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Q. My stepson is taking imipramine for ADHD, and I haven't heard of anyone taking this medication for ADHD before. My 16 year old son has ADD. He is on Adderall XR. I have dealt with ADD for years and I was wondering if my stepson is on the right medication because his mother says its also for bed wetting. Is this so? Crossville, Alabama

A. While imipramine isn't considered a first line medication for ADHD or a doctors usual first choice when treating a child with ADHD, it can still be used.

According to ADHD Guidelines from the American Academy of Child and Adolescent Psychiatry, first line medications that can be used to treat children with ADHD include stimulants, like Ritalin and Adderall, and the newer non-stimulant medication Strattera.

Forms of Ritalin

There are now many different forms of methylphenidate or Ritalin, including short (twice a day) and long acting (once a day) preparations. Some available forms include:

• Concerta (long acting)
• Daytrana (long acting Ritalin patch)
• Focalin (short acting) and Focalin XR (long acting)
• Metadate CD (long acting)
• Metadate ER (long acting)
• Methylin (short acting) - chewable tables and oral solution
• Ritalin (short acting) - generic
• Ritalin LA (long acting)

Forms of Amphetamine

Amphetamine stimulants are also available in different forms, including short acting (twice a day) and long acting (once a day) forms, including:

• Adderall (short acting) - generic
• Adderall XR (long acting)
• Dexedrine (short acting) - generic
• Vyvanse

Second Line ADHD Medications

Second line medications or alternatives to the stimulants and Strattera include antidepressants, like buproprion (Welbutrin), imipramine (Tofranil), and Nortriptyline (Pamelor), and alpha-2-adrenergic agonists, like clonidine (Catapres) and guanfacine (Tenex).

In general, doctors usually go to a second line medication when a child has either failed or not tolerated two or more first line medications.

So is your stepson on the right medication?

That really depends on how well he is doing. If his ADHD symptoms are under good control and he isn't having any side effects, then he is likely on the right medication, even if it isn't a standard or first line medication for ADHD. If he isn't doing well, then you should likely talk to your Pediatrician about adjusting his dose or considering a different medication.

And yes, imipramine is also used to treat children with bedwetting, in addition to treating ADHD and depression.

The last thing to consider is that if his 'ADHD symptoms' got better with imipramine and he didn't do well with the stimulants, then maybe he was just depressed in the first place and never really had ADHD. It isn't possible to make a real conclusion like that without a lot more information and a thorough evaluation, but it is something to think about.

_Sources:

AAP. Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder. Pediatrics 2001 108: 1033-1044.

American Academy of Child and Adolescent Psychiatry. Practice Parameter for the Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. J. AM. ACAD. CHILDADOLESC. PSYCHIATRY, 46:7, JULY 2007