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| |  DG DISPATCH - AACAP: Treat Depression First, Then AD/HD, Says Researcher By Lara Pullen Special to DG News CHICAGO, IL -- October 27, 1999 -- As more and more children and adolescents are being diagnosed with attention deficit/hyperactivity disorder (AD/HD), practitioners require new strategies for patients who do not respond to or cannot tolerate the stimulant medications that are typically prescribed.
One approach toward the treatment of these patients, who may also be suffering from depression, is to remove the stimulant and treat the depression first. At the 46th annual meeting of the American Academy of Child and Adolescent Psychiatry, Dr. Timothy E. Wilens, of Massachusetts General Hospital, in Boston, reviewed pharmacological strategies for treating AD/HD children who have not responded to first-line therapy. Four over-arching themes emerged from Dr. Wilen’s presentation: - Treat mood disorders first and then treat AD/HD. While very few physicians take this approach, it has been effective with some of his patients, he said. - Increase the dose of the medication. With Ritalin (methylphenidate; MPH), patients are frequently under-dosed and he recommended increasing the dosage to get optimal response. - Switch stimulants if one is not working. While MPH is the most frequently prescribed stimulant, other effective stimulants include amphetamine compounds such as dextroamphetamine (Adderall; Dexedrine). - Combine drugs. The benefits of combination pharmacotherapy include treatment of co-morbidity, enhanced specificity and potential synergy of medications.
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