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A Double-blind Comparison of Desipramine and Placebo in Children and Adolescents With Chronic Tic Disorder and Comorbid Attention-Deficit/Hyperactivity Disorder
Thomas Spencer, MD;
Joseph Biederman, MD;
Barbara Coffey, MD;
Daniel Geller, MD;
Margaret Crawford, MD;
Sarah Kate Bearman, BA;
Reem Tarazi, BA;
Stephen V. Faraone, PhD
Arch Gen Psychiatry. 2002;59:649-656.
Background Currently, there is no consensus on the best therapeutic approach to
chronic tic disorders and comorbid attention-deficit/hyperactivity disorder
(ADHD). To address this issue, we evaluated the tolerability and efficacy
of the noradrenergic tricyclic antidepressant desipramine hydrochloride in
the treatment of children and adolescents with chronic tic disorders and comorbid
ADHD.
Methods Forty-one children and adolescents with chronic tic disorders, including
Tourette disorder and comorbid ADHD, were studied in a 6-week, double-blind,
placebo-controlled, parallel trial. Desipramine was titrated weekly up to
3.5 mg/kg per day. We rated ADHD and tic symptoms weekly and monitored adverse
effects, laboratory findings, and cardiovascular parameters.
Results Treatment with desipramine (mean total daily dose, 3.4 mg/kg per day)
was well tolerated without meaningful adverse effects. Desipramine significantly
reduced core symptoms of ADHD (ADHD Rating Scale; 42% decrease from baseline
relative to placebo, P<.001), with equal response
in inattentive symptoms and hyperactive/impulsive symptoms (P<.001 for both). The ADHD response rate was robust (71% vs 0%;
desipramine vs placebo, P<.001). Likewise, desipramine
significantly reduced tic symptoms (Yale Global Tic Severity Scale; 30% decrease
from baseline relative to placebo, P<.001), with
equal response in motor and phonic tic symptoms (P<.01
for both). The tic response rate was substantial (58% vs 5%; desipramine vs
placebo, P<.001). There were small but statistically
significant differences between desipramine and placebo in heart rate and
blood pressure.
Conclusions Treatment with desipramine was well tolerated and was associated with
robust clinically significant reductions in tic and ADHD symptoms in children
and adolescents with chronic tic disorders and ADHD diagnoses.
From the Pediatric Psychopharmacology Unit, Psychiatry Service, Massachusetts
General Hospital, Boston (Drs Spencer, Biederman, Crawford, and Faraone, Ms
Bearman, and Ms Tarazi); the Department of Psychiatry, Harvard Medical School,
Boston (Drs Spencer, Biederman, Coffey, Geller, and Faraone); the Tourette's
Disorder Clinic (Dr Coffey) and the Obsessive Compulsive Disorders Clinic
(Dr Geller), McLean Hospital, Belmont, Mass; and the Harvard Institute of
Psychiatric Epidemiology and Genetics, Harvard Medical School, Boston (Dr
Faraone).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
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Desipramine Shows Promise in Treating ADHD and Tics
JWatch Psychiatry 2002;2002:5-5.
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