Antidepressant 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.

Antidepressant medication dosage:

Often these 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.

Antidepressant side effects:

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 medications.

Summary of 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.