The case of a 13-year-old boy with a history of ADHD and depressive disorder who had a tonic-clonic seizure 1 week after treatment with methylphenidate (80 mg/day) and sertraline (50 mg/day) is reported from Wright State University, School of Medicine, Dayton, OH. MPH dosage had been gradually increased over 1 year, and sertraline was added because of a worsening of depression. The seizure occurred one week after starting the combination therapy. The EEG was normal. Sertraline was discontinued, and MPH was continued unchanged with no recurrence of seizures. 
COMMENT. Methylphenidate alone may induce seizures in susceptible patients (see Ped Neur Briefs May 1997;p38), but the risk is aggravated by the addition of certain antidepressants. Despite the normal EEG in the above patient, it is probably advisable to order an EEG in a child with ADHD who requires a combination of stimulant and antidepressant medication. Epileptiform discharges in the EEG may prompt the addition of antiepileptic medication in some patients requiring treatment for ADHD and/or depression.