Child on Paxil diagnosed with ADHD and prescribed Concerta

At 14 months old, my son had pneumococcal meningitis.  At 9 years old he was diagnosed with Anxiety. He was very anxious over everything in his life, it affected his school life, had trouble sleeping, and hated life. He had behavioral issues in school not academic issues.  He was placed on Paxil and is now taking 20 mg. a day and has gained over 20 lbs in less than 2 years.  While he does not have severe anxiety issues any longer, he still has verbal outbursts at least 3 - 4 times a month when things don't go his way.  He is extremely smart and continues getting good grades, but struggles with sitting still, blurting out answers and being disruptive in class.  The Old Psychiatrist did not seem to think he had any issues with ADHD.  Now at 11 1/2 years old he is being diagnosed with ADHD.  He met 7 of the 8 signs of ADHD in the hyperactivity section and only a couple on the impulsiveness and attention section.  A new Psychiatrist prescribed 18 mg of Concerta.  We are thinking of trying this for a few weeks and start withdrawing off the Paxil in 2.5 mg stages for a period of a few weeks. Is there anything that we should be aware of during this transition?  We are aware of the Paxil withdrawal symptoms.  Should we withdraw off Paxil first before going on Concerta?  Can going on Concerta and helping the ADHD lessen the effects of Paxil Withdrawal?  Can Paxil cause ADHD Symptoms? Is Concerta safe?  Has anyone been on both medications at once?  Is there a danger in this?  Please help. Thank you.

[Kevin Kennedy, Ph.D.]

Many children are prescribed both Paxil and Concerta and tolerate them well. There is no reason to avoid taking the medications at the same time. In fact, it is sensible to maintain your child on the Paxil while he starts the Concerta, rather than make an adjustment to the Paxil. As a general rule of thumb, changing only one variable at a time makes sense in order to determine the impact of the intervention. It sounds like your son tolerates the Paxil fine; symptoms of hyperactivity are not generally associated with Paxiil use. In some patients Paxil can prompt agitation, but that side effect is not the same as hyperactivity. And it would be unusual for your son to develop any activating side effect from the medication at this point. There is also no reason to wean your son from Paxil before commencing Concerta treatment. The medications are addressing two different goals.