Attention-deficit/hyperactivity disorder (ADHD), the single most common neuropsychiatric disorder with cognitive and behavioral manifestations, often starts in childhood and usually persists into adolescence and adulthood. Rarely seen alone, ADHD is most commonly complicated by other neuropsychiatric disorders that must be factored into any intervention plan to optimally address ADHD symptoms. With more than 30 classical Schedule II (CII) stimulant preparations available for ADHD treatment, only three nonstimulants (atomoxetine and extended-release formulations of clonidine and guanfacine) have been approved by the United States Food and Drug Administration (FDA), all of which focus on modulating the noradrenergic system. Given the heterogeneity and complex nature of ADHD in most patients, research efforts are identifying nonstimulants which modulate pathways beyond the noradrenergic system. New ADHD medications in clinical development include monoamine reuptake inhibitors, monoamine receptor modulators, and multimodal agents that combine receptor agonist/antagonist activity (receptor modulation) and monoamine transporter inhibition. Each of these “pipeline” ADHD medications has a unique chemical structure and differs in its pharmacologic profile in terms of molecular targets and mechanisms. The clinical role for each of these agents will need to be explored with regard to their potential to address the heterogeneity of individuals struggling with ADHD and ADHD-associated comorbidities. This review profiles alternatives to Schedule II (CII) stimulants that are in clinical stages of development (Phase 2 or 3). Particular attention is given to viloxazine extended-release, which has completed Phase 3 studies in children and adolescents with ADHD.

More than half of all patients consulting at public health facilities in Cali, Colombia have been shown to present mental disorders, the majority of which were non-psychotic; there is a high female preponderance amongst the affective disorders. As in other developing countries, in Colombia depressive disorders tend to present as somatic complaints, rather than as mood disturbances. The nomenclature used to describe these disorders is poorly codified, with most patients classed as “neurotic” or “depressed”; the diagnosis of “dysthymia” is very seldom encountered. Mental disorders are frequently misdiagnosed in primary care settings; when identified, treatment of depression by GPs generally involves TCAs or MAOIs, sometimes in conjunction with anxiolytics or neuroleptics. Only very severe cases are referred to psychiatrists, and many patients purchase drugs upon the recommendation of a pharmacist. Diagnostic trends and treatment results of a comparative study of amisulpride and viloxazine carried out in 80 patients assessed by DSM III-R criteria are reported.

Une étude contrôlée comparative de la viloxazine et de la clomipramine injectables, par la méthode du cotateur aveugle avec temps aveugle, a été conduite chez 30 sujets des 2 sexes hospitalisés dans un service spécialisé lors de la survenue d’un épisode dépressif majeur. Une répartition homogène de la population recrutée pour cet essai a été obtenue en recourant à la méthode d’homogénéisation décrite par Taves. La comparabilité des 2 groupes ainsi recrutés à partir des variables définies préalablement à cet essai s’est révélée satisfaisante. Deux sujets n’ont pas terminé l’essai, un dans chaque groupe de traitement. Les résultats globaux mettent en évidence une efficacité antidépressive non significativement différente entre les 2 groupes à 21 jours de traitement dont 7 jours de perfusion à la posologie de 300 mg de viloxazine ou 75 mg de clomipramine suivis d’un relais à 600 mg de viloxazine ou de 150 mg de clomipramine. Une analyse en composante principale des instruments d’évaluation semble indiquer une polarité d’action plus marquée de la clomipramine sur l’humeur, tandis que la viloxazine voit ses effets plus marqués sur le ralentissement. Le suivi des concentrations plasmatiques de viloxazine réalisé dans le cadre de cet essai a confirmé les principales caractéristiques pharmacocinétiques de la viloxazine et mis en évidence l’absence de modification des concentrations après le passage de la forme IV à la forme comprimés. Elle n’a pas, enfin, mis en évidence de corrélation entre les taux plasmatiques et la réponse thérapeutique.