Can Solriamfetol Help Treat Attention Deficit Hyperactivity Disorder in Adolescents?

What you need to know

• Solriamfetol, a medication primarily used for sleep disorders, shows potential in treating ADHD in a case study of an adolescent patient.
• The patient experienced significant improvement in ADHD symptoms and academic performance after treatment with solriamfetol.
• While promising, more research is needed to confirm the effectiveness and safety of solriamfetol for ADHD treatment in children and adolescents.

Introduction to ADHD and Treatment Challenges

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that affects both children and adults. It is characterized by persistent inattention, hyperactivity, and impulsivity that interfere with daily functioning and development. For many individuals with ADHD, finding an effective treatment can be a challenging process, often involving trials of different medications and therapies.

In this article, we’ll explore a case study that introduces a potential new treatment option for ADHD, particularly for those who haven’t responded well to conventional therapies. This case involves the use of solriamfetol, a medication typically used for sleep disorders, in treating ADHD symptoms in an adolescent patient.

The Case Study: A Challenging ADHD Presentation

The case study focuses on a 15-year-old male patient in Kuwait who was struggling with poor academic performance. He had previously been diagnosed with ADHD, specifically the inattentive presentation. This means that while he didn’t show significant hyperactivity or impulsivity, he had persistent difficulties with focus, organization, and completing tasks.

What made this case particularly challenging was that the patient had already tried several common ADHD medications without success. These included:

1. Atomoxetine: A non-stimulant medication that works by increasing norepinephrine levels in the brain.
2. Methylphenidate: A stimulant medication that increases dopamine and norepinephrine levels.
3. Clonidine: Often used as an add-on treatment for ADHD, particularly to help with sleep issues or hyperactivity.
4. Venlafaxine: An antidepressant sometimes used off-label for ADHD.

Despite these treatments, along with academic support and remedial teaching, the patient’s ADHD symptoms persisted, significantly impacting his school performance and social interactions.

Introducing Solriamfetol: A New Approach

Given the lack of response to conventional ADHD treatments, the treating clinicians decided to try a novel approach using solriamfetol. Here’s what you need to know about this medication:

1. Primary Use: Solriamfetol (brand name Sunosi®) is primarily approved for treating excessive daytime sleepiness in conditions like narcolepsy and obstructive sleep apnea.

2. Mechanism of Action: It works as a Norepinephrine Dopamine Reuptake Inhibitor (NDRI). This means it increases the levels of norepinephrine and dopamine in the brain by preventing these neurotransmitters from being reabsorbed too quickly.

3. Similarity to Other Medications: Its mechanism is similar to bupropion, an antidepressant that has also been used to treat ADHD in some cases.

4. Duration of Effect: Solriamfetol promotes wakefulness for about 9 hours.

5. Potential Side Effects: Like stimulant medications used for ADHD, solriamfetol can cause side effects such as headache, anxiety, reduced appetite, and insomnia.

The Treatment Process and Results

The treatment with solriamfetol was carefully implemented and monitored:

1. Initial Dose: Treatment started at 37.5 mg taken in the morning.

2. Dose Adjustment: After 3 days, the dose was increased to 75 mg.

3. Early Response: Two weeks into treatment, the patient reported noticeable improvement.

4. Further Adjustment: The dose was gradually increased to a maximum of 150 mg.

5. Significant Improvement: After another two weeks, both parents and school reports indicated substantial improvement in the patient’s overall performance.

6. Symptom Assessment: A standardized ADHD assessment tool (Vanderbilt Assessment Scales) showed a dramatic reduction in inattentive symptoms, from 8 out of 9 symptoms before treatment to just 1 out of 9 after treatment.

7. Sustained Response: The positive effects were maintained for at least three months at the time the case was reported.

Additional Benefits and Considerations

Beyond the improvement in ADHD symptoms, the patient experienced some additional benefits:

1. Weight Loss: The patient, who was described as morbidly obese, lost 6 kg (about 13 pounds) during treatment. This was considered advantageous for his overall health.

2. Tolerability: The patient did not report any significant side effects from the medication.

3. Vital Signs: Blood pressure and pulse remained normal throughout the treatment period.

Understanding the Potential of Solriamfetol for ADHD

While this case study shows promising results, it’s important to understand the broader context:

1. Novel Use: This is one of the earliest reports of using solriamfetol for ADHD, particularly in a difficult-to-treat case.

2. Lack of Data: There is currently no data available on the use of solriamfetol in children and adolescents for psychiatric conditions.

3. Mechanism Rationale: The way solriamfetol works in the brain (increasing norepinephrine and dopamine) is similar to how some established ADHD medications work, which provides a theoretical basis for its potential effectiveness.

4. Potential for Other Conditions: The authors suggest that solriamfetol might also have potential for treating conditions like major depressive disorder, aiding in smoking cessation, and managing binge-eating disorder. However, clinical trials for these uses are lacking.

Conclusions

• Solriamfetol showed significant effectiveness in treating ADHD symptoms in an adolescent patient who had not responded to several conventional ADHD medications.
• The medication was well-tolerated, with no reported side effects and some additional benefits like weight loss.
• While promising, this is a single case study, and large-scale clinical trials are needed to confirm the safety and efficacy of solriamfetol for ADHD treatment in children and adolescents.
• Clinicians and patients should still prioritize well-established, evidence-based treatments for ADHD before considering novel approaches like solriamfetol.

This case study opens up new possibilities for ADHD treatment, particularly for individuals who haven’t responded well to conventional therapies. However, it’s crucial to approach these findings with caution and to continue researching to fully understand the potential benefits and risks of using solriamfetol for ADHD in younger populations.