CASA of Arizona

ADHD - pg. 7

Anti-depressants



Antidepressants may be helpful in certain people with ADHD. In fact, some experts recommend them as first line treatments for adults with the disorder.

Designer Antidepressants

Bupropion (Wellbutrin) and venlafaxine (Efexor) are unique antidepressants, sometimes referred to as designer antidepressants, which affect one or more neurotransmitters that are not targeted by other, earlier antidepressants. They may actually be helpful for treating ADHD itself as well as for accompanying depression. One study suggested that bupropion may be helpful for ADHD adolescents with conduct disorder problems.

SSRIs

The antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), are effective and safe and often recommended for treating depression with ADHD. It should be noted, however, that some SSRIs may increase the risk for impulsive behavior. Sertraline has also helped adults with pervasive development disorder, but its effect on children is unknown; other SSRIs have not been very helpful for childhood ADD.

MAOIs

Tranylcypromine (Parnate) is an antidepressant known as a monoamine oxidase inhibitor (MAOI) that has helped some children. Patients who are prescribed MAOIs, however, have a restricted diet and cannot eat certain foods including cheese, dried meats and fish, canned figs, fava beans, and concentrated yeast products. They must also avoid certain drugs, including some common over-the-counter cough medications. It is important to note that fatal reactions have occurred when SSRIs and MAOIs were taken at the same time. There should be a two to five-week break, depending on the specific medication, when a patient is changing from one type of antidepressant to the other.

Other Drug Treatments



Alpha-2 Agonists

Clonidine (Catapres), a drug known as an alpha-2 agonist, is used for Tourette's syndrome and for ADHD children with tics and whose problems tend more toward impulsivity and aggression than inattentiveness. The drug stimulates the neurotransmitter norepinephrine, which appears to be important for concentration. Sedation is the most common side effect. A clonidine skin patch, which gradually releases the medication, helps reduce the sedative effect. Few major studies have been conducted on its efficacy in ADHD children, however. Because the drug slows the heart down, it can have very adverse effects in some children. Going off too quickly or missing doses can cause rapid heartbeats and other symptoms that may lead to severe problems. Of great concern are reports of severe adverse effects, including four deaths from heart problems, in children taking the drug in combination with Ritalin for improving sleep. Experts strongly recommend that no child be given this medication without a preliminary examination of any heart problems, and no child with existing heart, kidney, or circulatory problems should take it. A similar drug, guanfacine (Tenex), also improves symptoms in ADHD children and may cause less drowsiness than clonidine.

Other Medications

Neuroleptics have been found to be occasionally effective, yet the risk of movement disorders, such as tardive dyskinesia, make their use problematic. Lithium, fenfluramine, or benzodiazapines have not been found to be effective treatments for ADHD. Furthermore, more than 20 studies have shown that dietary manipulation is not effective, and controlled studies failed to demonstrate that sugar exacerbates the symptoms of children with ADHD.


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