Nortriptyline for treating enuresis in ADHD--a randomized double-blind controlled clinical trial
Ahmad Ghanizadeh1,2,3, Rezvan Haghighat4
1Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran. ghanizadeha@hotmail.com.
Insights
Nortriptyline effectively reduced enuresis in children with ADHD during treatment but relapsed after discontinuation. Both nortriptyline and placebo were well-tolerated, indicating temporary benefits for nocturnal enuresis management.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Pharmacology
Background:
- Enuresis treatment in children with Attention Deficit Hyperactivity Disorder (ADHD) lacks prior investigation.
- This study explores nortriptyline's efficacy and safety for enuresis in ADHD patients.
Purpose of the Study:
- To assess the effectiveness of nortriptyline as an add-on therapy for enuresis in children with ADHD.
- To evaluate the tolerability and adverse effects of nortriptyline in this pediatric population.
Main Methods:
- A randomized controlled trial involving 43 children (5-14 years) with ADHD and enuresis.
- Participants received methylphenidate plus either nortriptyline or placebo for 30 days.
- Enuresis frequency was parent-reported pre-intervention, during, and post-intervention.
Main Results:
- Nortriptyline significantly decreased nocturnal enuresis incidence during treatment compared to placebo.
- No significant difference in enuresis frequency from baseline was observed after discontinuing nortriptyline or placebo.
- Both nortriptyline and placebo treatments were well-tolerated by the children.
Conclusions:
- Nortriptyline demonstrates statistical superiority over placebo in reducing enuresis in children with ADHD.
- Enuresis recurrence is likely after nortriptyline cessation in ADHD children continuing methylphenidate therapy.
- Nortriptyline offers a temporary solution for enuresis in ADHD but does not provide a sustained effect.
Background:
Treating enuresis in children with attention deficit hyperactivity disorder (ADHD) has not been previously reported. This study aims to investigate the efficacy, tolerability, and adverse effects of nortriptyline for treating enuresis in children with ADHD.
Methods:
Forty-three children aged from 5 to 14 years old were randomized into two groups. The treatment group received methylphenidate plus nortriptyline, while the placebo group received methylphenidate plus placebo. Nortriptyline and placebo were administered for 30 days and methylphenidate was administered for 45 days. The major outcome measure was parent-reported frequency of enuresis for 2 weeks prior to the intervention, during the intervention, and for 2 weeks after stopping the adjuvant therapy. Adverse effects were also checked.
Results:
While nortriptyline statistically decreased the incidence of nocturnal enuresis during the intervention, the number of enuresis events did not significantly change in the placebo group. In addition, enuresis was not different from the baseline frequency of enuresis after stopping nortriptyline or placebo administration. Both nortriptyline and placebo were tolerated well.
Conclusions:
Administration of nortriptyline for treating enuresis in ADHD has not been investigated before. Nortriptyline is statistically superior to placebo. However, enuresis will relapse after stopping nortriptyline in children with ADHD who continue taking methylphenidate.
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