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.
Anxiety, ADHD, depression, comorbidity, mirtazapine, treatment