Dr. Bob's Psychopharmacology Tips

Side-effects of stimulants

From: shakti@penn.com
Date: Wed, 24 Jan 1996 22:00:11 -0500
Subject: Side-effects of stimulants

My question concerns a woman in her 30s that I am treating for ADD. We started with methylphenidate (Ritalin), and as we reached reasonable dosage range, she noted definite improvements in her concentration, attention, organization, etc. She was delighted with the response, except for one thing -- an hour or two after each dose, she developed tachycardia, reportedly as high as 140 bpm.

--Roberta M. Richardson, M.D.

Maybe you could consider splitting the dose and giving her Ritalin at a lower dose more frequently. In my practice I find patients sometimes tolerate this better.

Another possibility, since the patient responded to Ritalin, is to reduce the dose to a point where she no longer has the tachycardia and then augment with clonidine. This strategy has worked very well for me in the past (in patients who have shown an initial response to the Ritalin).

If nothing works consider desipramine.

Date: Wed, 24 Jan 1996 22:44:46 -0800
From: ckuttner@proaxis.com (Charles Kuttner)
Subject: Side-effects of stimulants

I just finished reading Wender's excellent book on treating adult ADD. He uses lots of small doses of stimulants, e.g., 10 mg six times a day, mainly for sustained effectiveness, partly for limiting side effects.

I think the same applies for depression rx. I have had good results with methylphenidate, d-amphetamine, or pemoline as adjuncts in depression rx.

Consider giving something like 5 mg of methylphenidate every two hours or whatever. Definitely try different stimulants -- there are amazing differences in side effects, at least in some patients.

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