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

Note: In October 2004, The FDA 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 effects similar to other ADHD stimulant and nonstimulant treatments that appear to work by similar mechanisms.

Antidepressants seem 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 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 in the following situations:

  • 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 MAO 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 of tricyclic antidepressants include:

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

In addition, tricyclics are potentially lethal in the event of an overdose of medication.

Tricyclics also have the potential to cause serious heart conduction defects and may require periodic ECGs to look for these heart problems.

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.
  • If you develop any depressive symptoms or feelings that you might harm yourself.
  • If you develop irregular heartbeats (heart palpitations) or fainting spells.

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 at least 2 to 4 weeks before the full effects are apparent. Be patient and don't give up before giving them a chance to work.
  • Your doctor will probably want to start your medication 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.

Blood Pressure Drugs Used to Treat ADHD

Some drugs normally taken for high blood pressure, like Catapres and Tenex, may help control ADHD when used alone or in combination with stimulant drugs. The drugs can improve mental functioning as well as behavior in people with ADHD.

How Do High Blood Pressure Drugs Treat ADHD?

How high blood pressure drugs work in treating ADHD is not yet known, but it is clear that they have a calming effect on certain areas of the brain.

Clonidine can be applied in a weekly patch form for gradual medication release. This delivery method helps decrease some side effects, such as dry mouth and fatigue. After a few weeks, side effects usually diminish considerably.

Clonidine and guanfacine can help reduce some of the side effects of stimulant therapy, especially sleeplessness and aggressive behavior. However, combining stimulants with one of these drugs is controversial, because there have been some deaths in children taking both stimulants and Catapres.


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