Attention deficit-hyperactivity disorder antidepressants

Amphetamine Clinically used for narcolepsy (sudden day-time onset sleep) and Attention Deficit Hyperactivity Disorder (ADHD) formerly used as a short-term slimming agent, as an antidepressant and to boost athletic performance recreational use widespread tolerance develops readily highly addictive regular users suffer many health problems and a reduced life expectancy amphetamine psychosis may develop, with similar symptoms to acute paranoid schizophrenia. 

Maidment ID. The use of antidepressants to treat attention deficit hyperactivity disorder in adults. J Psychopharmacol 2003 17(3) 332-336. 

ADHD, attention-deficit hyperactivity disorder MAOI, monoamine oxidase inhibitor TCA, tricyclic antidepressants. Cluster B symptoms, reexperiencing, intrusive recollections, traumatic nightmares, flashbacks cluster C symptoms, avoidant behavior, numbing, dissociation cluster D symptoms, hyperarousal, insomnia, irritability, hypervigilance, hyperstartle. 

Data support its usefulness in conditions not typically responsive to other antidepressants, specifically adult attention deficit hyperactivity disorder (ADHD) ( 169) and smoking cessation (170). 

Wilens TE, Biederman J, Mick E, et al. A systematic assessment of tricyclic antidepressants in the treatment of adult attention deficit hyperactivity disorder. J Nerv Ment Dis 1995 183 48-50. 

The main indication for antidepressants is depressive disorders, which have received increased attention owing to the growing recognition of their high prevalence. Other antidepressant uses include treatment of anxiety disorders, attention deficit hyperactivity disorders, nocturnal enuresis or psychosomatic disorders... 

Gelenberg AJ, Chesen CL (2000) How fast are antidepressants J Qin Psychiatry 61 712-721 GUI M, Daly G, Heron S, Hawi Z, Fitzgerald M (1997) Confirmation of association between attention deficit hyperactivity disorder and a dopamine transporter polymorphism. Mol Psychiatry... 

Several medical, medication-induced, or substance-related causes of mania and depression have been identified (see Table 68-2 for causes of mania and Table 67-1 in Chap. 67 on depressive disorders for causes of depression). " A complete medical, psychiatric, and medication history physical examination and laboratory testing are necessary to rule out any organic causes of mania or depression. An accurate diagnosis is important because some psychiatric and neurologic disorders present with manic-like symptoms. For example, attention-deficit/hyperactivity disorder and a manic episode have similar characteristics thus individuals with bipolar disorder may be misdiagnosed and prescribed central nervous system stimulants. Use of any substance that affects the central nervous system (e.g., alcohol, antidepressants, caffeine, central nervous system stimulants, hallucinogens, or marijuana) can worsen symptoms and decrease the... 

After antidepressants, stimulants constitute the second most widely prescribed class of therapeutic agents for children with ASD (Oswald and Sonenklar, 2007). The primary rationale for the use of stimulants in ASD is to reduce symptoms of hyperactivity and irritability, based on their effectiveness in treating behavioral symptoms of attention-deficit hyperactivity disorder (ADHD) (Findling, 2008). 

Norepinephrine reuptake antagonists (NETs) have antidepressant activity and have been found to be effective in the treatment of attention deficit hyperactivity disorder (ADHD). (/ )-tomoxetine (Strattera ) 95 is a marketed drug with a label indication for ADHD. Control of the absolute stereochemistry of these compounds is critical in that the (S) enantiomer is nine times less potent. The CBS reduction could be used to set the desired chirality as demonstrated in the reduction of 93 to produce alcohol 94.26 This intermediate could then be readily converted into 95. 

OTHER THERAPEUTIC USES OE THESE DRUGS The various antidepressant agents have found broad utility in other disorders that may not be related psychobiologicaUy to the mood disorders. Current applications include rapid but temporary suppression of enuresis with low (e.g., 25 mg) pre-bedtime doses of tricyclic antidepressants, including imipramine and nortriptyline, by uncertain mechanisms in children and in geriatric patients, as well as a beneficial effect of duloxetine on urinary stress incontinence. Antidepressants have a growing role in attention-deficit/hyperactivity disorder in children and adults, for which imipramine, desipramine, and nortriptyline appear to be effective, even in patients responding poorly to or who are intolerant of the stimulants (e.g., methylphenidate). Newer NE selective reuptake inhibitors also may be useful in this disorder atomoxetine is approved for this application. Utility of SSRIs in this syndrome is not established, and bupropion, despite its similarity to stimulants, appears to have limited efficacy. 

Antidepressants tend to provide a more sustained and continuous improvement of the symptoms of attention-deficit/hyperactivity disorder than do the stimulants and do not induce tics or other abnormal movements sometimes associated with stimulants. Indeed, desipramine and nortriptyhne may effectively treat tic disorders, either in association with the use of stimulants or in patients with both attention deficit disorder and Tourette s syndrome. Antidepressants also are leading choices in the treatment of severe anxiety disorders, including panic disorder with agoraphobia, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder, as weU as for the common comorbidity of anxiety in depressive illness. Antidepressants, especially SSRIs, also are employed in the management of posttraumatic stress disorder, which is marked by anxiety, startle, painful recollection of the traumatic events, and disturbed sleep. Initially, anxious patients often tolerate nonsedating antidepressants poorly (Table 17-1), requiring slowly increased doses. Their beneficial actions typically are delayed for several weeks in anxiety disorders, just as they are in major depression. 

In addition, it exerts beneficial effects in many disorders as an adjuvant to other treatment modalities. Such effects are apparent only if it is administered to an already pharmacologically treated patient. For example, in unresponsive major depressive disorder, the co-administration of lithium to an ongoing antidepressant treatment increases the response rate by up to 50%. In most cases, the response to lithium augmentation is either considerable or not at all ( all-or-none phenomenon). Some (currently not convincing) results have also been reported in unipolar depression, bulimia nervosa, and attention deficit hyperactivity disorder (ADHD). Lithium also exerts antiaggressive effects in conduct disorder, independent of any mood disorder, and can reduce behavioral dyscontrol and self-mutilation in mentally retarded patients. One of the most striking effects of lithium is its antisuicidal effect in patients who suffer from bipolar and unipolar depressive disorder irrespective of comorbid axis I disorder. ... 

About a quarter of the 3 million campers in the 2,600 camps belonging to the American Camp Association are medicated for attention deficit disorder, psychiatric problems, or mood disorders, according to Peg L. Smith, chief executive officer. The proliferation of children on stimulants for attention deficit hyperactivity disorder (ADHD), antidepressants, or antipsychotic drugs is not only in the setting of camps. It is the extension of an increasingly common year-round regimen in schools and at home. 

Laugesen K, Olsen MS, Telen Andersen AB, Froslev T, Sorensen HT. In utero exposure to antidepressant drugs and risk of attention deficit hyperactivity disorder a nationwide Danish cohort study. BMJ Open 2013 3(9) e003507. 

Perhaps even more important in children is the issue of bipolar disorder. Mania and mixed mania have not only been greatly underdiagnosed in children in the past but also have been frequently misdiagnosed as attention deficit disorder and hyperactivity. Furthermore, bipolar disorder misdiagnosed as attention deficit disorder and treated with stimulants can produce the same chaos and rapid cycling state as antidepressants can in bipolar disorder. Thus, it is important to consider the diagnosis of bipolar disorder in children, especially those unresponsive or apparently worsened by stimulants and those who have a family member with bipolar disorder. These children may need their stimulants and antidepressants discontinued and treatment with mood stabilizers such as valproic acid or lithium initiated. 

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