OPEN-LABEL TREATMENT OF COMORBID DEPRESSION AND ATTENTIONAL DISORDERSWITH COADMINISTRATION OF SEROTONIN REUPTAKE INHIBITORS AND PSYCHOSTIMULANTS IN CHILDREN, ADOLESCENTS, AND ADULTS - A CASE SERIES

Attention-deficit hyperactivity disorder (ADHD) and major depression a re common ailments that can cause significant dysfunction throughout t he life cycle. These two disorders may occur comorbidly. This case ser ies describes 7 pediatric patients (aged 10-16 years) and 4 adults (ag ed 38-44 years) whose ADHD and comorbid major depression were treated in a naturalistic open clinical fashion. For all 11 patients, symptoms of major depression appeared to respond well to either fluoxetine or sertraline monotherapy. Using starting doses of fluoxetine 10 mg or se rtraline 25 mg daily, we did not observe any adverse behavioral activa tion or clinical deterioration. However, no improvement in ADHD sympto ms was observed in any patient during fluoxetine or sertraline monothe rapy. Adjunctive treatment with a psychostimulant seemed necessary for chronic ADHD symptoms to be effectively addressed. The psychostimulan ts did not appear to provide observable antidepressant effects. With t he exception of one adult who had a 20 mm Hg increase in diastolic pre ssure on methylphenidate monotherapy at 22.5 mg daily, the administrat ion and coadministration of these agents were not associated with sign ificant changes in blood pressure or heart rate. No patient developed suicidality, increased aggressiveness, mania, or other problematic sid e effects. This combination therapy was well tolerated and appeared to be effective in ameliorating both ADHD and depressive symptoms. These cases support previous suggestions that adjunctive treatment with psy chostimulants might be a safe and effective intervention for children treated with fluoxetine or sertraline who have persistent ADHD symptom s and suggests that such combined treatment may be suitable for adults as well.