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Re: ADHD and childhood depression

Posted By L.M.M.D.HFHS on July 13, 1998 at 00:38:28:

In Reply to: ADHD and childhood depression posted by Joy on June 11, 1998 at 00:22:48:

I have a 6-year-old son who has been diagnosed for 3 years with ADHD.  The past month he has been demonstrating severe mood swings, outbursts, fussiness during sleep, wetting himself, inappropriate language, and desires to hurt others sometimes.  His psychiatrist who prescribes his Ritalin for the ADHD has recommended him also taking 10 mg of Prozac.  He was taking 10 mg 3x daily of ritalin and that was decreased to 5 mg 3x daily.  Is Prozac truly safe for a 6-year-old?  Is it often prescribed for children?  Does his symptoms truly seem to be depression?  There is a family history of depression.  What side effects are most common or should be looked for?
Response ;ADHD and Depression
Dear Joy ;
Thank you for your question . ADHD is one entity that has many families running in circles without much to show for.
For many years , there has been debate on whether Attention deficit-Hyperactivity disorder is a disease in itself .Because of the consistency of certain clinical features , ADHD has forced itself to be defined as a disorder . It is perhaps a neuropsychiatric entity with mixed underlying biological causes ( and thereby respond to a variety of medications ).
Overdiagnosis of ADHD is possible , as its symptoms are mimicked by other psychological entities , one of them is depression . One study has shown that probably only a very small portion of children diagnosed are truly pure ADHD.
Ritalin and other psychostimulants are still the first line of treatment . Their benefit appears to be maximal on the attention component of ADHD . Psychostimulants have a short period of action , as the short-acting effects subside, symptoms rebound ( sometimes symptoms appear to be worse than their baseline ) making them appear as if they are aggravating the exact same symptoms they were intended for . To overcome that rebound , stimulants may have to be given more frequently . In 25% of cases , psychostimulants may fail to help ADHD , and its reasonable to try another stimulant before going to alternative treatments .
Antidepressant medication effects are mainly behavioral ( they are not intended to treat depression as the dose used is below the range used for depression ), their action on improving attention are not as effective as psychostimulants . On the other hand , antidepressants dont tend to cause rebound symptoms .
Prozac ( Fluoxetine ) , one of the antidepressants proposed to help in ADHD , has been used with some documented benefit . It's main indication in literature is as an antidepressant and in cases of obssesive- compulsive behaviors . Regarding it's early side effects ,there maybe some "behavioral activation" with nervousness , sleeplessness and a feeling of being excited . You would have to alert your psychiatrist if he develops any rashes or hives .
On the long term use ( several months ) , you will have to follow up with your psychiatrist regarding your child's performance of tasks and home work and alert him to any change in productivity or signs of apparent lack of interest ( the interest being there , but he may lack initiative ). it has been shown that the lack of initiative can be minized by combining Prozac with a psychostimulant .
Some studies show that behavior modification therapy has good results on the long run with children . Others show best results when this is combined with medications . This can be arranged through your local behavioral services linked to your primary physicians office . They can be done individually or in groups .  A child can learn to slow down impulsive responses , focus his/her attention on certain tasks , double check errors , learn how to manage strong feelings and aggressive impulses , arrange for additional time to complete tasks .
A good way to approach your childs problem is to identify which part of ADHD is affecting him most in his daily activities and how its influencing his experiences , education and relationships . Decide whether his problem is mainly behavioral , attention or cognitive ( ability to learn ) . Then discuss with your childs psychiatrist the benefits of each medication on these different components of ADHD ( some medications are marketed as antiseizures or antihypertensives with behavior stabilizing effects ) ,its side effects ( every medication has them ), your psychiatrists personal experience with the medications he prescribes , and identify together the best medication for your son's specific needs .
Oganizations such as ( CHILDREN AND ADULT WITH ADD AT  www.chadd.org  ) may offer support and up to date news for families dealing with ADHD.
Thank you for your question and we hope to hear from you soon.
Disclaimer : This information is intended for educational purposes only . Your Physician is ultimately responsible for your health care .
Keywords : ADHD* , Antidepressants * , Prozac(Fluoxetine)* , Psychostimulants* ,  Behavioral modification therapy*

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