Swanson has broached an important issue and as we expand our database, we plan to test for effects of sex. Authors' reply Sir—None of the six patients with ADHD who we studied took psychotropic drugs for at least 1 month before the study. Four participants had been treated with psychostimulants previously and two had never been exposed to any psychotropic drug. The effects of psychostimulants are probably the result of immediate interactions of the drug with dopamine transporter—ie, alterations in neuronal gene expression do not appear to be necessary. Lastly, several lines of evidence support the contention that these findings are not drug-induced,1Madras BK Imaging and dopamine transporter: a window on dopamine neurons.in: Marwah J Teitelbaum H Advances in neurodegenerative disorders, volume 1. Parkinson's disease. Prominent Press, Scottsdale1998: 229-253Google Scholar including previous findings of dopaminergic abnormalities in patients with ADHD.2Ernst M Zametkin AJ Matochik JA et al.High midbrain [18F]DOPA accumulation in children with attention deficit hyperactivity disorder.Am J Psychiatry. 1999; 156: 1209-1215PubMed Google Scholar The statement made by Fred Baughman that the observed effects in our imaging study are a result of past stimulant use is grossly premature and devoid of any scientific basis. Nonetheless, although the differences we describe in our study may represent a phenotypic difference, this was a preliminary report of six patients and Baughman has addressed an important point that needs to be examined. Further studies are needed to clarify these issues and such investigations are underway. Lastly, Baughman states that “ADHD is yet to be validated as a disease”. Despite some controversy, an emerging body of scientific data3Faraone SV Biederman J Neurobiology of attention-deficit hyperactivity disorder.Biol Psychiatry. 1998; 44: 951-958Summary Full Text Full Text PDF PubMed Scopus (523) Google Scholar consisting of clinical, genetic, neuropsychological, imaging, and treatment studies strongly support not only the validity of the diagnosis of ADHD in adults,4Spencer T Biederman J Wilens T Faraone SV Adults with attention-deficit/hyperactivity disorder: a controversial diagnosis.J Clin Psychiatry. 1998; 59: 59-68PubMed Google Scholar but also syndromatic continuity with a paediatric condition. James Swanson raises two important points. First, he requests details regarding the differences in average binding potential between the two groups (table). The six patients with ADHD had a mean age-corrected binding potential of 3·00 (SD 0·51), whereas the 30 control participants had a mean age-corrected binding potential of 1·77 (0·53). An unpaired t test revealed a highly significant difference in age-corrected binding potential between the two study groups (t=5·25; p<0·001). As indicated by the graph in the original report, the binding potential of each patient with ADHD differed from the mean-age-corrected binding potential for age-matched control participants by at least 2 SDs. These data are presented in greater detail in the table shown here. Even for the single patient in the youngest age group, age-corrected binding potential was more than 2 SDs greater than the age-corrected mean for age-matched control participants (2·71 vs 2·12 [0·25]). Second, Swanson asks about the sex ratio in the control group. This group of 30 participants comprised 14 women and 16 men. There was no significant difference in binding potential in the control participant data based on sex. The six patients with ADHD included four women and two men. Given the small sample size, we do not believe any generalisations can be made regarding effects of sex. However, Swanson has broached an important issue and as we expand our database, we plan to test for effects of sex. We thank Scott L Rauch for his help preparing this reply. Dopamine-transporter density in patients with ADHDDarin Dougherty and colleagues (Dec 18/25, p 2132)1 state that patients were excluded from their study of patients with attention-deficit-hyperactivity disorder (ADHD) if they were on “drugs which affect the dopamine system within 1 month before participation”. They probably are referring to the amphetamines—methylphenidate (Ritalin), d-, 1- amphetamine (Adderall), and d-amphetamine (Dexedrine). Brown and colleagues2 have shown such a theory to be simplistic and invalid, accentuating that it cannot be said of any drug, or class of drugs, that they are known to act exclusively on any one set of chemical transmitters, or, that it is known exactly how they act. Full-Text PDF Dopamine-transporter density in patients with ADHDDarin Doughterty and colleagues1 report that the binding potential for the dopamine transporter is extraordinarily high in adults with ADHD compared with controls. If true, this is a major finding and points the way for new investigations of the primary pharmacological treatment for ADHD (with the stimulant drugs-eg, methyphenidate), for which the dopamine transporter is the primary site of action.2,3 The potential importance of this finding demands special scrutiny of the report. Full-Text PDF" @default.
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