Desipramine

Evidence suggests that attention deficit hyperactivity disorder (ADHD) persists in 10 to 60 percent of young adults who had ADHD as children. A substantial number of these adults do not respond to the stimulants commonly used in children with ADHD. Wilens and associates performed a randomized, six-week, placebo-controlled study to evaluate the effectiveness of desipramine in adult patients with ADHD.

Forty-one patients were randomly assigned to receive either placebo or desipramine in one daily dose, titrated up to a target dose of 200 mg per day by week 2 unless adverse effects were demonstrated. The groups consisted of 20 women and 21 men who ranged in age from 21 to 60 years. The ADHD group was classified as moderately to severely affected. Only two subjects had been diagnosed in childhood with ADHD, and none had been previously treated. Thirty-three of the study subjects had at least one past episode of psychiatric disorder. Seventy-nine percent of the subjects had a first- or second-degree relative with ADHD.

Desipramine treatment was clinically and statistically more effective for ADHD patients than placebo. Over time, the ADHD symptoms in the group receiving desipramine significantly decreased compared with baseline and the control group. Significant reductions in ADHD symptoms were noted in the desipramine group by the end of weeks 2, 4 and 6. A total of 68 percent of the 19 patients receiving desipramine showed significant improvement in ADHD symptoms, compared with none of the control group. The desipramine group showed highly significant reductions in broad categories of hyperactivity, impulsivity and inattentiveness.

No relationship was found between response to desipramine and dose. The most common adverse effects in the desipramine group were dry mouth, constipation, lightheadedness and insomnia. Ten subjects receiving desipramine and one subject receiving placebo had the dose lowered because of side effects.

The authors conclude that desipramine at daily doses of up to 200 mg was significantly more effective than placebo in treating ADHD in adults. The study findings support the assumption that ADHD is a syndrome that is exhibited in both adults and children and that adults can be effectively treated with desipramine without adverse effects.

Wilens TE, et al. Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder. Am J Psychiatry 1996;153:1147-53.

COPYRIGHT 1997 American Academy of Family Physicians
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