Aggression methylphenidate

Winsberg, B.G. Press, M. Bialer, I. and Kupietz, S. Dextroamphetamine and methylphenidate in the treatment of hyperactive/aggressive children. Pediatrics 53 236-241, 1974. 

Methylphenidate (Ritalin). Methylphenidate was developed in the late 1950s and its first use was the treatment of what we now call ADHD. Since that time, it has also been approved for the treatment of narcolepsy. Its only other use is the treatment of severe refractory depression either in medically ill patients who need rapid clinical improvement or as an augmentation agent when added to other antidepressants. In the treatment of ADHD, methylphenidate not only improves attention but also reduces hyperactivity and impulsivity. Verbal and physical aggression typically decreases as well. 

Methylphenidate also has been combined with clon-idine, the a.2 agonist, to reduce aggression, to provide better control of ADHD symptoms after the stimulant wears off, and to counteract insomnia associated with stimulant treatment (Wilens et ah, 1994). The report of four deaths on the Federal Drug Administration (FDA) s MEDWATCH surveillance network, however,... 

Connor, D.F., Barkley, R.A., and Davis, H.T (2000) A pilot study of methylphenidate, clonidine, or the combination in ADHD comorbid with aggressive oppositional defiant or conduct disorder. Clin Pediatr 39 15-25. 

Gadow, K.D., Nolan, E.E., Sverd, J., Sprafkin, J., and Paolicelli, L. (1990) Methylphenidate in aggressive-hyperactive boys I. Effects on peer aggression in public school settings. / Am Acad Child Adolesc Psychiatry 29 710—718. 

Kaplan, S.L., Busner, J., Kupietz, S., Wasserman, E., and Segal, B. (1990) Effects of methylphenidate on adolescents with aggressive conduct disorder and ADDH a preliminary report. J Am Acad Child Adolesc Psychiatry 29 719-723. 

A. D., McBride, M.C., and Loeb, S. (1989) Comparative effects of methylphenidate on attention-deficit hyperactivity disorder with and without aggressive/noncompliant features. Psychophar-macol Bull 25 109—113. 

Murphy, D., Pelham, W., and Lang, A. (1992) Aggression in boys with attention deficit-hyperactivity disorder Methylphenidate effects on naturalistically observed aggression, response to provocation, and social information processing. J Abnorm Child Psychol 20 451-466. 

Klorman, R., Brumaghmi, J.T., Fitzpatrick, P.A., et al. Clinical and cognitive effects of methylphenidate on children with attention deficit disorder as a function of aggression/oppositionality and age. J. Ahnorm. Psychol. 103, 206-221, 1994. 

In other studies, methylphenidate has been shown to improve subjective mood evaluations in both adults (44) and children (42). A comparison between d-amphetamine, /-amphetamine, and methylphenidate (administered in dosages equimolar to 10 mg or 20 mg) indicated that methylphenidate s euphoric effects were between those found with rf-amphetamine and /-amphetamine (55). In the earlier-mentioned study by Coons et al. (49), methylphenidate increased subjective ratings of concentration and aggression compared to placebo. In the study by Peloquin and Klorman (42), 0.3 mg/kg methylphenidate prevented the increased ratings of dysphoria over time, and produced an overall lower dysphoria rating than placebo. In Roehrs et al. (53), methylphenidate (10 mg) remedied the adverse... 

Post-marketing reports received by FDA regarding Concerta and other methylphenidate products [e.g., Ritalin] include psychiatric events such as visual hallucinations, suicidal ideation, psychotic behavior, as well as aggression or violent behavior. 

As monotherapy or in combination with methylphenidate for ADHD with conduct disorder or oppositional defiant disorder, may improve aggression, oppositional, and conduct disorder symptoms... 

At this time, the preferred first-line drug therapy for ADHD is either methylphenidate, dexmethylphenidate, mixed amphetamine salts, or dextroamphetamine. Atomoxetine, bupropion, or TCAs are good options for those umesponsive to or unable to tolerate stimulants. Clonidine and guanfacine are third-line options or adjuncts that require careful cardiovascular monitoring. Mood stabilizers (e.g., lithium, divalproex, and carbamazepine) and atypical antipsychotics are adjuncts for control of aggression or comorbid bipolar disorder. Other agents require further investigation before their status in the treatment of ADHD can be fuUy determined. 

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