Clonidine depression with

Clonidine may potentiate the effects of alcohol, sedatives and CNS depressants (102 ). High doses of clonidine combined with high doses of propranolol were in several cases associated with the development of nightmares, delusion and marked drowsiness (8 ). The combination of clonidine with the 3-adrenergic blocker Sotalol gave rise to an antagonistic effect, comprising a marked rise of blood pressure in 3 out of 6 cases so treated (103 ). 

Fyer AJ, Liebowitz MR, Gorman JM, et al Effects of clonidine on alprazolam discontinuation in panic patients a pilot study. J Clin Psychopharmacol 8 270—274,1988 Garvey MJ, Tollefson GD Prevalence of misuse of prescribed benzodiazepines in patients with primary anxiety disorder or major depression. Am J Psychiatry 143 1601-1603, 1986... 

Growth hormone. Mood disorders have been related to alterations in the activity of the growth-hormone axis. A blunted growth-hormone response to clonidine, an a2 receptor agonist, has been consistently found in depression. Increased growth-hormone secretion during the day and decreased nocturnal growth-hormone secretion have also been observed in depressed patients. Depressed patients have lower CSF concentrations of somatostatin, compared to those with schizophrenia and normal controls. While lower CSF somatostatin is a state-dependent marker of depression, it occurs in a number of unrelated nonpsychiatric conditions, and thus appears to be relatively nonspecific. 

The most common side effect of clonidine is drowsiness. This can begin with the very hrst dose and usually goes away after a few weeks. Clonidine s sedating effects can actually be useful when it s taken at bedtime. Insomnia is a common problem for patients with ADHD either as a side effect of stimulants or as a consequence of rebound hyperactivity at night when the daytime dose of stimulant has worn off. Clonidine can help the ADHD patient with insomnia to go to sleep. Other side effects of clonidine include low blood pressure, dizziness, depression, dry mouth, nausea, and slowed heart rate. One important point to remember is that not only does clonidine not cause tics, it can, in fact, relieve tics when they appear in patients with ADHD. 

Clonidine 0.003-0.01 bid or tid Tourette s syndrome ADHD Aggression/self-abuse Severe agitation Withdrawal syndromes Sedation (very frequent) Hypotension (rare) Dry mouth Confusion (with high dose) Depression Rebound hypertension Localized irritation with transdermal preparation... 

Loof et al. (1995) reported the use of carbamazepine (300-1200 mg/day, serum levels 10-11.5 pg/mL) in 28 children and adolescents with sexual abuse histories. By treatment end, 22 of 28 patients were asymptomatic of PTSD. The remaining six were significantly improved in all PTSD symptoms except for continued abuse-related nightmares. Half of this cohort had com-orbid ADHD, depression, ODD or polysubstance abuse and were treated with concomitant medications, e.g., methylphenidate, clonidine, sertraline, fluoxetine, or imipramine. 

Pandey GN, Janicak PG, Javaid Jl, et al Increased 3H-clonidine binding in the platelets of patients with depressive and schizophrenic disorders. Psychiatry Res 28 73-88, 1989... 

The drug should not be given to patients who are at risk for mental depression and should be withdrawn if depression occurs during therapy. Concomitant treatment with tricyclic antidepressants may block the anti hypertensive effect of clonidine. The interaction is believed to be due to cr-adrenoceptor-blocking actions of the tricyclics. 

Nicotine dependence may respond to replacement therapy with either nicotine gum or transdermal patches, and detoxification from nicotine dependence has been described using clonidine. Bupropion, an antidepressant, also shows efficacy for smoking cessation. The nicotinic receptor blocker mecamylamine, which has good central nervous system access, has been used with limited efficacy. Overall, success rates for smoking abstinence at 1 year are about 20%, with even less success for depressed smokers. 

Clonidine, an antihypertensive drug, also has been used in the treatment of mania. Sudden withdrawal can produce a rebound hypertensive crisis. Consistent with the brain-disabling principles, it can produce a variety of psychiatric symptoms, including sedation, vivid dreams or nightmares, insomnia, restlessness, anxiety, and depression. More rarely, it can cause hallucinations. Unfortunately, this drug is too commonly used as a so-called mood stabilizer in children. When mistakenly prescribed with stimulants, it causes an elevated risk of cardiac arrhythmia and cardiac arrest in children. 

Treatment with centrally acting agents is characterized by a relatively high incidence (up to 60% in some studies) of nervous system depressant effects (dizziness, drowsiness, tiredness, dry mouth, headache, depression), particularly during the initial period of treatment or after dosage increments. Sedation, lethargy, and tiredness are common with clonidine, particularly at the start of treatment (13). 

Clinically important, potentially hazardous interactions with alcohol, amprenavir, arbutamine, cholestyramine, clonidine, CNS depressants, epinephrine, formoterol, guanethidine, isocarboxazid, linezolid, MAO inhibitors, phenelzine, QT interval prolonging agents, quinolones, selegiline, sparfloxacin, sympathomimetics, tranylcypromine... 

The most common side effect of clonidine is dose-dependent sedation that usually subsides after 2 to 3 weeks of therapy. Of concern are reports of bradycardia, rebound hypertension, heart block, and sudden death. Four children have died on the combination of methylphenidate and clonidine however, complicating factors make it impossible to link the drug combination directly with the cause of death. Of 10,060 children exposed to clonidine and assessed by a poison control center over a 7-year period, moderate (19%) to major (2%) toxic effects (bradycardia, hypotension, and respiratory depression) including one death were reported. Overdoses, concurrent clonidine and stimulant administration, as well as missed doses of clonidine aU add to the risk of adverse cardiovascular events. Similar adverse-effect concerns apply to treatment with guanfacine, although its U2a selectivity may result in less sedation and hypotension than clonidine. ... 

Overdosage with clonidine causes bradycardia, hypotension, CNS depression, respiratory depression, hypothermia, apnea, and hypoventilation. Atropine sulfate is able to reverse bradycardia, and epinephrine, dopamine, or tolazine are effective in combating hypotension. 

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