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Selegiline in the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized
Shahin Akhondzadeh1, Reza Tavakolian, Rozita Davari-Ashtiani
1Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, South Kargar Avenue, Tehran 13334, Iran. s.akhond@neda.net
Insights
Selegiline shows potential as an alternative treatment for Attention Deficit Hyperactivity Disorder (ADHD) in children, offering a tolerable side effect profile compared to methylphenidate. Further research is needed to confirm its efficacy and safety for ADHD management.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Pharmacology
Background:
- Attention Deficit Hyperactivity Disorder (ADHD) affects 3-6% of school-aged children.
- Conventional stimulant medications are effective but have limitations, with ~30% of children inadequately responding or experiencing adverse effects.
- Alternative, safe, and effective ADHD treatments are needed.
Purpose of the Study:
- To evaluate the efficacy of selegiline, a monoamine oxidase inhibitor metabolized to stimulant compounds, for treating ADHD in children.
- To compare selegiline with methylphenidate under double-blind, controlled conditions.
Main Methods:
- A 4-week double-blind clinical trial involving 28 children diagnosed with ADHD (DSM IV criteria).
- Participants were randomized to receive either selegiline (5-10 mg/day) or methylphenidate (1 mg/kg/day).
- Outcomes were assessed using Teacher and Parent ADHD Rating Scales, with evaluations by a child psychiatrist at baseline, day 14, and day 28.
Main Results:
- No significant differences in Parent and Teacher Rating Scale scores were observed between the selegiline and methylphenidate groups.
- While dropout rates were not significantly different, fewer children discontinued selegiline compared to methylphenidate.
- Adverse effects like decreased appetite, sleep difficulties, and headaches were more prevalent in the methylphenidate group.
Conclusions:
- Selegiline may offer a beneficial and tolerable alternative for ADHD treatment in children.
- Preliminary findings suggest selegiline's potential, with a favorable side effect profile being a key advantage.
- Further research is warranted to confirm these preliminary results for ADHD management.
Abstract:
Attention deficit hyperactivity disorder (ADHD) is a common disorder of childhood that affects 3% to 6% of school-age children. Conventional stimulant medications are recognized by both specialists and parents as useful symptomatic treatment. Nevertheless, approximately 30% of ADHD children treated with them do not respond adequately or cannot tolerate the associated adverse effects. Such difficulties highlight the need for alternative safe and effective medications in the treatment of this disorder. Selegiline is a type B monoamine oxidase inhibitor (MAOI) that is metabolized to amphetamine and methamphetamine stimulant compounds that may be useful in the treatment of ADHD. The authors undertook this study to further evaluate, under double-blind and controlled conditions, the efficacy of selegiline for ADHD in children. A total of 28 children with ADHD as defined by DSM IV were randomized to selegiline or methylphenidate dosed on an age and weight-adjusted basis at selegiline 5 mg/day (under 5 years) and 10 mg/day (over 5 years) (Group 1) and methylphenidate 1 mg/kg/day (Group 2) for a 4-week double-blind clinical trial. The principal measure of the outcome was the Teacher and Parent ADHD Rating Scale. Patients were assessed by a child psychiatrist at baseline, 14 and 28 days after the medication started. No significant differences were observed between the two protocols on the Parent and Teacher Rating Scale scores. Although the number of dropouts in the methylphenidate group was higher than in the selegiline group, there was no significant difference between the two protocols in terms of the dropouts. Decreased appetite, difficulty falling asleep and headaches were observed more in the methylphenidate group. The results of this study must be considered preliminary, but they do suggest that selegiline may be beneficial in the treatment of ADHD. In addition, a tolerable side effect profile may be considered as one of the advantages of selegiline in the treatment of ADHD.
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