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PubMed2000

Sudden death of a child treated with imipramine. Case study.

Since 1990, there have been seven reported cases of sudden death in children treated with tricyclic antidepressants. This case study describes the sudden death of an additional child (8 years 9 months old, 29 kg in weight) treated with a tricyclic antidepressant, imipramine (100 mg orally, twice daily), and dextroamphetamine (10 mg orally every morning). Prior to death, there were signs of possible cardiovascular abnormalities after treatment was begun with imipramine. The report adds to the concern over the use of tricyclics in children.

Antidepressive Agents, Tricyclic↗
PubMed2004

Stimulant drug treatment in childhood-onset schizophrenia with comorbid ADHD: an open-label case series.

The administration of psychostimulants to children with psychotic symptoms is controversial. This study reports the stimulant drug response of 5 children, aged 8-15 years, with childhood-onset schizophrenia (COS) and comorbid attention deficit hyperactivity disorder (ADHD). Four COS inpatients were given stimulants for comorbid ADHD after stabilization of psychosis on antipsychotic medication. A fifth COS inpatient received stimulants while still actively psychotic, despite concurrent neuroleptic treatment. Data from the 10-item Brief Conners Teachers Ratings Scale (BCTRS) were examined the week before, and the week after, stimulant addition. A paired t test, conducted using Conners Teachers data from these 4 subjects, indicated significant improvement in ADHD symptoms (p = 0.02). Data obtained from a retrospective chart review indicated no significant worsening of psychosis. The 2 subjects treated with mixed salts of dextroamphetamine sulfate and amphetamine sulfate remained on that medication at 6 months and at the 2-year follow-up. Our results suggest that ADHD comorbid with COS may be safely treated with a stimulant, once the psychosis is stabilized. A systematic investigation of this question may be warranted.

Adolescent↗
PubMed2005

Bulimia nervosa and attention deficit hyperactivity disorder: a possible role for stimulant medication.

BACKGROUND: Bulimia nervosa and attention deficit hyperactivity disorder (ADHD) share several key features, including impulsivity and low self-esteem. Stimulant medications have been highly effective in the treatment of ADHD. However, medication management of bulimia with antidepressants has demonstrated only partial resolution of bulimic symptoms. To date, there are no published reports of controlled trials evaluating the efficacy of stimulants for bulimia. The purpose of this paper is to report 6 patients with comorbid bulimia and ADHD who were treated with the stimulant medication, dextroamphetamine. RESULTS: All 6 patients described reported complete abstinence from binge eating and purging after treatment with psychostimulants, and none of the patients discontinued taking the medication because of side effects. The side effect of decreased appetite proved beneficial in decreasing the desire to binge eat. However, all 6 patients remained within a healthy weight range. CONCLUSIONS: Data from these case reports suggest a possible benefit of screening for ADHD as part of the overall evaluation of bulimia. In addition, these cases suggest the potential role of psychostimulants in the management of bulimia because of the high rate of abstinence from bulimic symptoms and the low rate of adverse side effects. Clinical trials are needed to fully evaluate the efficacy and tolerability of psychostimulants in the treatment of bulimia nervosa.

Adolescent↗
PubMed2001

Stability of Adderall in extemporaneously compounded oral liquids.

The short-term stability of Adderall in three extemporaneously compounded oral liquids was studied. Three suspensions of Adderall 1 mg/mL were prepared from commercially available 10-mg Adderall tablets with Ora-Sweet, Ora-Plus, and a 1:1 mixture of Ora-Sweet and Ora-Plus. Each suspension was stored in the dark in a stability chamber at 25 degrees C and 60% relative humidity for 30 days. The stability of the active drug (a mixture of levoamphetamine and dextroamphetamine salts) in each of the three vehicles was determined immediately after preparation and at 10, 20, and 30 days by using gas chromatography-mass spectrometry (GCMS). No significant changes in concentrations of either amphetamine isomer occurred during the 30-day study period. Visual inspection of samples revealed no changes in color or odor. Extemporaneously compounded liquid oral formulations of Adderall 1 mg/mL in Ora-Sweet, Ora-Plus, or a 1:1 mixture of Ora-Sweet and Ora-Plus were stable for at least 30 days at 25 degrees C and 60% relative humidity.

Administration, Oral↗
PubMed1997

Compliance with stimulant medications in patients with narcolepsy.

The goals of this descriptive study were to determine what percentage of our treated narcoleptic subjects took their stimulant medications as prescribed and to examine the relationship between compliance and response to stimulant medications. Data obtained from a screening questionnaire, sleep diaries, and medical records showed that 22 of our 43 treated narcoleptic subjects reduced their dosage of stimulant medications or had not taken any stimulant medications during a 24-hour monitoring period during which they were expected to be on medication. Although we had expected better compliance among subjects who responded to stimulant medications (day-wake subjects), statistical testing revealed no significant differences between the two groups. Nor were there any significant differences in age, gender, or educational level when compliant and noncompliant subjects were compared. Only the type of drug prescribed (short versus long-acting stimulant) affected compliance; 39.4% of the subjects with prescriptions for dextroamphetamine or methylphenidate took the amount of medication prescribed compared to 87.5% of the subjects with prescriptions for pemoline.

Adolescent↗
PubMed1989

Treatment of ADDH in mentally retarded children: a preliminary study.

The use of CNS stimulant medication for the treatment of attention deficit disorder with hyperactivity (ADDH) in subnormal intelligence children remains controversial, and the majority of the literature does not support the use of CNS stimulants in these children, although the choice of dependent variables and research designs may have contributed to this outcome. A single case research design was used to assess the effectiveness of CNS stimulant medication (methylphenidate and dextroamphetamine) in three subnormal intelligence children with ADDH, using excessive movement and on-task behaviors as dependent variables. The results and implications for future research are discussed.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

Controlled stimulant treatment of ADHD and comorbid Tourette's syndrome: effects of stimulant and dose.

OBJECTIVE: To determine the effects of methylphenidate (MPH) and dextroamphetamine (DEX) on tic severity in boys with attention-deficit/hyperactivity disorder (ADHD) comorbid with Tourette's syndrome. METHOD: A 9-week, placebo-controlled, double-blind crossover using a wide range of doses was completed by 20 subjects in three cohorts. RESULTS: Relatively high doses of MPH and DEX in the first cohort produced significant increases in tic severity which were sustained on higher doses of DEX but which attenuated on MPH. Overall, 14 of 20 subjects continued stimulant treatment for 1 to 3 years, generally in combination with other psychotropics. Stimulant-associated adverse effects, including tic exacerbations, were reversible in all cases. CONCLUSION: A substantial minority of comorbid subjects had consistent worsening of tics on stimulants, although the majority experienced improvement in ADHD symptoms with acceptable effects on tics. MPH was better tolerated than DEX.

Analysis of Variance↗
PubMed1989

The role of dopaminergic and noradrenergic receptors in human TSH and LH release.

The present study was undertaken to evaluate the relative roles of noradrenergic (NA) and dopaminergic (DA) neurotransmission in the control of thyrotropin (TSH) and luteinizing hormone (LH) release. Oral dextroamphetamine 20 mg caused a rise in the serum levels of TSH and LH in 24 healthy male volunteer subjects. The increase in TSH secretion was augmented by prior treatment with pimozide and reduced by thymoxamine. Conversely the LH response to destroamphetamine was reduced by pimozide and possibly accentuated by thymoxamine. The results confirm an inhibitory role for DA receptors in the control of TSH release and indicate that NA receptors may exert a facilitatory role. The converse would appear to be the case with LH, with DA being facilitatory and NA possibly inhibitory.

Adult↗
PubMed1978

Urinary catecholamines and amphetamine excretion in hyperactive and normal boys.

Urinary catecholamines and metabolites and urinary amphetamine excretion were examined for hyperactive and normal boys following a single dose of dextroamphetamine (0.5 mg/kg) and placebo. Hyperactive children showed a significantly faster rate of excretion of amphetamine which could not be accounted for by previous exposure to drug or by signs of neurological involvement. Urinary norepinephrine (NE) was significantly higher for hyperactive than for normal children, but NE excretion did not correlate with motor activity or any measures of arousal. The single dose of amphetamine produced a significant rise in urinary epinephrine excretion (EP) for the normal children but not for the hyperactive group, supporting the notion of a more sluggish catecholamine response to stimulants for hyperkinetic children.

Amphetamine↗
PubMed1987

Treatment of chronic closed head injury with psychostimulant drugs: a controlled case study and an appropriate evaluation procedure.

The psychostimulant drugs methylphenidate (MPH) and dextroamphetamine (DEA) have proven efficacy in clinical populations whose primary symptoms include disorders of attention, impulse control, and locomotor hyperactivity. These medications have also been shown to influence in a positive manner cognitive functioning, particularly in the areas of sustained attention and memory. In light of these facts, the psychostimulants MPH and DEA were administered in separate trials to a young man who suffered from similar symptoms secondary to a chronic closed head injury. The medication trials were double-blind, placebo-controlled, dose-response studies. Cognitive functions, particularly memory and attention, improved in the active drug conditions. In addition, there was a consistent, positive drug effect across behavioral assessments. This case study emphasizes the importance of studying psychostimulant effects in patients with neuropsychological and behavioral sequelae of closed head injury; it also presents an appropriate methodology for evaluating psychostimulant effects in a clinical research setting.

Adult↗
PubMed1992

Methylphenidate hydrochloride as an antidepressant: controversy, case studies, and review.

The use of psychostimulants as antidepressants remains controversial in the field of psychiatry. While methylphenidate hydrochloride (MPH) and dextroamphetamine (DA) are often considered to be equivalent drugs, differences in their neurobiologic mechanism of action may account for different clinical response patterns. Hence, clinical trials and literature reviews that examine the antidepressant efficacy of psychostimulants without distinguishing between MPH and DA may reach inaccurate conclusions. This paper is a critical review of controlled and uncontrolled studies examining the use of MPH as an antidepressant. We discuss the methodologic limitations of existing placebo-controlled trials that have reached mixed conclusions about the efficacy of MPH as an antidepressant. These studies are offset by uncontrolled open trials and clinical case reports that endorse the drug's effectiveness in alleviating depressive symptoms. The series of patients we treated with MPH demonstrates the safety and efficacy of this drug in alleviating depressive symptoms in the medically ill elderly with a variety of mood disorders. Reviewing these six cases and balancing the positive and negative reports in the literature, we provide practical guidelines for identifying patients who are potential candidates for treatment with MPH.

Age Factors↗
PubMed1996

Drug therapy in attention-deficit hyperactivity disorder.

Of 292 patients (210 males and 82 females) receiving medication for attention-deficit hyperactivity disorder (ADHD), 272 (93%) responded well to sustained-release dextroamphetamine (D-Amp) and 21 patients (7%) to sustained-release methylphenidate (MPD). The dose of D-Amp ranged from 0.2 to 3.6 mg/kg/day and the dose of MPD from 1.4 to 7.7 mg/kg/day, without side effects requiring cessation of therapy. This suggests that the clinical improvement rate can be increased to nearly 100% in appropriate situations.

Adolescent↗
PubMedDate not supplied

Landau-Kleffner syndrome: a pharmacologic study of five cases.

Five children with Landau-Kleffner syndrome (epilepsy, acquired aphasia, and continuous spike-wave discharges during sleep), were treated with antiepileptic drugs (AEDs), sleep-modifying drugs, and corticosteroids. The pharmacologic profiles differed from those observed in focal epilepsies, resembling instead those of certain generalized epilepsies, such as West or Lennox-Gastaut syndromes. Phenobarbital (PB), carbamazepine (CBZ), and phenytoin (PHT) were ineffective or worsened the EEG and neuropsychological symptoms, whereas valproate (VPA), ethosuximide (ESM), and benzodiazepines were partially or transiently efficacious. Dextroamphetamine produced a dramatic but transient improvement in waking and sleep EEG in one of two children; aphasia did not change. Corticosteroid treatment resulted in improved speech, suppression of seizures, and normalization of the EEG in three of three children. Our own experience and data from the literature suggest that corticosteroids should be given in high doses as soon as the diagnosis is firmly established and should be continued in maintenance dose for several months or years to avoid escape. Early diagnosis, before mutism or global deterioration develops, appears to be essential for effective therapy with minimal neuropsychological sequelae.

Adrenal Cortex Hormones↗
PubMed1993

Beneficial effects of dextro-amphetamine in the treatment of vasodepressor syncope.

Three patients with history of documented hypotension, near syncope, or syncope before or after the administration of isoproterenol during head-up tilt table are reported. Severe bradycardia was also noted in one patient. All three patients responded to the administration of 2.5 mg of oral dextroamphetamine 45 minutes prior to a repeat head-up tilt table study. The potent central and peripheral adrenergic agonist pharmacological properties of this drug permitted the prevention of severe vasodepressor syncope in these patients.

Aged↗
PubMed1985

Three tests of cortisol secretion in adult endogenous depressives.

Seventy-nine drug-free adult patients fitting RDC criteria for major depressive disorder endogenous subtype (EMDD), and 64 normal adult volunteers, were studied at pretreatment with at least one of three tests of cortisol secretion. The tests were: 1) Mean half-hourly cortisol concentrations from 1 p.m. to 4 p.m. (1-4 PM CORT); 2) plasma cortisol response to 0.15 mg/kg of dextroamphetamine hydrochloride (DACT) in the afternoon; 3) dexamethasone suppression test (DST) using 1 or 2 mg. Thirty-six depressive and 27 volunteers underwent all three tests. Analysis of the data was performed for each test singly, for all pairs of tests and for all three tests in same subjects. Results show that the single most sensitive cortisol test for depressions is the DACT (72%), with a specificity of 88%. These tests may measure different underlying pathophysiologies associated with depression.

Adolescent↗
PubMed1966

Sleep deprivation in the rat.

Sleep deprivation, induced by injections of dextroamphetamine or by forced treadmill activity, resulted in a temporary increase in daily sleep time. However, increasing the period of sleep deprivation above 24 hours to 72 or 120 hours did not result in increased recovery sleep above that present in the 24-hour group.

Animals↗
PubMed1974

Amphetamine effects in man: paradoxical drowsiness and lowered electrical brain acitivity (CNV).

Thirteen of 20 normal adults given 10 milligrams of dextroamphetamine exhibited paradoxical drowsiness accompanied by lowered electrical brain activity (contingent negative variation, or CNV) in the first hour post-drug. During this period, seven subjects showed behavioral alertness and increased CNV amplitude. Both groups of subjects showed heightened alertness 2 and 3 hours post-drug. Amphetamine is not a simple stimulant of the central nervous system but can also act as a depressant.

Acoustic Stimulation↗
PubMed1988

Response of HIV-related depression to psychostimulants: case reports.

Four depressed and cognitively impaired patients with HIV-related disease had a marked therapeutic response to treatment with psychostimulants. Use of dextroamphetamine and methylphenidate brought a prompt remission of depressive and cognitive dysfunctions without adverse side effects. The results suggest the need for further evaluation of psychostimulants in the treatment of HIV patients whose depression proceeds from an affective disturbance (either primary or secondary) or from a specific organic mental disorder. The importance of neuropsychiatric assessment of depressed HIV patients is stressed, and diagnostic and treatment guidelines are given.

Acquired Immunodeficiency Syndrome↗