A double-blind, placebo-controlled study of clonidine (.05 mg 4xd) and desipramine (25 mg 4xd) treatment of attention-deficit hyperactivity disorder (ADHD) behaviors in 34 children with TS + ADHD is reported from the Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. Desipramine was superior to clonidine in improving measures of ADHD, including parent-completed global linear analogue rating scale, hyperactivity subscale of the child behavior checklist (CBCL), and teacher CBCL subscales for nervous/overactive, anxious, and unpopular items. More than two thirds of families requested continuation of desipramine at the completion of the study. Neither drug made tics worse. [1]

COMMENT. Desipramine is a more effective medication than clonidine for the treatment of ADHD in children with Tourette’s syndrome. The authors hesitate to recommend the general use of desipramine. A review of the literature uncovered at least four sudden, unexplained deaths in children receiving desipramine. Careful monitoring, especially of the cardiovascular system, is advised.

Behavioral improvements found with tricyclic antidepressants and the positive effects of stimulant medication on cognitive tasks have prompted combined drug therapy of ADHD. Side effects occurred more frequently when a combination of desipramine and methylphenidate was employed compared to either medication used alone. (see Progress in Pediatric Neurology II, PNB Publ, 1994, pp210-211).

Bilineal transmission (from maternal and paternal sides) of Tourette’s syndrome, especially in families in which the proband’s symptoms were most severe, was a frequent finding (approx 1/3) in a study at the University of Rochester School of Medicine, NY, and University College London Medical School, London, UK. [2]