What Is the Relationship between Sertraline and ADHD?
Attention Deficit Hyperactivity Disorder or ADHD is a behavioral disorder of the young. Systematic reviews have found the global prevalence of the disorder to be between 2 and 7% in young adults. Patients with ADHD are hyperactive, impulsive, and have divided attention. Timely treatment can help improve the quality of life of patients.
Causes of ADHD
The exact underlying cause of ADHD development is unknown. However, researchers believe that the neurodevelopmental disorder may be due to brain injury at birth or premature birth. Genetics is also a significant risk factor for ADHD. People whose families have a history of ADHD are at a higher risk of suffering from the condition.
Alcohol or substance abuse during pregnancy is also linked to ADHD in children. Toddlers exposed to environmental risks and pollutants are at a greater risk of developing ADHD.
Symptoms of ADHD
Symptoms slightly differ between adolescents and adults based on the duties they perform. ADHD patients have trouble concentrating on one task. ADHD kids and adults are easily distracted. The result is an incomplete task. Some patients are forgetful about their duties. However, in some cases, you can notice an element of impulsiveness and aggression. Such patients are fidgety and interrupt others.
ADHD Treatment With CNS Stimulants And Antidepressants
Treatment for this neurodevelopmental disorder revolves around medications and a combination of different therapies. The first line of action of treatment is central nervous system stimulants that increase the levels of dopamine and norepinephrine in the brain. These neurotransmitters (dopamine and norepinephrine) help improve focus and concentration. Antidepressant drugs are only used if CNS stimulants have failed to perform.
Is Sertraline Effective for ADHD?
Sertraline is the generic name of an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class of drugs that is occasionally given to patients suffering from attention-deficit/hyperactivity disorder (ADHD). Also known by the brand name Zoloft®, sertraline has not been approved specifically for treating ADHD and may have potentially serious side effects.
Sertraline was initially used for the treatment of Attention Deficit Hyperactivity Disorder and Tourette’s syndrome.
Antidepressants like sertraline are not typically used as a treatment for ADHD but are frequently needed to treat concurrent depression or anxiety symptoms that commonly occur in ADHD patients.
Researchers have not thoroughly researched sertraline and ADHD together. Some research has focused on sertraline and depression, but typically patients with ADHD have been excluded from the studies. One exception is a 1996 study that examined the effects of sertraline and fluoxetine on depression in patients who also had symptoms of ADHD. While all experienced an improvement in depressive symptoms, none experienced an improvement in ADHD symptoms.
Sertraline for ADHD and Comorbidities
Sertraline is usually not recommended for the management of ADHD. However, according to a case series, administration of serotonin reuptake inhibitor drugs (sertraline) combined with psychostimulants (methylphenidate) can help improve attention in children and adults. In this study, no participant developed aggressiveness, mania, or suicidal tendencies.
However, this behavioral disorder is associated with other neurological conditions such as Obsessive-Compulsive Disorder (OCD). The high comorbidity of OCD in ADHD patients makes it evident that treatment is directed to both conditions.
Two case studies show that sertraline combined with guanfacine puts OCD and ADHD into remission. The combination of the drugs effectively reduces behavioral responses and impulsivity in patients.
As mentioned, sertraline is not the first choice of drug for ADHD patients. Therefore, it is primarily indicated in patients unresponsive to treatment or having associated comorbidities. Tourette's syndrome (a neurological condition in which the patient makes involuntary movements and sounds) can coexist with ADHD.
Research suggests that four months of sertraline treatment helped treat a refractory case (24-year-old female) of ADHD suffering from Tourette’s.
Depression in ADHD Patients
According to a study, childhood ADHD increases the risk of depression in adult life. Another study seems to back this claim as depression, generalized anxiety disorder (GAD), and oppositional defiant disorder (ODD) were the significant comorbidities in ADHD patients.
Treatment with drugs like fluoxetine and sertraline can improve depressive symptoms but has no significant effect on ADHD. Sertraline can be used as an adjunctive therapy to treat anxiety in ADHD patients.
Complications Associated With Sertraline Use in ADHD Patients
Doctors' biggest concern with sertraline and ADHD or depression is an increased risk of aggression and suicidal behavior during sertraline treatment in children and adolescents. A typical adolescent has a 2-percent risk of attempting suicide. Patients who were being treated for depression with sertraline saw a jump in suicidal behavior to 3.5 to 4 percent. Some adult patients also reported an increase in aggressive and violent behavior.
Other complications associated with sertraline administration in ADHD patients include seizures. In 2007, a 12-year-old ADHD girl reported to the ER with seizures. The case study helped establish a link between sertraline-methylphenidate therapy and seizures.
In 2003, the United Kingdom banned sertraline for children less than 18 years old because of the link between sertraline and suicidal behavior. Owing to this link, many doctors warn against sertraline and ADHD, even when depression is present. In the US, the only drug approved for depression in children is fluoxetine, which is also sold under the brand name Prozac® and does not have the potential for aggressive behavior or suicide.
Still, many doctors attempt to explain away the link between sertraline and aggressive behavior. Some hypothesize that the antidepressant eased depression enough that patients who had been already considering suicide were then energized enough to carry out the action. Many others have had positive experiences with sertraline and ADHD or depression without undesirable side effects.
Considering the controversy, it may be best to avoid mixing sertraline and ADHD in children. There are other antidepressants that are more appropriate and other medications for treating ADHD symptoms. If a child is taking sertraline, it’s best to watch for any changes in behavior.
These changes in behavior include aggression, violent outbursts, and increased angry episodes. Any time a child indicates that she intends to harm herself or others is a cause for concern and an issue to discuss with a physician.
Other Uses of Sertraline
The selective serotonin reuptake inhibitor drug sertraline might not be effective for ADHD but is potent in curing other mental health conditions. Sertraline is indicated in treating obsessive-compulsive disorder, anxiety disorders (social anxiety disorder), clinical depression, and panic attacks. The drug is known to improve the patients' sleep, appetite, and mood.
Other Treatment Modalities for ADHD
In addition to stimulant medications, ADHD patients can alleviate symptoms by psychotherapy. Cognitive behavioral therapy and special education can help ADHD patients have a better life. Adult patients can join support groups.
Natural Remedies to Manage ADHD
One can reduce hyperactivity by adopting simple natural remedies. ADHD patients can significantly increase their quality of life by adding omega-3 supplements, green vegetables, and fruits to their diet. Paying attention to sleep patterns and doing exercise daily can be beneficial for mental health. Yoga and mindfulness meditation are other options for managing your ADHD.
I used sertraline for a while and it did not help with my ADHD at all. There is an issue with prescribing antidepressants to someone who has both ADHD and depression and/or anxiety symptoms. Depression and anxiety can actually be due to poorly managed ADHD. That's why when most doctors have a patient with ADHD and depression, they prescribe an ADHD medication first. It's very much possible that depression and anxiety may go away when the ADHD is under control. If it doesn't, then the doctor may consider the depression separate from ADHD.
As far as sertraline for ADHD goes though, I don't think it works. I contribute to an ADHD forum and I've not heard anyone else say that sertraline helped their ADHD. If anyone out there has had a different experience though, I would love to hear about it.
Of course, if it has been proven that sertraline is dangerous for ADHD sufferers, it should not be used by them. But if there is no proof on this issue, then I don't see an issue with ADHD sufferers using sertraline for depression or ADHD if it helps them. Sometimes doctors give off-label drugs because they have personal experience with previous patients who have benefited. It's not an uncommon practice.
I'm not a doctor or expert on this topic. But I have had depression and anxiety on and off in my life and have been treated with some of these medications in the past. Some doctors' explanation that sertraline treated depression enough to energize the patient into suicide seems like utter nonsense to me.
It is a well known fact that all anxiety and depression medications may increase the occurrence of suicidal thoughts. I have not come across an SSRI that doesn't mention this in the potential risks and side effect section of the drug description. And manufacturers ask patients to tell their doctor immediately to change the dose or the drug if this does indeed happen.
So it is not surprising that ADHD patients using sertraline may experience this problem. And I agree that sertraline should not be used by ADHD patients because of the greater number of side effects they experience.
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