Antidepressant medication: Safe and effective for ADHD?
medications for ADHD:
Over the years,
clinicians have increasingly turned to the use of antidepressant
medications such as Imipramine and Desipramine for the management of
ADHD symptoms. Many speculate that this has frequently been done in
response to the massive publicity in the popular media about the
"over medication" and "over-prescription" of the stimulants,
especially Ritalin (methylphenidate). The use of antidepressant
medications for adults and children with ADHD has also frequently
been used in cases where the stimulants were not found be effective,
or when it was determined that there was a significant comorbid mood
disturbance, such as anxiety and/or depression. Unfortunately, less
is known about the way that antidepressant medications react
biochemically in children than is generally known about the
stimulants. However, there has been more research over the past
decade which generally supports the use of antidepressants in the
management of ADHD symptoms.
medications are given twice daily, usually in the morning and
evening. Antidepressant medications are generally more longer acting
than stimulants and as a result, it takes a longer period of time
for their therapeutic value to be achieved at any given dosage
level. Some research indicates that at low doses the tricyclics
produce similar improvements in increasing vigilance and sustained
attention as well as decreasing impulsivity. As a result, frequently
aggressive and disruptive behaviors may be reduced. Also, it has
been noted that frequently there may be an elevation in mood,
particularly in those children with significant pretreatment levels
of depression and anxiety. Unfortunately however, the treatment
effects of antidepressant medications seem to diminish over time
making them, unlike stimulants, unable to be used as a form of
long-term therapy for ADHD.
Some of the more
common antidepressant side effects of the tricyclics may be
drowsiness during the first few days to treatment, dry mouth,
constipation and flushing. Cardiotoxic effects are much more
important but less likely. Cardiotoxic effects include tachycardia
and arrhythmia, which may even cause death in cases of overdose.
Some children have been known to develop sluggish reactions in
focusing the optic lens which may appear similar to nearsightedness.
This reaction is usually not permanent and will usually dissipate
when treatment is withdrawn. Skin rashes occasionally have been
reported and usually warrant ceasing drug treatment with these
antidepressant usage for ADHD:
It seems that
tricyclic antidepressants may be used for short-term treatment of
ADHD children when the stimulants cannot be used, or when a
significant mood disturbance accompanies the ADHD symptoms. However,
the cardiac function must be properly monitored before treatment and
likely throughout treatment given the apparent risks of cardiac
impairment related to the use of tricyclic antidepressants.
Information adapted from
Treatment of Childhood Disorders by Eric J. Marsh and Russell A.
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