Mirtazapine Treatment for Comorbid Anxiety/Depressive Disorders in Young Subjects with Attention-Deficit Hyperactivity Disorder: Case Series

摘要

Objective: To investigate the efficacy and tolerability of mirtazapine combination with methylphenidate in young subjects with diagnosis of attention deficit hyperactivity disorder (ADHD) and comorbid anxiety or depressive disorders.Method: Subjects with DSM-IV diagnosis of ADHD and comorbid anxiety or depressive disorders were added mirtazapine 7.5 or 15 mg/day initially to treat anxiety or depressive disorders as well as to counteract or avoid methylphenidate or SSRIs related side effects. Improvement in target symptoms were assessed using relevant scales and the Clinical Global Impression-improvement (CGI-I) scale.Results: Subjects were four boys and three girls (11.85±2.91 years). Duration of methylphenidate and mirtazapine treatment was 14.28±9.41 and 3.71±0.95 months respectively. Final dose of mirtazapine was 16±2.64 mg/day. All subjects showed moderate to very much improvement in sleep and three subjects showed much improvement in appetite problems on CGI-I scale. Six subjects showed mild to very much improvement in anxiety disorders/symptoms and one subject showed much improvement in depression on CGI-I scale. Mirtazapine was generally tolerated well. Most frequently reported side effects were increased appetite (n=5), weight gain (n=4; 1000–4000 gm; 1357.14±1546.88 gm); day time sedation (n=4) and irritability (n=2).Conclusions: Young subjects with diagnosis of ADHD and comorbid anxiety or depressive disorders may benefit from mirtazapine addition particularly in the presence of methylphenidate or SSRIs related sleep and/or appetite problems.?ZETAma?: Dikkat eksikli?i hiperaktivite bozuklu?u (DEHB) olan ve metilfenidat tedavisi alan ?ocuk ve ergenlerde komorbid anksiyete/depresif bozukluklar?n tedavisinde mirtazapinin etkinli?i ve tolerabilitesini ara?t?rmak.Y?ntem: DSM-IV'e g?re DEHB ve komorbid anksiyete ya da depresif bozukluk tan?s? alan olgulara hem anksiyete/depresif bozukluklara y?nelik hem de metilfenidatla ili?kili yan etkileri gidermek ya da Se?ici Serotonin Gerial?m ?nleyicisi (SSG?) ile ili?kili yan etkilerden ka??nmak i?in mirtazapin 7.5–15 mg/gün tedavisi ba?land?. Hedef semptomlardaki iyile?me ili?kili ?l?ekler ve klinik global izlem-iyile?me (KG?-?) ?l?e?i kullan?larak de?erlendirildi.Bulgular: Olgular d?rt erkek ve ü? k?z ?ocu?undan olu?maktayd? (ya? ortalamas? 11.85±2.91 y?l). Metilfenidat ve mirtazapin tedavi süreleri s?ras?yla 14.28±9.41 ve 3.71±0.95 ayd?. Mirtazapin ortalama dozu 16±2.64 mg/gündü. Bütün olgular KG?-? ?l?e?inde uyku probleminde olduk?a ya da ?ok düzelme g?sterirken ü? olgu i?tah probleminde olduk?a düzelme g?sterdi. Alt? olgu KG?-? ?l?e?inde anksiyete semptom /bozukluklar?nda hafifle ?ok aras?nda de?i?en düzelme g?sterirken bir olguda depresyon olduk?a düzelme g?sterdi. Mirtazapin genel olarak iyi tolere edildi. En s?k bildirilen yan etkiler i?tah artmas? (n=5), kilo al?m? (n=4; 1000–4000 gram; 1357.14±1546.88 gram); gün i?i sedasyon (n=4) ve irritabiliteydi (n=2).Sonu?: DEHB ve komorbid anksiyete/depresif bozukluklar? olan ?ocuk ve ergenler, ?zellikle metilfenidat ya da SSG? ile ili?kili uyku ve i?tah problemlerinin varl???nda, metilfenidat tedavisine mirtazapin eklenmesinden fayda g?rebilirler.