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Desipramine for ADHD

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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:

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

Acts as an alpha-2-adrenoreceptor agonist and thus facilitates dopamine metabolism in the mesolimbic system (reward center).2
The binding of the serotonin and dopamine transporters is stronger than with imipramine, nortriptyline, protriptyline, amitriptyline or doxepin.3
According to another opinion, the noradrenergic effect predominates.4

2. Desipramine for ADHD

A Cochrane meta-study on the effect of tricyclic antidepressants in ADHD found a good evaluation of desipramine in the teacher rating and in the physician rating compared to placebo.5 The same was found in comparison with clonidine for comorbid Tourette’s in the parent rating.

Desipramine is recommended for comorbid tics.6

Cortisol reduces ACTH production and thus inhibits the HPA axis, which triggers the release of cortisol (negative feedback loop). Desipramine reverses this negative feedback into a positive one, while Resipin reverses this in Cushing’s disease.7
We do not consider inhibition of HPA axis deactivation to be beneficial in ADHD.

3. Side effects of desipramine

The treatment discontinuations with desipramine corresponded to those with placebo.5

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

  1. http://www.pharmawiki.ch/wiki/index.php?wiki=Desipramin, Stand 2016

  2. Nurse, Russell, Taljaard (1985): Effect of chronic desipramine treatment on adrenoceptor modulation of [3H]dopamine release from rat nucleus accumbens slices.Brain Res. 1985 May 20;334(2):235-42

  3. Zhou, Zhen, Karpowich, Goetz, Law, Reith, Wang (2007): LeuT-desipramine structure suggests how antidepressants inhibit human neurotransmitter transporters; Science. 2007 Sep 7; 317(5843): 1390–1393. doi: 10.1126/science.1147614; PMCID: PMC3711652; NIHMSID: NIHMS452952

  4. Häßler (2009): substanzgebundene Alternativen in der Therapie von ADHS, Seite 174, in: Häßler (Hrsg) das ADHS Kaleidoskop – State of the Art und bisher nicht beachtete Aspekte von hoher Relevanz; medizinisch wissenschaftliche Verlagsgesellschaft

  5. Otasowie, Castells, Ehimare, Smith (2014): Tricyclic antidepressants for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev. 2014 Sep 19;(9):CD006997. doi: 10.1002/14651858.CD006997.pub2. PMID: 25238582., METASTUDIE

  6. Häßler (2009): substanzgebundene Alternativen in der Therapie von ADHS, Seite 175, in: Häßler (Hrsg) das ADHS Kaleidoskop – State of the Art und bisher nicht beachtete Aspekte von hoher Relevanz; medizinisch wissenschaftliche Verlagsgesellschaft

  7. Fehm, Voigt, Pfeiffer: Die Bedeutung des Zentralnervensystems in der Ätiologie des Morbus Cushing, in: Deutsche Gesellschaft der inneren Medizin, 86. Kongress: Gehalten zu Wiesbaden vom 13. bis 17. April 1980; Seite 62