Combination pharmacotherapy for adult ADHD

Curr Psychiatry Rep. 2006 Oct;8(5):409-15. doi: 10.1007/s11920-006-0044-9.


Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neuropsychiatric disorders of adulthood. Although clinical guidelines recommend monotherapy with stimulants or atomoxetine, combination pharmacotherapy is a common practice among clinicians. There are four main situations in which combination medications may be necessary: partial response, dose-limiting side effects, associated disorders, and comorbid diagnoses. We present data from two chart reviews that support existing research on combination pharmacotherapy. Adjunct treatment of d-methylphenidate to stimulant medications extended the duration of therapeutic effect. Adjunct treatment of mirtazapine to stimulant medications reduced associated insomnia. These data support previous research that validates the use of combination pharmacotherapy for adults with ADHD.

MeSH terms

  • Adolescent
  • Adult
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Attention Deficit Disorder with Hyperactivity / drug therapy*
  • Central Nervous System Stimulants / adverse effects
  • Central Nervous System Stimulants / therapeutic use*
  • Child
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Methylphenidate / therapeutic use*
  • Mianserin / analogs & derivatives
  • Mianserin / therapeutic use
  • Middle Aged
  • Mirtazapine
  • Sleep Initiation and Maintenance Disorders / chemically induced
  • Sleep Initiation and Maintenance Disorders / drug therapy


  • Antidepressive Agents, Tricyclic
  • Central Nervous System Stimulants
  • Methylphenidate
  • Mianserin
  • Mirtazapine