Imipramine and Other Types of ADHD Medication

ADHD Basics

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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 it's also for bed wetting. Is this so? 

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

According to the ADHD Guidelines from the American Academy of Pediatrics and 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 medications.

Forms of Ritalin for ADHD

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 (methylphenidate ER) - long-acting
  • Daytrana (methylphenidate patch) - long-acting
  • Focalin (dexmethylphenidate) and Focalin XR
  • Metadate CD (methylphenidate) - long-acting
  • Metadate ER (methylphenidate) - long-acting
  • Methylin (methylphenidate liquid) - short-acting
  • Methylin ER (intermediate acting)
  • Ritalin (methylphenidate) - short-acting
  • Ritalin LA (methylphenidate) - long-acting
  • Ritalin-SR (methylphenidate) - intermediate-acting
  • Quillichew ER (methylphenidate chewable) - long-acting
  • Quillivant XR (methylphenidate liquid) - long-acting

Except for the newest medications, Daytrana, Quillichew ER, and Quillivant XR, most are available in generic forms.

Forms of Amphetamine for ADHD

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

  • Adderall (mixed amphetamine salts) - short-acting
  • Adderall XR (mixed amphetamine salts) - long-acting
  • Adzenys XR ODT (amphetamine) - long-acting
  • Dexedrine (dextroamphetamine) - short-acting
  • ProCentra (dextroamphetamine liquid) - short-acting
  • Vyvanse (lisdexamfetamine) - long-acting

Except for the newest medications, Adzenys XR ODT and Vyvanse, most are available in generic forms.

Non-Stimulants for ADHD

In addition to stimulant medications, there are more non-stimulant options to treat ADHD now, including:

  • Intuniv - extended-release Guanfacine
  • Kapvay - extended-release Clonidine
  • Strattera

Strattera is still not available as a generic.

Second Line ADHD Medications

Second-line medications or alternatives to the stimulants and Strattera have typically included antidepressants, like bupropion (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.

With the FDA approval of Kapvay and Intuniv for treating kids with ADHD, the latest American Academy of Pediatrics guidelines don't address second line ADHD medications, instead stating that:

  • "for elementary school-aged children (6–11 years of age), the primary care clinician should prescribe FDA-approved medications for ADHD and/or evidence-based parent- and/or teacher-administered behavior therapy as treatment for ADHD, preferably both"
  • and that "the evidence is particularly strong for stimulant medications and sufficient but less strong for atomoxetine, extended-release guanfacine, and extended-release clonidine (in that order)"

The latest recommendations from the American Academy of Child and Adolescent Psychiatry, from 2007, do still state that "if none of the above agents result in satisfactory treatment of the patient with ADHD, the clinician should undertake a careful review of the diagnosis and then consider behavior therapy and/or the use of medications not approved by the FDA for the treatment of ADHD." This recommendation leaves room open to trying medicines like Wellbutrin and Imipramine, etc.

So is your stepson on the right ADHD 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 depression and other conditions.

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.

View Article Sources
  • American Academy of Pediatrics Clinical Practice Guideline. ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 108(4):1033.
  • 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