Selegiline for ADHD

Selegiline: L-deprenyl; C13H17N

Brand names: Movergan, Antiparkin, Xilopar as well as generic

• 1. Mechanisms of action of selegiline
• 2. Selegiline for ADHD
• 3. Selegiline side effects
• 4. Contraindications of selegiline

1. Mechanisms of action of selegiline¶

Selegiline is an MAO inhibitor used primarily in Parkinson’s disease. At low doses, it is a selective MAO-B inhibitor.
Selegiline irreversibly inhibits MAO-B, reducing dopamine degradation. In the process, selegiline itself is metabolized to amphetamines or methamphetamines.
In higher doses (above 20 mg/day), selegiline additionally inhibits MAO-A, which increases serotonin and norepinephrine levels in the brain.

Furthermore, selegiline acts as a dopamine reuptake inhibitor.

2. Selegiline for ADHD¶

One study comparing 20 mg and 60 mg selegiline versus placebo found no improvement in self-report ADHD symptomatology in the subjects.¹ Another study of 24 children with ADHD and comorbid Tourette’s found only modest improvements in ADHD symptomatology while maintaining a high dropout rate among participants²

An older study found good improvement in ADHD symptoms with selegiline in children with ADHD and comorbid tic disorder over a test period of more than 6 months. Only 2 of the 29 subjects reported worsening of tics. Side effects were mild.³
Three smaller studies found no difference in effect between selegiline and methylphenidate in parent report in 15 families,⁴ in parent and teacher report in 28 children,⁵ and in parent and teacher report in 40 children.⁶
In another small placebo-controlled study, selegiline improved only inattention but not hyperactivity/impulsivity.⁷ In animal studies, a significant reduction in impulsivity was found in SHR (animal model of ADHD-C) at as little as 0.25 mg/kg⁸

Selegiline appears to be used at times off-label for ADHD.⁹

3. Selegiline side effects¶

• Dizziness
• Nausea
• Vomiting
• Dry mouth
• Movement disorders
• Psychoses
• Blood pressure drop
• moderate elevation of liver enzymes

The side effects of

• Loss of appetite
• Sleep problems
• Headache

were slightly less frequent with selegiline than with methylphenidate, with otherwise comparable amounts of side effects.⁵

4. Contraindications of selegiline¶

• Extrapyramidal syndromes not due to dopamine deficiency
• Impaired kidney or liver function
• Stomach or intestinal ulcers
• Pregnancy and lactation

Selegiline must not be combined with:

• SSRI
• SNRI
• tricyclic antidepressants
• Sympathomimetics
• Pethidine
• Opioids
• Serotonin agonists
• Bupropion

A study of comedication of stimulants and MAO inhibitors in depression found no problems arising.¹⁰ Another study reported successful comedication of selegiline and lisdexamfetamine (Vyvanse) in ADHD and comorbid depression¹¹
Thus, combination medication of selegiline with stimulants may also be considered for ADHD.