Abstract
Youth with Attention-Deficit Hyperactivity Disorder (ADHD) may suffer from comorbid difficulties, such as anxiety–depressive symptoms, social withdrawal, and somatic complaints. Although stimulants remain the ADHD cornerstone treatment, mental fatigue, school problems and low self-esteem may persist, often being the most unacceptable symptoms for these patients. We present two cases of adolescents (14 and 15 years old) with methylphenidate-treated ADHD, where cognitive fatigability, depressive thoughts, anxiety, irritability, and poor social relationships remained. Based on clinical observation and the completion of parent and child rating scales, the aforementioned manifestations appeared to progressively reduce by the time of the subsequent control visits planned 1, 3, and 5 months after, following the use of vortioxetine (up to 10 mg/day) as add-on therapy to methylphenidate. No significant side effects were reported in both cases in a follow-up period of 3 months, also supporting the stability of the observed clinical improvement. Vortioxetine monotherapy has already been tested for the treatment of anxiety–depressive symptoms in youth, as well as ADHD in adulthood. The cases presented here suggest that vortioxetine could also be an effective option for ADHD treatment in childhood and adolescence, warranting further investigation of its potential benefits as both a monotherapy and adjunctive therapy to stimulants.
Highlights
According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), Attention-Deficit Hyperactivity Disorder (ADHD) is a childhood-onset neurodevelopmental condition, characterized by attentional fluctuations, increased motor activity and impulsive behavior, interfering with the subject’s daily activities in social and school/job contexts
Vortioxetine (VTX) is an antidepressant with a multimodal mechanism of action: it acts as serotonin reuptake inhibitor, 5-HT7, 5-HT3 and 5-HT1D receptor antagonist, 5-HT1B receptor partial agonist, and 5-HT1A receptor agonist
A very recent review of the evidence suggests that key sickness behavior symptoms represent a transdiagnostic feature, being reported across different diagnostic categories, and possibly share neurobiological underpinnings
Summary
According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), Attention-Deficit Hyperactivity Disorder (ADHD) is a childhood-onset neurodevelopmental condition, characterized by attentional fluctuations, increased motor activity and impulsive behavior, interfering with the subject’s daily activities in social and school/job contexts. Anxiety may be reported over an ADHD patient’s lifetime, from inhibiting impulsivity during childhood to aggravating working memory impairments during adolescence and exacerbating sleep difficulties during adulthood [1]. Even when multimodal treatments are offered, ADHD patients may still present with cognitive difficulties and fatigue, distractibility, reduced motivation and interest, poor social interaction, and anhedonia. In such cases, further titration of stimulants may not be indicated, in order not to expose the patient to potential adverse effects, such as inappetence, cardiovascular events, or sleep disturbances. Despite initial compensation in terms of attention span and school performance, residual mental fatigue, social problems, anxiety, and depression-like symptoms led to the choice of an add-on treatment with vortioxetine (VTX)
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