Non-stimulant ADHD medication: amantadine (Symmetrel) use in children

I'd like to share anectdotal reports of my use of amantadine in children. Amantadine is a medication that is not used much in child psychiatry. It was originally developed for the treatment of flu symptoms. It was later found to be helpful in Parkinson's. I ran across an article about using it for the treatment of ADHD in the late 80"s. I have always kept it "in my back pocket" in case I needed an alternative to traditional ADHD medication when there was a history of tics, bipolar or an intolerance to stimulants. I have had some very good results in the treatment of ADHD with amantadine with very few side effects. The most common side effects are a decrease in appetite, weight loss and upset stomach. Dizziness can also occur.

It can be a a good option that shouldn't be overlooked.

Amantadine comes in liquid and 100mg capsules. The maximal dose is 100mg three times a day.

ADHD medications with Bipolar children

There is much co-morbidity (co-existance) of ADHD in bipolar children. The concern, however, is that stimulants sometimes cause an upset to the delicate balance of mood. It is not uncommon to see more anger issues, depression and even psychosis when stimulants are added. It is important therefore to be careful when using stimulant medication with bipolar children. Strattera (atomoxetine) is in the same camp since it exerts antidepressant effects and can cause manic activation in bipolar children.

Safer medications to consider in children with bipolar to address attention issues include tenex, provigil (though I have seen it increase anger on occasion), amantadine, buspar and to some extent wellbutrin (though it can cause manic activation it seems less likely compared to other antidepressants).

Bipolar Children

When I was in training in the late 1980's, the concept of Bipolar illness in Children was unheard of. It was supposed to occur in late adolescence and early adulthood and so we "didn't see it' in younger children. It came as a surprise when I saw an 8 year old with classic, undeniable symptoms that "walked like a duck, looked like a duck and quacked like a duck". The fact that bipolar occurs in children makes sense because when adults with legitimate diagnosis of Bipolar are interviewed they typically tell you that they date back their symptoms to childhood. Often times they describe years of misdiagnosis until it finally makes sense.

We used to think that 10% of ADHD kids would "convert" to Bipolar but in reality the "ADHD symptoms" were probably an early manifestation of Bipolar.

We psychiatrists are at a disadvantage in that we do not have solid neurologic or blood testing that can give us a definitive diagnosis, instead, we have to base our hunches on history provided by parents and patients and trying to put the "pieces of the puzzle" together, eg, family history of Bipolar, response to previous medication, etc.

Websites such as www.bpkids.org are excellent as parent resources.