For older adolescents and adults with ADHD, there's an increasing interest among medical professionals in using a newer class of antidepressants called SSRIs when there is concurrent depression or anxiety. These Selective Serotonin Reuptake Inhibitors help regulate the neurotransmitter serotonin in the brain. Some of the more common SSRIs that are used in ADHD include fluoxetine (Prozac and Prozac Weekly) and sertraline (Zoloft).
There is a newer drug, one of the so-called "designer antidepressants," called Bupropion (Wellbutrin and Wellbutrin SR) that is now being used to treat adults and adolescents with ADHD and depression. However, it may take several weeks to see a benefit.
Other antidepressants (Paxil, Paxil Weekly, Effexor, and Effexor XR) are best not used in children and teens. The reason? Although Paxil and Effexor are still used in children and adolescents, both have recently received criticism from the FDA, AAFP, and Effexor's company because of the inability to show benefit (for depression) and a slight rise in "suicidal behaviors." No suicides have resulted from these unpublished trials, but for now we should use other SSRIs and SNRIs instead for children and adolescents.
In one report, bupropion was shown to be effective in treating adolescents with ADHD and conduct disorder problems. Some experts are even using bupropion for ADHD in children. These medications affect one or more of the brain's neurotransmitters that are not targeted by other antidepressants. And, many experts are starting to use these antidepressants as first line drugs - even before trying stimulant medications. Antidepressant Adhd Medications
Some physicians like to use the designer antidepressants instead of the stimulants. They feel they have less potential for abuse - by your kid's friends! In addition, they can be used for adolescents or adults with ADHD and depression or those who don't respond to stimulants.
One last class of antidepressants still used by physicians in the treatment of ADHD is the tricyclic antidepressants. This is an older class of medications that have been available for decades. Examples include desipramine (Norpramin) and imipramine (Tofranil, Tofranil-PM). In one study of adults with ADHD, it was reported that desipramine worked as well as Ritalin.
The tricyclics are much less expensive than the brand name SSRIs or designer antidepressants. However, they may have more side effects, including drowsiness and dry mouth. Typically these side effects decrease over time. In addition, case reports of sudden deaths in children taking tricyclics have caused concern. Although a rare side effect (and it is still questioned whether the tricyclic actually caused these deaths), most parents who are made aware of this possibility will choose other options.
In addition, case reports of delirium and tachycardia (a racing heart rate) in adolescents who take tricyclics and smoke marijuana cause some parents to choose other options for their teenagers.
Other Medication Options
Besides stimulants and antidepressants, there are several other medication options your physician may consider:
MAOI
The monoamine oxidase inhibitor (MAOI) tranylcypromine (Parnate) has been reported to help some children with ADHD. However, taking it requires a significantly restricted diet and the avoidance of a number of over-the-counter drugs (including some common cough syrups, herbs, and supplements) and prescription drugs.
In addition, fatal reactions have been reported when MAOIs and SSRIs have been taken together. Because of these interactions, most physicians use a MAOI only if no other options seem to work as well, This class is usually prescribed only by psychiatrists. Antidepressant Adhd Medications
BuSpar
The antianxiety drug buspirone (BuSpar) has been reported to help some children with ADHD and is currently being studied in children and adolescents with ADHD.
Catapres
The alpha-2 antagonist clonidine (Catapres) is one of the most common "add-on" medications for ADHD. In other words, if a stimulant or antidepressant is not fully effective, many physicians will "add-on" clonidine as a second medication, especially for those children who have more problems with impulsivity, aggression, or oppositional symptoms.
This medication affects the neurotransmitter norepinephrine, an important chemical in the process of concentration. Uncommon side effects include dizziness, dry mouth, drowsiness, or constipation, which usually lessen over time. Also, clonidine can cause the heart to slow down and missing doses has been known to cause tachycardia (rapid heartbeat) and other problems. A handful of deaths in children taking clonidine and Ritalin have been reported. Therefore, some experts recommend children be evaluated for heart or kidney problems.
Provigil (modafinil)
Approved only for the treatment of excessive daytime sleepiness associated with narcolepsy, modafinil significantly improves the symptoms of ADHD in children, according to a study conducted by Dr. Joseph Biederman, professor of psychiatry at Harvard Medical School. Optimum dosing may take some time to determine, yet it seems to be a good alternative for those patients who do not respond positively to stimulant therapies.
Strattera (atomoxetine HCI)
In January 2003, Strattera was released with FDA approval. In studies, the drug was shown to have fewer side effects than stimulants and controlled substances, and no risk of insomnia or addiction. It was the first new drug to be approved for ADHD in nearly three decades, and also the first nonschedule II drug. It is indicated for the treatment of adolescents and adults, and therefore may become first line therapy.
Clinical Studies have not yet proved its effectiveness as opposed to stimulants, but as a selective norepinephrine reuptake inhibitor, researchers believe it may have a better ability to regulate norepinephrine than Catapres and with fewer side effects.
Other medications
Some physicians also use a similar to clonidine, guanfacine (Tenex). It causes less drowsiness than Clonidine.
The anti-Parkinson's drug Sinemet (levodopa/carbidopa} has been given to kids with Restless Leg Syndrome (RLS). Kids with RLS and ADHD who have been treated with Sinemet have been reported to show improvement in their ADHD. More research is currently being done on this medication in kids with ADHD.
Next post, we'll go in combined medications. At mean time, you can find more details at Antidepressant Adhd Medications.
