ADHD in Children
Visual Abstracts
Sequential Pharmacotherapy for Children With Comorbid Attention-Deficit/Hyperactivity and Anxiety Disorders
Summarized by Charles Li, MD
August 10, 2022
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ADHD often comes with significant anxiety.
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A small clinical trial wanted to see whether adding an SSRI to Ritalin could better treat children with ADHD and anxiety.
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They found that Ritalin can treat ADHD in kids with ADHD and anxiety, but adding an SSRI may not help much.
Visual Abstract
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Objective
ADHD often comes "bundled" with other symptoms and conditions.
Children with ADHD often suffer from significant anxiety as well.
There are many great treatment options for ADHD in children. However, there has not been as much research on treating anxiety in children with ADHD.
Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxiety disorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherap...
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Method
This study recruited 32 children who had not previously taken medication for their ADHD. They were randomized to either receive methylphenidate (Ritalin) and fluvoxamine, an antidepressant, or just methylphenidate alone to see whether the combination of a stimulant and an SSRI could treat ADHD and anxiety.
Children, age 6 to 17 years, with ADHD/ANX were titrated to optimal methylphenidate dose and assessed along with children who entered the study on a previously optimized stimulant. Children with improved ADHD who remained anxious were randomly assigned to 8 weeks of double-blind stimulan...
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Results
They found that 81% of the children with ADHD and anxiety showed improvements in their ADHD symptoms when treated with methylphenidate.
This demonstrates that ADHD medications can be quite effective in children with anxiety.
However, adding fluvoxamine, an antidepressant, did not improve anxiety symptoms.
Methylphenidate was able to help children with ADHD and anxiety. However, the addition of fluvoxamine did not improve anxiety symptoms.
Of the 32 medication-naive children openly treated with methylphenidate, 26 (81%) improved as to ADHD. Twenty-five children entered the randomized trial. Intent-to-treat analysis indicated no differences between the STIM/FLV (n = 15) and STIM/PL groups on the Pediatric Anxiety Rating Sca...
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Conclusions
Based on this study, researchers concluded that Ritalin can help kids with ADHD and anxiety. The presence of anxiety in these children doesn't necessarily interfere with their ADHD treatment. However, it's still unclear whether giving kids an antidepressant on top of the stimulant helps.
Children with ADHD/ANX have a response rate to stimulants for ADHD that is comparable with that of children with general ADHD. The benefit of adding FLV to stimulants for ANX remains unproven.
Can adding an SSRI to Ritalin help treat children with anxiety and ADHD? A small clinical trial found that methylphenidate can reduce ADHD symptoms in children with anxiety. But, it's unclear whether adding an SSRI helps.