|

Is Mirtazapine Effective for Treating ADHD?

ByPrimary Researcher

Executive Summary

  • One of the common off-label prescriptions for antidepressants is ADHD.
  • We evaluate the evidence for the effectiveness of antidepressants for ADHD or Mirtazapine ADHD.

Introduction

Ever since antidepressants were first introduced, they began expanding in their off-label applications. A major off-label prescription has become for treating ADHD. This article investigates whether antidepressants like the antidepressant Mirtazapine are effective for ADHD, as the medical establishment has claimed.

Studies into Mirtazapine for ADHD

This results from a study reported in the article Mirtazapine Treatment for Comorbid Anxiety/ Depressive Disorders in Young Subjects with Attention-Deficit Hyperactivity Disorder states it is effective. Mirtazapine is sold under the brand Remeron.

Objective: To investigate the efficacy and tolerability of mirtazapine combination with methylphenidate in young subjects with diagnosis of attention deficit hyperactivity disorder (ADHD) and comorbid anxiety or depressive disorders. Method: Subjects with DSM-IV diagnosis of ADHD and comorbid anxiety or depressive disorders were added mirtazapine 7.5 or 15 mg/day initially to treat anxiety or depressive disorders as well as to counteract or avoid methylphenidate or SSRIs related side effects. Improvement in target symptoms were assessed using relevant scales and the Clinical Global Impression-improvement (CGI-I) scale. Results: Subjects were four boys and three girls (11.85±2.91 years). Duration of methylphenidate and mirtazapine treatment was 14.28±9.41 and 3.71±0.95 months respectively. Final dose of mirtazapine was 16±2.64 mg/day. All subjects showed moderate to very much improvement in sleep and three subjects showed much improvement in appetite problems on CGI-I scale. Six subjects showed mild to very much improvement in anxiety disorders /symptoms and one subject showed much improvement in depression on CGI-I scale. Conclusions: Young subjects with diagnosis of ADHD and comorbid anxiety or depressive disorders may benefit from mirtazapine addition particularly in the presence of methylphenidate or SSRIs related sleep and/or appetite problems.

That is not true. The low serotonin hypothesis for depression has been disproven as This is a very low number of test subjects. The quote continues.

Kratochvil et al. (2005) reported that mirtazapine could be a choice of treatment in the presence of treatment induced insomnia and comorbid anxiety or depressive disorders in subjects with ADHD (28). Finally mirtazapine would be generally tolerated well and less likely to cause behavioral activation than SSRIs. Clinicians may dissuade from using SSRIs medications in children with ADHD given their potential for behavioral activation which may be particularly problematic in children with ADHD. Furthermore SSRIs may also cause or worsen sleep and appetite problems in children. One of the subjects developed significant behavioral activation characterized with increased hyperactivity, excessive talking, irritability, and aggressive behaviors with fluoxetine that was started for his depression. Three subjects developed or worsened significant sleep/appetite or other gastrointestinal problems or headache after SSRIs were added to their treatment.

This proposes Mirtazapine as a replacement for SSRIs. However, the paper has no discussion of financial conflicts of interest. This normally means the authors did have financial conflicts, most likely with the maker of Mirtazapine, and chose not to disclose them.

Antidepressants Prescribed for ADHD

According to WebMD, antidepressants like the antidepressant Mirtazapine for ADHD tend to be prescribed when amphetamines like Ritalin or Adderall are found to be ineffective. This is explained in the following quotation.

A lot of adults with ADHD (attention deficit hyperactivity disorder) take stimulant drugs to manage their symptoms. But if you don’t get better with those medicines, or you don’t like how they make you feel, your doctor may suggest you try an antidepressant.

Sometimes the MDs prescribe antidepressants for ADHD because the patient has a variety of symptoms. There is also an overlap between ADHD and depression. Problems in concentration and overall attention spans mark both. Some adults with ADHD also have depression and anxiety. Antidepressant drugs might be an option if that’s your situation since they can treat these conditions and ADHD.

When it comes to improving your concentration or attention span, antidepressants usually don’t work as well as stimulants and other drugs made specifically to treat ADHD.

While part of this statement is correct — the part about having antidepressants for ADH

D not working as well as stimulants to treat this condition — the problematic part of this statement is that studies have not even found a relationship between these neurotransmitters and depression. WebMD leaves out this information — because pharmaceutical companies fund WebMD to keep saying this to readers long after this hypothesis has been proven to be false. GoodRx addresses this same topic in the following quotation.

Both ADHD and depression are linked to low levels of the neurotransmitter dopamine in the brain, which is involved in pleasure, concentration, motivation, and movement. Many of the medications used to treat depression and ADHD aim to increase dopamine levels.