The efficacy and safety of antidepressants as alternative treatment of attention-deficit/hyperactivity disorder in pediatric populations

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is a common, multifactorial neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and/or impulsivity. Beyond behavioral therapy approaches, methylphenidate and amphetamine stimulant agents are recommended as first-line pharmaceutical treatments for ADHD. Because of the adverse effect profile and misuse potential of stimulants, other psychiatric medications have been explored in the literature as a potential alternative treatment in pediatric patients with ADHD. This report aimed to consolidate the body of knowledge published surrounding the exploration of using the antidepressant class as primary treatment for ADHD in pediatric and adolescent populations.

METHODS: PubMed secondary databases were used. Key terms included pediatric ADHD, ADHD, ADHD treatments, and antidepressants in ADHD. Randomized control trials and observational trials were included for analysis.

RESULTS: Most (11/12) studies revealed that antidepressants were efficacious in reducing ADHD symptoms but not necessarily superior to first-line stimulant medications. Particular focus on selective serotonin reuptake inhibitors, SNRIs, tricyclic antidepressants, and bupropion was demonstrated in the literature.

DISCUSSION: More research needs to be conducted to fully explore the effects and efficacy of antidepressants compared with first-line medications for ADHD. In addition, data supporting long-term effects and efficacy for antidepressants in ADHD are not yet established.