Nortriptyline for treating enuresis in ADHD--a randomized double-blind controlled clinical trial.
BACKGROUND
Treating enuresis in children with attention deficit hyperactivity disorder (ADHD) has not been previously reported. This study aims to investigate the efficacy, tolerability, and adverse effects of nortriptyline for treating enuresis in children with ADHD.


METHODS
Forty-three children aged from 5 to 14 years old were randomized into two groups. The treatment group received methylphenidate plus nortriptyline, while the placebo group received methylphenidate plus placebo. Nortriptyline and placebo were administered for 30 days and methylphenidate was administered for 45 days. The major outcome measure was parent-reported frequency of enuresis for 2 weeks prior to the intervention, during the intervention, and for 2 weeks after stopping the adjuvant therapy. Adverse effects were also checked.


RESULTS
While nortriptyline statistically decreased the incidence of nocturnal enuresis during the intervention, the number of enuresis events did not significantly change in the placebo group. In addition, enuresis was not different from the baseline frequency of enuresis after stopping nortriptyline or placebo administration. Both nortriptyline and placebo were tolerated well.


CONCLUSIONS
Administration of nortriptyline for treating enuresis in ADHD has not been investigated before. Nortriptyline is statistically superior to placebo. However, enuresis will relapse after stopping nortriptyline in children with ADHD who continue taking methylphenidate.
Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran. ghanizadeha@hotmail.com.|Department of Psychiatry, Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran. ghanizadeha@hotmail.com.|Research Center for Psychiatry and Behavioral Sciences, Department of Psychiatry, Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran. ghanizadeha@hotmail.com.
Ahmad
A
Ghanizadeh
Department of Psychiatry, Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran.
Rezvan
R
Haghighat
D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D053206:Nocturnal Enuresis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D009661:Nortriptyline / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D009661:Nortriptyline