[dr. bob]

Dr. Bob's
Psychopharmacology Tips


Date: Wed, 24 Jul 1996 15:34:31 +0300 (EET DST)
From: Pekka Roponen <shrink@walrus.megabaud.fi>
Subject: Moclobemide for adult ADHD

I have given some ADHD-like adult patients in Finland, where stimulants and standard MAOIs not availble, moclobemide (a RIMA) with some success.

Date: Thu, 31 Oct 1996 22:58:44 -0500
From: Ivan Goldberg <Psydoc@psycom.net>
Subject: MAO-B inhibitors for adult ADHD

Paul Wender, MD, sent me the following message and asked me to post it to the list:

We have conducted trials of MAO-B inhibitors (selegiline, Wood et al., 1983; pargyline, Wender et al., 1983). Selegeline is worth trying. Details and additional material may be found in my book.

I look forward to hearing from my colleagues about their success with the various pharmacological regimens we have employed.


Wood, D.R., Reimherr, F.W., and Wender, P.H. The use of 1-deprenyl in the treatment of attention deficit disorder, residual type (ADD, RT). Psychopharmacol Bull 19, 627-629 (1983).

Wender, P.H., Wood, D.R., Reimherr, F.W., and Ward, M. An open trial of pargyline in the treatment of attention deficit disorder, residual type. Psychiatry Research 9, 329-336 (1983).

Wender, P.H. Attention-Deficit Hyperactivity Disorder in Adults. New York: Oxford University Press, 1995.

Date: Mon, 17 Mar 1997 07:38:55 -0500
From: "Kaan R. Ozbayrak" <kuda11@ibm.net>
Subject: Selegiline for ADHD

I did a Medline search using the keywords "selegiline" and "ADHD". Well, one open study from Baylor found it beneficial. One of the two recent double-blind, placebo controlled ones reported borderline results in the younger age group, and the other found it ineffective in adults. This is, of course, from looking just at the abstracts:

  1. Arch Neurol 50: 286-288 (1993). Deprenyl in attention deficit associated with Tourette's syndrome. Jankovic J.

    While central nervous system stimulants usually improve attention deficit hyperactivity disorder (ADHD) associated with Tourette's syndrome, they often exacerbate tics and can produce other potentially serious complications. Because deprenyl may have a stimulatory effect and monoamine oxidase inhibitors have been shown to ameliorate hyperactive behavior, we studied this drug in children with the Tourette's syndrome-ADHD combination. Twenty-nine patients, 25 boys and four girls, with a mean age of 11.2 years (range, 6 to 18 years) and duration of symptoms for an average of 6.2 years (range, 1 to 13 years), were enrolled in this open trial after they became refractory to conventional treatments for ADHD. The average duration of treatment with deprenyl was 6.7 months (range, 3 to 15 months) and the average daily dose was 8.1 mg/d (range, 5 to 15 mg/dL). Twenty-six of all patients (90%) reported clinically meaningful improvement in their ADHD (score > or = 2 on a scale of 0 to 4), with the mean global improvement rated at 2.6. There were no serious adverse side effects and only two patients noted exacerbation of their tics. Deprenyl appears to be a safe and effective treatment of ADHD in patients with Tourette's syndrome.

  2. Neurology 46: 965-968 (1996). A controlled trial of deprenyl in children with Tourette's syndrome and attention deficit hyperactivity disorder. Feigin A, Kurlan R, McDermott MP, Beach J, Dimitsopulos T, Brower CA, Chapieski L, Trinidad K, Como P, Jankovic J.

    We conducted a double-blind placebo-controlled crossover study to assess the efficacy of deprenyl for attention deficit hyperactivity disorder (ADHD) in children and adolescents with comorbid Tourette's syndrome (TS). Twenty-four subjects (21 boys, 3 girls; mean age 12 years) were enrolled at two sites (University of Rochester and Baylor College of Medicine). The design included two 8-week treatment periods separated by a 6-week washout period. The primary outcome measures for ADHD and tic severity were total scores on the DuPaul Attention Deficit Hyperactivity Scale (DADHS) and the Yale Global Tic Severity Scale (YGTSS). Fifteen subjects completed the study. The primary analysis revealed no statistically significant beneficial effect of deprenyl on the DADHS (mean improvement 1.3; 95% CI, -2.7 to 5.3; p = 0.50). Further post-hoc analyses revealed, however, that the effect of deprenyl in the first period was substantial (p = 0.02). There was a marginally statistically significant beneficial effect of deprenyl on the YGTSS total score (p = 0.06). Deprenyl may improve both ADHD and tics in children with TS and warrants further study.

  3. Psychopharmacol Bull 32: 327-334 (1996). Selegiline in adults with attention deficit hyperactivity disorder: clinical efficacy and safety. Ernst M, Liebenauer LL, Jons PH, Tebeka D, Cohen RM, Zametkin AJ.

    Clinical effects of high-dose and low-dose selegiline treatment were examined in 24 adults with attention deficit hyperactivity disorder (ADHD). The study used a double-blind randomized three-arm parallel-groups design with a 2-week placebo baseline followed by 6 weeks of treatment (placebo, 20 mg/day, or 60 mg/day selegiline) and then by 2 weeks of placebo post-treatment. A two-way repeated measures analysis of variance (ANOVA) showed no Drug x Time interaction and no main effect of Drug on severity of ADHD symptoms as self-rated by the subjects on the Conners Abbreviated Teacher Rating Scale (Conners ATRS). There was a significant effect of Time, indicating decreased ADHD symptom severity scores in all three groups. Selegiline treatment was not more effective than placebo. Side effects were more severe in the high-dose selegiline group than in either of the other groups. These preliminary results must be interpreted with caution because of methodological limitations in terms of sample size, patient population selection, and measurement tools.

Subject: Selegiline for adult ADD
Date: Fri, 09 Oct 98 12:13:56 -0500
From: Carl Rosenmann <rosenman@rci.rutgers.edu>

Paul Wender reports, referring to work done in 1983, that selegiline, a selective MAO-B inhibitor, in low doses (presumably 5 mg/day) produces moderate to marked improvement in 60% of adult ADHD patients. This is the same response rate reported for full doses of stimulants.

Wender PH. Pharmacotherapy of attention-deficit/hyperactivity disorder in adults. Journal of Clinical Psychiatry. 59 Suppl 7: 76-9, 1998.

Date: Fri, 09 Oct 1998 17:23:17 -0700
From: Randall Riggs <riggs@workmind.com>
Subject: Selegiline for adult ADD

Based on that report and the fact that selegiline is metabolized to amphetamine in the CNS, I tried it with one adult patient who has mild ADD and got a moderately good response. I don't see many folks with ADD, though, so I haven't had another opportunity.

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[dr. bob] Dr. Bob is Robert Hsiung, MD, dr-bob@uchicago.edu

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