Cochrane for Clinicians

Putting Evidence into Practice

Tricyclic Antidepressants for the Treatment of ADHD in Children and Adolescents


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Am Fam Physician. 2015 Sep 1;92(5):352-353.

Clinical Question

Do tricyclic antidepressants (TCAs) effectively treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents?

Evidence-Based Answer

TCAs, specifically desipramine and nortriptyline (Pamelor), are superior to placebo at reducing ADHD symptoms in the short term (two to six weeks); however, the quality of evidence is low. Increased heart rate and diastolic blood pressure may be noted with treatment. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

ADHD is defined as a pattern of behavior with onset before 12 years of age with components of inattention, hyperactivity, and impulsivity that are present in multiple settings and cause impairment.1 Stimulants are first-line treatment for patients with ADHD, but they are associated with decreased appetite, decreased height, and development or worsening of tic disorder.2,3

This review included six double-blind, randomized controlled trials (RCTs) with a total of 216 patients treated for ADHD with desipramine, clomipramine (Anafranil), and nortriptyline. Two of the trials had co

The practice recommendations in this activity are available at

The views expressed in this article are those of the authors and do not reflect the policy or position of the U.S. Army Medical Department, the Department of the Army, the U.S. Air Force, the Department of Defense, or the U.S. government.


Otasowie J, Castells X, Ehimare UP, Smith CH. Tricyclic antidepressants for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev. 2014;(9):CD0006997.


show all references

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013....

2. Lerner M, Wigal T. Long-term safety of stimulant medications used to treat children with ADHD. J Psychosoc Nurs Ment Health Serv. 2008;46(8):38–48.

3. Charach A, Figueroa M, Chen S, Ickowicz A, Schachar R. Stimulant treatment over 5 years: effects on growth. J Am Acad Child Adolesc Psychiatry. 2006;45(4):415–421.

4. Conners CK. Conners’ rating scales. In: Maruish ME, ed. The Use of Psychological Testing for Treatment Planning and Outcome Assessment. Hillsdate, N.J.: L. Erlbaum Associates; 1994:550–578.

5. Achenbach TM. Manual for the Child Behavior Checklist/4–18 and 1991 Profile. Burlington, Vt.: University of Vermont Department of Psychiatry; 1991.

6. National Institute of Mental Health. CGI (Clinical Global Impression Scale). Psychopharmacol Bull. 1985;21:839–844.

7. Wolraich M, Brown L, Brown RT, et al.; Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128(5):1007–1022.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at


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