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- Title
Depression and ADHD: do SSRI's "kill or cure"?
- Authors
Petrykiv, S.; Arts, M.; De Jonge, L.
- Abstract
Introduction: Dopamine depletion in prefrontal cortex (PFC) plays a key pathofysiological role in severity of ADHD. Depression is an frequent cormobide condition of ADHD. To date, effect of SSRI's on dopamine level in PFC is limited to animal studies. Authors of current paper provide our experience with fluoxetine in relation to ADHD treatment. Objectives: To provide pharmacological insights in treatment of depression and ADHD. Methods: A case rapport of a patient treated with fluoxetine, followed by deterioration of ADHD symptoms. Results: A 28 y.o. and otherwise healthy male, was receiving 20mg and 40mg. of fluoxetine for minor depression for a total period of two months. During the course of treatment he started to complain about increasing attention deficit and developing of chaotic, obviously deviant, sexual thoughts and disorganised behaviour. The burden of disease caused him to abandon his occupation. Patient contacted psychiatric emergency service. Fluoxetine was gradually reduced and stopped within two weeks, while symptomatologic treatment with small doses of olanzapine was started. Shortly thereafter the DIVA test was accomplished and the patient was found to score heavily positive for ADHD symptoms. Subsequently, treatment with venlafaxine and methylphenidate was initiated. Shortly hereafter, patient reported a significant relief of the symptoms and he was able to resume his job. Conclusions: Fluoxetine might worsen the symptoms of ADHD through the diminished postsynaptic D2 receptor binding capacity in PFC. Given the long wash out period of the drug, we recommend to consider an SNRI or NDRI as drug of choice because of a favorable effect on ADHD symptomatology.
- Subjects
ATTENTION-deficit hyperactivity disorder; MENTAL health services; PREFRONTAL cortex; MENTAL depression; DRUG therapy; PSYCHIATRIC emergencies; PSYCHOTIC depression
- Publication
European Psychiatry, 2020, Vol 63, pS93
- ISSN
0924-9338
- Publication type
Article