Amitriptyline and Methylphenidate Treatment of Behaviorally Disordered Children

Abstract

THIS STUDY is one in a series of continuing investigations Winsberg et aL, 1974b) which seeks to determine the relative effectiveness of various psychotropic drugs in controlling hyperactive/aggressive behaviors among children.In our previous work, we found the psychostimulants (dextroamphetamine and methylphenidate) to be comparable in effectiveness for the treatment of such behavior disorders (Winsberg et al., 1974b), while the tricyclic compound, imipramine, was also found to be effective in a study which compared it to dextroamphetamine . The findings from this research were consistent with our clinical experience in showing that many children fail to respond to each of these medications. Since pharmacotherapy with dextroamphetamine, mctliylphenidatc, and imipramine is frequently ineffective, and sinee the neuroIcptics (e.g. phenothiazines and butyrophcnones) are associated with dyskincsias (McAndrew et al., 1972; PoHzos et aL, 1973) and other potentially noxious side effects (Winsberg et al., 1976), alternative drugs are clearly needed.In our ongoing clinical work, another tricyclic, amitriptyline, has been useful for some of these children. There is also research evidence which points to the potential utility of this compound in treating children with behavior disorders. Kraft et al. (1966) in a noncontroUed study, found amitriptyline to be effective in 60% of outpatient children with different psychiatric problems. Krakowski (1965) studied 50 hyperkinetic children whose diagnoses included: neurosis, psychophysiological disorders, mental deficiency, schizophrenia, neurotic traits, and habit and conduct disorders. Sixty per cent ofthe children with the diagnosis of conduct disorders were reported to have a good or excellent response to amitriptyline therapy. However, a major weakness of that study was that the prime behavioral dependent measure was a subjective clinical evaluation. Lucas et al. (1965), in a double-blind study, used amitriptyline for childhood depressions and found that the behavior category in w hich the greatest number of patients improved was that which the authors termed "problems of external control." The latter report does not allow for a more precise categorization of the subjects' behavior problems.

Evidence-based pharmacotherapy for attention-deficit hyperactivity disorder

“…Five studies each reported that stimulants were superior to TCAs (Garfinkel et al, 1983;Gittleman-Klein, 1974;Greenberg et al, 1975;Rapoport et al, 1974), or equal to TCAs (Gross, 1973;Huessy and Wright, 1970;Kupietz and Balka, 1976;Yepes et al, 1977) and three studies reported that TCAs were superior to stimulants (Watter and Dreyfuss, 1973;Werry, 1980;Winsberg et al, 1972). Analysis of response profiles indicate that TCAs more consistently improve behavioural symptoms, as rated by clinicians, teachers and parents than they impact on cognitive function as measured in neuropsychological testing (Gualtieri and Evans, 1988;Quinn and Rapoport, 1975;Rapport et al, 1993;Werry, 1980).…”

Uso de amitriptilina na síndrome de hiperatividade com déficit de atenção

“…Os resultados encontrados neste estudo coincidem com os verificados por Guardiola ao comparar grupos tratados com imipramina e placebo 17 . Usando as provas de persistência motora como parâmetro da eficácia da AMI, a exemplo de trabalho publicado por Guardiola e colaboradores em 1997 32 , verificamos que amitriptilina se mostra eficaz no tratamento de crianças com SHDA, fato já verificado em estudos feitos por Krakowski 28 , Kupietz e Balka 29 e Yepes e col. 30 .…”

“…Kupietz e Balka, em ensaio clínico, compararam os efeitos da AMI, metilfenidato (MTF) e placebo sobre o desempenho de 20 crianças com comportamento hiperativo e agressivo observando que tanto AMI quanto MTF apresentaram resposta superior ao placebo 29 . Yepes e colaboradores, usaram AMI em ensaio clínico, comparado com MTF e placebo em 21 crianças com comportamento hiperativo e agressivo, verificando, em ambas as drogas, respostas similares e melhores em relação ao placebo 30 . Spencer, em estudo que avalia e compara as várias opções terapêuticas para a SHDA, cita os trabalhos acima mencionados e refere que pacientes tratados com AMI tiveram resposta similar a dos estimulantes 31 .…”

Ineffectiveness of imipramine in children who fail to respond to methylphenidate

“…AMT has not been extensively researched with children. Although it appears to be effective, it is highly sedative and almost all children appear drowsy (Yepes, Balka, Winsberg, & Bialer, 1977). IMI has been shown to be effective in a number of comparative studies, although it too causes a variety of adverse side effects.…”

“…However, the sedative effects of AMT raise the question of whether the tricyclics as a class might impair children's ability for attention. Although highly sedative, AMT has been found to facilitate performance on the Continuous Performance Test (CPT) measure of attention (Yepes et al, 1977). Clinically, IMI is less sedative than AMT, but its effect on attention has not been studied.…”