Desipramine for ADHD

Desipramine is a metabolite of imipramine
Trade names: Pertofran, Petylyl

Desipramine is no longer available in Switzerland.¹

• 1. Mechanism of action of desipramine:
• 2. Desipramine for ADHD
• 3. Desipramine side effects

1. Mechanism of action of desipramine:¶

• Norepinephrine reuptake inhibitor
• Serotonin reuptake inhibitor
• Dopamine reuptake inhibitor
• Alpha-Adrenerg
• Acts as a FIASMA (functional inhibitor of acid sphingomyelinase)
• Antinociceptive: suppresses the perception of pain by acting on the nociceptors

Acts as an alpha-2 adrenoreceptor agonist, thereby facilitating dopamine metabolism in the mesolimbic system (reward center).²
Serotonin and dopamine transporter binding is stronger than with imipramine, nortriptyline, protriptyline, amitriptyline, or doxepin.³
According to other opinions, the noradrenergic effect predominates.⁴

2. Desipramine for ADHD¶

A Cochrane metastudy on the effects of tricyclic antidepressants in ADHD found good ratings for desipramine in teacher ratings and physician ratings compared with placebo.⁵ The same was found in comparison to clonidine in comorbid Tourette’s in parent ratings.

Desipramine is recommended for comorbid tics.⁶

Cortisol decreases ACTH formation and thus inhibits the HPA axis through which cortisol secretion was initiated (negative feedback loop). Desipramine reverses this negative feedback into a positive one, Resipin reverses the reversal in Cushing’s disease.⁷
We do not consider inhibition of HPA axis shutdown to be beneficial in ADHD.

3. Desipramine side effects¶

Treatment discontinuations for desipramine were similar to those for placebo.⁵

• Weight loss
• May prolong QT time
• Micturition disorders (disorders during urination)
• Inner restlessness
• Feeling thirsty
• Sedative (weak)
• States of confusion (occasionally)
• Intestinal paralysis / intestinal obstruction (occasional)
• Urinary retention (occasional)