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• W2005173270 abstract "Back to table of contents Previous article Next article Letter to the EditorFull AccessDexamphetamine for Obsessive-Compulsive DisorderJAMES B. WOOLLEY, M.R.C.Psych., M.R.C.P., and ISOBEL HEYMAN, Ph.D., M.R.C.Psych., JAMES B. WOOLLEYSearch for more papers by this author, M.R.C.Psych., M.R.C.P., and ISOBEL HEYMANSearch for more papers by this author, Ph.D., M.R.C.Psych., London, U.K.Published Online:1 Jan 2003https://doi.org/10.1176/appi.ajp.160.1.183AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Obsessive-compulsive disorder (OCD) may emerge with stimulant treatment for attention deficit hyperactivity disorder (ADHD). We report a case of OCD worsening with methylphenidate treatment but not with dexamphetamine. This adds to the sparse evidence for methylphenidate exacerbating obsessions and compulsions (1–3), suggests parallels with the emergence of tics in susceptible individuals when they are treated with stimulants, and may help illuminate genetic and neurochemical relationships between OCD and tic disorders.Andy, an 11-year-old boy with ADHD diagnosed at age 5, was treated with methylphenidate. His overactivity, impulsivity, and attention improved, but anxiety symptoms emerged as the dose was increased to 40 mg/day. He started washing his hands excessively; this was accompanied by checking rituals, reassurance seeking, and emetophobia. OCD was diagnosed, and behavior therapy was initiated. For 1 year, Andy’s hyperactivity and impulsivity were well controlled with methylphenidate, but his obsessions and compulsions continued.At his assessment in our service, Andy met DSM-IV criteria for OCD, and a cognitive behavior program was continued with some success. After 3 months, Andy still had significant OCD symptoms. Because his ADHD was quiescent, methylphenidate was withdrawn, as it is a potential anxiogenic agent. His response after 1 week was dramatic; Andy had reduced ritualization and anxiety. His hyperactivity and concentration were unaffected, but his parents found him more affectionate. This improvement lasted 3 weeks before Andy experienced a resurgence of hyperactivity, poor concentration, and attacks of rage. Risperidone, 1 mg/day, was added to his treatment and had some effect on his rage but no impact on his anxiety. His OCD symptoms remained in remission, so methylphenidate was gradually reintroduced. His OCD symptoms then returned, especially the reassurance seeking, hand washing, and fear of illness.Dexamphetamine was substituted for methylphenidate and was gradually increased to 30 mg/day. The anxiety and ritualistic behavior lessened. After 6 weeks, there was still some generalized anxiety and a depressed mood, so citalopram, 10 mg/day, was added. This was associated with significant improvement in affective and anxiety symptoms, socialization, and school performance. These three medications—dexamphetamine, risperidone, and citalopram—have been maintained for Andy, who continues to improve.Methylphenidate and dexamphetamine are often used interchangeably in ADHD treatment but have differing effects on dopaminergic and serotonergic metabolism. In complex comorbidity, subtle differences in metabolism and receptor sensitivity may require careful pharmacological choice. Dexamphetamine may be more suitable for ADHD with associated OCD (4). Recent case reports (5, 6) have implied that dexamphetamine improves OCD symptoms, further suggesting the need for more research into dopaminergic and serotonergic interactions in OCD (7).References1. Kotsopoulos S, Spivak M: Obsessive-compulsive symptoms secondary to methylphenidate treatment (letter). Can J Psychiatry 2001; 46:89Google Scholar2. Kouris S: Methylphenidate-induced obsessive-compulsiveness (letter). J Am Acad Child Adolesc Psychiatry 1998; 37:135Google Scholar3. Koizumi HM: Obsessive-compulsive symptoms following stimulants (letter). Biol Psychiatry 1985; 20:1332-1333Crossref, Medline, Google Scholar4. Joffe RT, Swinson RP, Levitt AJ: Acute psychostimulant challenge in primary obsessive-compulsive disorder. J Clin Psychopharmacol 1991; 11:237-241Crossref, Medline, Google Scholar5. Albucher RC, Curtis GC: Adderall for obsessive-compulsive disorder (letter). Am J Psychiatry 2001; 158:818-819Link, Google Scholar6. Owley T, Owley S, Leventhal B, Cook EH Jr: Case series: Adderall(R) augmentation of serotonin reuptake inhibitors in childhood-onset obsessive-compulsive disorder. J Child Adolesc Psychopharmacol 2002; 12:165-171Crossref, Medline, Google Scholar7. Insel TR, Hamilton JA, Guttmacher LB, Murphy DL: D-Amphetamine in obsessive-compulsive disorder. Psychopharmacology (Berl) 1983; 80:231-235Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byPathophysiology of Obsessive-Compulsive Disorder: Insights from Normal Function and Neurotoxic Effects of Drugs, Infection, and Brain Injury3 January 2023Toward a neurocircuit-based taxonomy to guide treatment of obsessive–compulsive disorder7 January 2021 | Molecular Psychiatry, Vol. 26, No. 9Pharmacotherapeutic Strategies and New Targets in OCD10 March 2021Pathophysiology of Obsessive-Compulsive Disorder: Insights from Normal Function and Neurotoxic Effects of Drugs, Infection, and Brain Injury4 September 2021Frontiers in Psychiatry, Vol. 10Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents - assessment of adverse events in non-randomised studies10 May 2018 | Cochrane Database of Systematic Reviews, Vol. 48Current Treatment Options in Psychiatry, Vol. 3, No. 3Comorbidity Between Attention Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder Across the LifespanHarvard Review of Psychiatry, Vol. 23, No. 4Cigarette smoking in obsessive-compulsive disorder and unaffected parents of OCD patients15 April 2020 | European Psychiatry, Vol. 30, No. 1Pathophysiology of Obsessive-Compulsive Disorder: Insights from Normal Function and Neurotoxic Effects of Drugs, Infection, and Brain Injury29 April 2014Journal of Obsessive-Compulsive and Related Disorders, Vol. 2, No. 1CNS Neuroscience & Therapeutics, Vol. 17, No. 4Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, Vol. 21, No. 3Safety of stimulant treatment in attention deficit hyperactivity disorder: part II8 July 2010 | Expert Opinion on Drug Safety, Vol. 9, No. 6Medical Hypotheses, Vol. 71, No. 3Addicted to Hair Pulling? How an Alternate Model of Trichotillomania May Improve Treatment OutcomeHarvard Review of Psychiatry, Vol. 15, No. 2Adjunctive Lamotrigine as a Possible Mania Inducer in Bipolar PatientsSERGEY RASKIN, M.D., ALEXANDER TEITELBAUM, M.D., JOSEF ZISLIN, M.D., and RIMONA DURST, M.D., 1 January 2006 | American Journal of Psychiatry, Vol. 163, No. 1Pharmacoepidemiology and Drug Safety, Vol. 12, No. 5Current Opinion in Pediatrics, Vol. 15, No. 5Reactions Weekly, Vol. &NA;, No. 943 Volume 160Issue 1 January 2003Pages 183-183 Metrics PDF download History Published online 1 January 2003 Published in print 1 January 2003" @default.
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