Imipramin on Kids

[worriedfather]

Hi,

my wife and I are parents of a beautiful daughter of 7 years of age. We live in Mexico City. Last week she was diagnosed with ADD. I must say that hearing the diagnoses did not scare us, it was more a relieve, because finally we found a cause for her behaviour and are now able to help her, so she can become a happy kid.
The doctor, a well known psychiatrist in Mexico City, prescribed her an imipramin medication called Talpramin. Together with a psycho-pedagogig Therapy he told us that in 6 month our daughter Cecilia could be cured.

Today on the internet I found out, that imipramin is a anti-depressent and I am quite worried about this. It is hard to imagine that a kid with the symptoms of ADD is taking an anti-depressent. I must say though, that she is taking it for 3 days and we can already see dramatic changes in her behaviour. She is friendly, accesible, can handle frustration much better, does not get aggressive anymore, etc. All in one she is more relaxed with herself and happier.
So the effect of the medication is very positiv. And this, according to the doctor, will make her more accessible to the therapy that follows. And we think he is right.
Still, we were really shocked when we found out about the anti-deppressent. Our daughter is not deppressive, also she has partially shown symptoms of it, but maybe once in 3-4 month.

Does anybody have more experience with Imipramin and can maybe give us some advise on it ?

Thanks
Paul

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I'm not a doctor but I'll share with you some of what I've read on the subject. First of off there is no cure of ADHD. ADHD can be treated effectively but a cure doesn't exist and anyone who tells you there is is operating outside the mainstream thinking on the subject. Imipramine was the first tricyclic antidepressant and is sometimes used to treat ADHD when stimulent medication such as Ritalin, Concerta, Adderall, Dexedrine, etc are not considered a good first option due to a preexisting drug abuse problem or other medical considerations. According to Russell Barkley (a leading researcher in the ADHD arena for the past 25+ years) in his book Taking Charge of ADHD, "The stimulents, the drugs most commonly used, have been shown to be effective in improving behavior, academic work, and social adjustment in anywhere from 50% to 95% of children with ADHD........... there is absolutely no controversy among the scientific community as to the safety and effectiveness of these medications....... First, parents must understand that the stimulants have been on the market for 30 to 60 years. In that time, millions of children with ADHD have been treated with these medications, many for several years or longer. In none of these cases have any reports of significant long-trem side effects been reported to either the pharmaceutical companies or the Food and Drug Administration." I could go on but stimulents are clearly the first choice for the treatment of most ADHD and a very safe choice.

According to William Appleton, MD in his book The New Anti Depressants and Antianxieties, "The tricyclics make the pulse spped up by 20 or more beats per minute ... The older antidepressants may disrupt the orderly beat of the heart, either by delaying electrical conduction within cardciac muscle, which can be seen on an electrocardiogram, or on rare occasions causing complete disorder and sudden death. The danger of sudden death is of particular concern in patients with serious heart disease and in children ..." Other problems he list in volve blurred vision which may disappear after a week or two, dry mouth which can lead to tooth decay, constipation, urinary problems, and weight gain (some people have gained as much as 30 pounds).

I would research all I could if I were you -- this would be a choice I wouldn't make for my 8 year old ADHD daughter. I believe there are safer options, especially for the first line of treatment. Some good books containing medication and non medication treatment options include: Driven to Distraction by Hallowell and Ratey; Attention Deficit Disorder: The Unfocused Mind in Children and Adults by Brown; and Taking Charge of ADHD by Russell Barkley.

Behavioral therapy for ADHD kids works as long as you are doing it, but tends to stop as soon as it is removed. The results with behavior therapy tend to improve slowly over time. Talk therapy alone won't "fix" what is wrong in the ADHD brain. The neurotransmitters are basically recycled back to the sending neuron before the entire message has time to jump the synaptic gap -- no amount of talking will change this. What stimulent medication and imipramine do is increase the amount of dopamine or norepharine in the synaptic gap to help improve brain functioning. Both may work but stimulents have a better profile for side effects and a better safety record.

Take care and good luck!
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[Scattered]

Bipolar Medications Library

Catalogue of side effects for the medication Tofranil - generic Imipramine - a tryciclic antidepressant sometimes prescribed in the treatment of bipolar disorder and other mood disorders.



Common Side Effects:

Check with your doctor if any of the following side effects continue or are bothersome:

Dizziness; drowsiness; dryness of mouth; headache; increased appetite (may include craving for sweets); nausea; tiredness or weakness (mild); unpleasant taste; weight gain

Less Common Side Effects:

Check with your doctor if any of the following side effects continue or are bothersome:

Diarrhea; heartburn; increased sweating; trouble in sleeping (more common with protriptyline, especially when taken late in the day); vomiting

Always Notify Doctor:

Less Common: Blurred vision; confusion or delirium; constipation (especially in the elderly); decreased sexual ability (more common with amoxapine and clomipramine); difficulty in speaking or swallowing; eye pain; fainting; fast or irregular heartbeat (pounding, racing, skipping); hallucinations; loss of balance control; mask-like face; nervousness or restlessness; problems in urinating; shakiness or trembling; shuffling walk; slowed movements; stiffness of arms and legs

Rare: Anxiety; breast enlargement in both males and females; hair loss; inappropriate secretion of milk - in females; increased sensitivity to sunlight; irritability; muscle twitching; red or brownish spots on skin; ringing, buzzing, or other unexplained sounds in the ears; seizures (more common with clomipramine); skin rash and itching; sore throat and fever; swelling of face and tongue; swelling of testicles (more common with amoxapine); trouble with teeth or gums (more common with clomipramine); weakness; yellow eyes or skin

Withdrawal Side Effects - Notify Doctor:

Headache; irritability; nausea, vomiting, or diarrhea; restlessness; trouble in sleeping, with vivid dreams; unusual excitement

Overdose Effects - Notify Doctor: Confusion; convulsions (seizures); disturbed concentration; drowsiness (severe); enlarged pupils; fast, slow, or irregular heartbeat; fever; hallucinations (seeing, hearing, or feeling things that are not there); restlessness and agitation; shortness of breath or troubled breathing; unusual tiredness or weakness (severe); vomiting

http://bipolar.about.com/cs/sfx/a/sfx_tofranil.htm

One of the things that would really concern me is the tardive dyskensia that is mentioned -- that is a condition where there is a loss (frequently permantly) of full muscle control in the tongue, face, arms, legs, etc. See the effects described above in the area I high lighted.

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[Scattered]

Medication Offers Relief, Not a Cure

At present, there is no cure for ADD syndrome, but there are medication treatments that have been demonstrated safe and effective in alleviating symptoms of ADD syndrome in 80 to 90 percent of children, adolescents, and adults who have the disorder. Just as eyeglasses do not repair the patient's eyes and cure impaired vision so medications that alleviate ADD syndrome do not cure problems of brain chemistry that cause these impairments: the improvements last only as long as the medication is active in the body.

Tricyclic antidepressants (TCAs)...have the advantage of lasting relatively long, so they do not require multiple daily doses and do not produce the "hills and valleys" or "rebound' effects sometimes found in treatment with stimulants. They tend to be quite effective in alleviating hyperactive and impulsive symptoms of ADHD, though they have not generally been found to improve the inattention symptoms of ADHD as much as do the stimulents. TCAs tend to be especially helpful for ADHD patients who suffer from comorbid depression, anxiety, oppositionality, or tics......

Adverse effects with TCAs may include sedation, weight gain, dry mouth, constipation, and sexual dysfunction...The primary disadvantage of TCAs is their relatively narrow margin of safety. If these medications are taken in significant overdose, accidental or deliberate , they can cause severe, even fatal, cardiovascular problems. This is an important risk factor, especially in households with young children or for individuals with depressive problems. Despite a substantial body of research showing the effectiveness of desipramine for treatment of ADHD, many physicians stopped prescribing it, at least for prepuescent children, after sudden deaths were reported in four children who had been taking appropriate, not excessive, doses of desipramine for ADHD Joseph Biederman and other (1995a) have reported that the risk of sudden death when taking appropriate doses of desipramine is elevated only slightly above the normal risk for sudden, unexplained death in children. Nevertheless, caution is advised when considering this specific medication for prepubescent children. For ADHD most clinicians feel more comfortable prescribing nortriptyline because it tends to have fewer adverse effects than most other TCAs.

I almost forgot -- welcome to the forums, worriedfather!

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[wendybonsey]

hi
my son (who i believe has adhd) was prescribed imipramine for a completely diferent reason (not depression) and it has has a remarkable effect on his attitude and behaviour at school and the knock on effect is better self confidence. i have been back to his dr to see about it and have now been referred back to the specialist so see where we go from here, so fingers crossed he may finally get the diagnosis and help he needs and deserves.

[KurtG85]

I took imipramine for awhile. It made me really tired and also slowed down my mental processing speed. It raised my physical anxiety symptoms as well and made me pretty irritable (but more emotionally even keeled despite the consistent irritability. Not including nervousness, if you want to call that an emotion, it made me more nervous generally). It did help my depression a decent amount though. As a bonus, it also raised my libido quite a bit. I guess it may have helped me focus a little bit better. My heart was always going a hundred miles per hour on it.
I stopped it after a year or so because all the side effects weren't worth it. While it helped my depression a good amount, the strong dumbing down effect it had and the irritability it was causing was agitating my social anxiety/depression.

[adhdaloha]

If Imipramine works for you then you should consider that you have anxiety and not ADHD. I can tell you that anxiety will give you symptoms in your inablity to concentrate and focus exactly like adhd.

[KurtG85]

Yea, I wasnt really taking imipramine for ADD, it was to try and help anxiety/depression. I havn't really found anything that im happy with in terms of my anxiety/depression/ADD relief. Adderall helps my concentration, panic attacks and depression alot but raises my general anxiety so much that I essentially cannot keep focused on anything because I am always trying to escape the anxiety.
I have tried pretty much everything outside of a couple meds I am trying to find a doc to prescribe to me (mirapex, selegeline (SP) and deplin) and nothing has helped much outside of lexapro (with crappy side effects included).

[adhdaloha]

aloha
what is it you like about these medications?

mirapex, selegeline (SP) and deplin

[KurtG85]

1. I haven't tried them.
2. Mirapex and selegeline for their dopaminergic action (possibly correlates to the help I get from adderall) and deplin just being a mega folic acid supplement essentially.

[adhdaloha]

looks like you have been looking at Parkinson's drugs

me also, i was trying to get my doc to prescribe l-dopa since it is a natural precursor to dopamine.

thanks for the mirapex lead it looks like that may act on the d2 d3 dopamine subtypes which is what i am looking for. my insurance does not cover but i am sure i can get a sample from my doc, his office is full of samples including mirapex


Selegiline, available since 1989, has been reformulated in a new freeze-dried orally disintegrating form (Zelapar), which dissolves rapidly and is absorbed directly through the buccal mucosa.^{7 This allows once-daily administration with a lower dose than the older tablet or capsule form. Selegiline is approved as an adjunct to carbidopa/levodopa for patients who experience a loss of effectiveness with the latter therapy}

[KurtG85]

Thanks for the selegiline lead.