BACKGROUND: Adults who identify themselves as having problems with attention and concentration will often make an office visit to request treatment with a stimulant medication, rather than an antidepressant. The uncertainty of the diagnosis and the prospect of a long-term prescription with a stimulant medication can create a dilemma for physicians. METHODS: We searched MEDLINE for any English-language studies of antidepressant or stimulant treatment of adults with attention deficits. References from relevant articles were reviewed to supplement the MEDLINE search. RESULTS: Antidepressants and stimulants seem to be equally effective for adults with attention-deficit hyperactivity disorder (ADHD). Recent controlled studies suggest that desipramine (an antidepressant) may be as effective as methylphenidate (a stimulant) for improving symptoms of adult ADHD. CONCLUSIONS: Although few good controlled studies exist, the available research suggests that certain antidepressants and stimulants are equally effective for adults with ADHD. Antidepressants may offer a safe first-line treatment for adults with ADHD.