Nonstimulant Therapy, Strattera: Other ADHD Drugs (cont.)

Strattera should always be taken exactly as prescribed. It is usually taken once or twice a day and may be taken with or without food. No specific laboratory testing is required while taking Strattera and it may be used for extended, or long-term, treatment as long as there are periodic evaluations with your health care provider.

Antidepressant Therapy

Several types of antidepressant drugs can be used to treat ADHD. Antidepressant therapy for ADHD is sometimes used as the treatment of choice for children or adults who have ADHD and depression.

antidepressants, however, are generally not as effective as stimulants or Straterra at improving attention span and concentration.

Antidepressants used for treating ADHD include:

• Tricyclic antidepressants, such as Pamelor, Aventyl, Tofranil, Norpramin, and Pertofrane, have been shown to be helpful in children and adults with ADHD, but they can cause some unpleasant side effects, such as dry mouth, constipation or urinary problems. They are also relatively inexpensive.
• Wellbutrin is a different type of antidepressant that is very effective in treating ADHD in adults and children. It is generally well-tolerated but it also has some side effects that may be a problem with some people who have anxiety, headaches or seizures.
• Effexor and Effexor XR are newer antidepressants that increase the levels of norepinephrine and serotonin in the brain. The drugs are effective at improving mood and concentration in adults as well as children and teens.
• MAO inhibitors are a group of antidepressants that can treat ADHD with some benefit but are rarely used because they have significant and sometimes dangerous side effects and can dangerously interact with foods and other medications. They may be of benefit in people where other medications have failed. Examples include Nardil or Parnate.

Note: In October 2004, The FDA has determined that antidepressant medications increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health care provider.

How Do Antidepressants Work?

Since most antidepressants work by increasing the levels of brain messenger chemicals (neurotransmitters), such as norepinephrine, serotonin and dopamine, it makes sense that they might have similar effects to other ADHD stimulant and nonstimulant treatments that appear to work by similar mechanisms.

Antidepressant treatment seems to improve attention span as well as impulse control, hyperactivity and aggressiveness. Children and adolescents treated with antidepressants are often more willing to take direction and are less disruptive.

Antidepressants have the advantage of having a low potential for abuse and there is no evidence that they suppress growth or contribute to significant weight loss.

Who Should Not Take Antidepressants?

Antidepressants should not be used

• If you have a history or tendency toward manic behavior or manic depression ( bipolar disorder)
• Wellbutrin can't be taken if you have any history of seizures or epilepsy.
• Treatment with antidepressants should not be initiated if you have taken a monoamine oxidase inhibitor antidepressant, such as Nardil or Parnate, within the last 14 days.
• Each type of antidepressant has its own contraindications and usage warnings, and you should discuss these with your doctor.

Side Effects of Antidepressants

The most common side effects experienced with tricyclic antidepressants include:

• Stomach upset
• Constipation
• Dry mouth
• Blurred vision
• Drowsiness
• Low blood pressure
• Weight gain
• Tremor
• Sweating
• Difficulty urinating

Wellbutrin sometimes causes stomach upset, anxiety, headaches and rashes.

Effexor can cause nausea, anxiety, sleep problems, tremor, dry mouth and sexual problems in adults.

MAO inhibitors can cause a wide variety of side effects, including dangerously increased blood pressure when combined with certain foods or medications.

Antidepressants Therapy: Tips and Precautions

When taking antidepressants for ADHD, be sure to tell your health care provider:

• If you are nursing, pregnant, or plan to become pregnant
• If you are taking or plan to take any dietary supplements, herbal medicines or nonprescription medications
• If you have any past or present medical problems, including high blood pressure, seizures, heart disease and urinary problems
• If you have a history of drug or alcohol abuse or dependency or if you have had mental health problems, including depression, manic depression or psychosis.

The following are useful guidelines to keep in mind when taking antidepressants or giving them to your child for ADHD:

• Always give the medication exactly as prescribed. If there are any problems or questions, call your doctor.
• Antidepressants usually take 2-4 weeks before the full effects are apparent. Be patient and dont give up before giving them a chance to work!
• Your doctor will probably want to start out at a low dose and increase gradually until symptoms are controlled.
• It is better not to miss doses of antidepressants. Most are given once or twice a day. If you miss a day or two of Effexor, it can cause an unpleasant withdrawal syndrome.
• Tell your doctor if you notice any new or unusual side effects. Taking bulk laxatives (fiber) and drinking lots of water is a good idea with tricyclic antidepressants as they tend to cause constipation and hard stools.
• If you become constipated as a result of taking tricyclic antidepressants, take a bulk laxative (fiber) and drink lots of water.