Stimulants and antidepressant pharmacokinetics in hyperactive children

Psychopharmacological treatment of attention-deficit hyperactivity disorder (ADHD), is well established. The central nervous system stimulants, especially dextroamphetamine and methylphenidate, are the drugs of choice. Response is rapid, consistent and predictable. Most children respond to one or the other when a trial of both stimulants are given across wide dose ranges (Elia et al. 1991). The efficacy of pemoline is also well established, but its variable onset and duration of action in children has made it a secondary treatment. Tricyclic antidepressants also produce rapid behavioral effects in ADHD, at doses less than those used for depression. Adverse effects are a limiting factor for continued treatment as well as the fact that beneficial effects are often short-lived.