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I. Clinical Efficacy

Alan Zametkin, MD; Judith L. Rapoport, MD; Dennis L. Murphy, MD; Markku Linnoila, MD, PhD; Deborah Ismond, MA

Arch Gen Psychiatry. 1985;42(10):962-966.

Abstract
• Fourteen boys (mean age, 9.2±1.5 years) with Attention Deficit Disorder (ADD) With Hyperactivity were treated with dextroamphetamine sulfate or a monoamine oxidase inhibitor (MAOI) (six received clorgyline, eight received tranylcypromine sulfate) for four weeks each in a double-blind, cross-over study that included a two-week placebo washout between active drug periods. The MAOIs had immediate, clinically significant benefit and were clinically indistinguishable from dextroamphetamine. Most children responded to both stimulant and MAOI. These findings of equivalent efficacy of MAOIs in ADD are in contrast to our previous studies with neurotransmitter system selective agents, which showed only weak effects, and suggest that multiple neurotransmitter alterations may be required for stimulant drug effects in ADD. The immediate response to MAOIs indicates a different mechanism from that mediating antidepressant effect. The MAOIs may be useful alternate treatments in selected cases of ADD.

Author Affiliations
From the Child Psychiatry Branch (Drs Zametkin and Rapoport and Ms Ismond) and the Clinical Neuropharmacology Branch (Dr Murphy), National Institute of Mental Health, Bethesda, Md; and the Laboratory of Clinical Studies, National Institute of Alcohol Abuse and Alcoholism, Bethesda, Md (Dr Linnoila). Dr Zametkin was a child psychiatry fellow at George Washington University, Washington, DC.

Footnotes
Accepted for publication March 12, 1984.

Reprint requests to Child Psychiatry Branch, National Institute of Mental Health, Bldg 10, Room 6N240, 9000 Rockville Pike, Bethesda, MD 20205 (Dr Rapoport).

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