Methylphenidate anxiety with

This conclusion stands in contrast to the statements made in an earlier review (Kauffmann and Hallahan, 1979) that behavioral therapeutic techniques have an important role to play in ADHD, and partly contradicts the results of some more recent studies. As summarized in Chapter 7 (p. 250 f.), the US MTA study did not detect any significant difference between combined treatments and treatment with methylphenidate alone with regard to their effects on ADHD symptoms however combined treatments had some advantage over drug alone on features such as anxiety disorders, social skills, consumer (mainly parent) satisfaction and possibly academic achievement (Pelham et al., 2000). Additional statistical analysis of the MTA study by responders and in terms of composite outcome measures also revealed additional benefit of combined treatments over drug therapy alone (Jensen et al., 2001). 

Patients with marked anxiety, tension, and agitation, because the drug may aggravate these symptoms hypersensitivity to methylphenidate or other components of the product patients with glaucoma, motor tics, or a family history or diagnosis of Tourette s syndrome during treatment with monoamine oxidase inhibitors (MAOIs), and also within a minimum of 14 days following discontinuation of an MAOl (hypertensive crises may result). 

The safety and efficacy of combined SSRI and stimulant pharmacotherapy have been addressed in two open studies. Gammon and Brown (1993) reported on the successful addition of fluoxetine to stimulants in the treatment of 32 patients with ADHD with comorbid depressive and anxiety disorders (Gammon and Brown 1993). These children with comorbid conditions had failed to respond to methylphenidate alone. Another report detailed the addition of methylphenidate to SSRI treatment (Findling, 1996). Depressed children and adults with comorbid ADHD were treated with either fluoxetine or sertraline. While depressive symptoms remitted, ADHD symptoms persisted. Methylphenidate was added and successfully treated the ADHD symptoms. In both investigations, the combined treatment was well tolerated. 

Diamond, I.R., Tannock, R., and Schachar, R.J. (1999) Response to methylphenidate in children with ADHD and comorbid anxiety. / Am Acad Child Adolesc Psychiatry 38 402—409. 

Tannock, R., Ickowicz, A., and Schechar, R. (1995) Differential effects of methylphenidate on working memory in ADHD children with and without comorbid anxiety. J Am Acad Child Adolesc Psychiatry 34 886-896. 

Recent open and double-blind studies indicate that methylphenidate can help a subset of autistic hyperactive children, particularly those with IQs >45, by decreasing ADHD-like symptomatology without increasing stereotypies, tics, or anxiety (Birmaher et ah, 1988 Aman et ah, 1993, 1997 Quintana et al. 1995 Handen et al., 1999). While some patients with pervasive developmental disorders (FDD) experienced adverse reactions to stimulants, the majority of them had IQs of <45 (Handen et al., 1999). 

A 22-year-old man who had had ADHD since the age of 8 years took methylphenidate, and had an adequate response for 14 years (52). However, his symptoms worsened and he switched from methylphenidate to mixed amfetamine salts 20 mg bd. A month later he continued to have difficulty in focusing on tasks, and the dosage was eventually increased to 45 mg tds over several weeks, with symptomatic improvement. However, 5 days later, he awoke feeling nauseated and agitated and had choreiform movements of his face, trunk, and limbs. He had also taken escitalopram 10 mg/day for anxiety and depression for 2 months before any changes in his ADHD medications. He was treated with intravenous diphenhydramine, lora-zepam, and diazepam without improvement in the chorea. Amfetamine was withdrawn and 3 days later his chorea abated. He restarted methylphenidate and the movement disorders did not recur. 

INDIRECT SSRIs 1. Case report of serotonin syndrome when dexamfetamine was co-administered with citalopram 2. Case reports of psychiatric disturbances when methylphenidate was given with sertraline and phenylpropanolamine co-adminis-tered with phenylpropanolamine 1. Uncertain postulated that it is an additive effect of the inhibition of serotonin reuptake by citalopram with the release of serotonin by venlafaxine 2. Uncertain 1. Avoid co-administration of dexamfetamine and citalopram 2. Warn patients to watch for early signs such as anxiety... 

Methylphenidate increased some of the motor effects of levodopa in selected patients with Parkinson s disease (52). Changes in self-assessed analogue ratings of mood, anxiety, arousal, or concentration did not differ. 

A 10-year-old boy with ADHD, oppositional defiant disorder, and generalized and separation anxiety disorders started taking OROS methylphenidate 18 mg/day and fluoxetine 10 mg/day. Four days later, he had an acute episode of intense hallucinations 3 hours after taking the medications. His mother reported that the visual hallucinations lasted about 1 hour and the tactile hallucinations more than 2 hours. Two days later he had a similar episode. His mother withdrew the medications for 10 days, during which time he was symptom free. When OROS methylphenidate 18 mg/day monotherapy was restarted he did not report any hallucinations. Mirtazapine 15 mg/day was added for symptoms of anxiety and sleep disturbances. During the next 2 months his condition improved and he had no further hallucinations. 

In a 6-week-randomised, double-blind study, 44 patients diagnosed with ADHD were randomly assigned to receive bupropion 100-150 mg/day or methylphenidate (20-30 mg/day) treatment. No serious events were observed in the study in any of the patients. The most commonly reported adverse events were abdominal pain (30%), anxiety (25%), decreased appetite (55%), agitation (20%), insomnia (50%), dizziness (5%), dry mouth (15%), nervousness (25%), tachycardia (5%), headache (50%) and vomiting (15%) [18 ]. In a randomised, double-blind. 

---