Combined methylphenidate and atomoxetine therapy in attention deficit hyperactivity disorder; a retrospective study

Objective: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder, which is characterized by hyperactivity, impulsivity and lower sustained attention. Most of the symptoms of ADHD resolved with pharmacotherapy. ADHD treatment consists stimulants (methylphenidate) and non-stimulants (atomoxetine). Combined therapy administrated in patients which symptoms doesn’t resolve with monotherapy or couldn’t use effective treatment dose because of adverse effects. Our purpose in this study is investigated efficiency, safety and tolerability of combined therapy.

Method: We included 12 patients, which apply to Ege University Child and Adolescent Psychiatry Department Disruptive Behavior Disorders Clinic and diagnosed with ADHD and using combined therapy. These patients’ files searched retrospectively. We use Turgay ADHD scale, child behavior checklist (CBCL) for ADHD diagnosis, clinic global impression scales (CGI-S and CGI-I) for clinic evaluation. To evaluate patients mental capacity we use Wechsler Intelligence Scale for Children (WISC-R).

Results: We evaluate 12 patient with ADHD diagnosis and using combined therapy. Mentally retarded patients don’t included. Age group is between 7 and 17. Current axis I disorders among participants were ADHD only (n=7, 58.3%), ADHD with conduct disorder (n=2, 16.7%), ADHD with other psychiatric conditions (n=3, 25%). Commonest side effects in our patients are irritability (n=5, 41.6%), anorexia (n=3, 25%), palpitations (n=2, 16.7%), headache (n=1, 8.3%), no side effect (n=2, 16.7%). We found significant improvement in ADHD symptoms in 9 out of 12 patients (CGI-I point=2), minimal improvement in 2 patients (CGI-I point= 3), no change in 1 patient (CGI-I point=4).

Conclusion: Commonest side effects in our patients are irritability, headache, anorexia and palpitations. These side effects and their frequencies found similar with monotherapy. 9 out of this 12 patients show significant improvement in their symptoms, we found this improvement statistically important which means combined therapy enhance the effectiveness of monotherapy. These results about efficiency and safety are consistent with findings in recent literature.