title: Use of serotonin norepinephrine reuptake inhibitors in the treatment of attention-deficit hyperactivity disorder in pediatrics.
abstract: OBJECTIVE
  To review the current literature on the efficacy and safety of serotonin norepinephrine reuptake inhibitors in the treatment of attention-deficit hyperactivity disorder (ADHD) in the pediatric population.
  
  
  METHODS
  A literature search from 1996 to August 2013 was conducted using MEDLINE, CINAHL, and EMBASE databases. Search terms included attention-deficit hyperactivity disorder, serotonin norepinephrine reuptake inhibitor, pediatric attention-deficit hyperactivity disorder, venlafaxine, duloxetine, desvenlafaxine, milnacipran, and nefazodone.
  
  
  METHODS
  Relevant articles on duloxetine and venlafaxine for the treatment of pediatric ADHD were reviewed; 5 studies on venlafaxine and 1 study on duloxetine were evaluated. Studies included open-label and randomized, double-blind trials. Case studies in pediatric populations and all studies in adult populations were excluded.
  
  
  RESULTS
  Patients 6 to 17 years old were evaluated in the venlafaxine and duloxetine studies. Trials on venlafaxine, ranging from 2 to 6 weeks, showed patient improvement as measured by the Conners Rating Scale and ADHD Rating Scale. Venlafaxine was initiated at 12.5 to 25 mg/d and titrated up to 1.4 to 3.8 mg/kg/d to a maximum of 150 mg/d. Duloxetine showed minimal efficacy in treating ADHD symptoms at doses of 60 mg/d at 6 weeks. The most common side effects for venlafaxine and duloxetine included drowsiness and decreased appetite, respectively.
  
  
  CONCLUSIONS
  Data for venlafaxine and duloxetine are limited. However, venlafaxine may be considered as an alternative agent when patients cannot tolerate or fail stimulants, tricyclic antidepressants, or bupropion. Duloxetine has been studied in children; however, with only 1 study available, it is difficult to recommend.
authors.affiliation: VA Connecticut Healthcare, West Haven, CT, USA.
authors.forename: Pauline
authors.initials: P
authors.lastname: Park
authors.forename: Joshua
authors.initials: J
authors.lastname: Caballero
authors.forename: Hossein
authors.initials: H
authors.lastname: Omidian
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D003511:Cyclohexanols / Q000627:therapeutic use; D000068736:Duloxetine Hydrochloride; D006801:Humans; D009638:Norepinephrine / Q000378:metabolism; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D013876:Thiophenes / Q000627:therapeutic use; D000069470:Venlafaxine Hydrochloride
chemical_list: D018759:Adrenergic Uptake Inhibitors; D003511:Cyclohexanols; D000068736:Duloxetine Hydrochloride; D009638:Norepinephrine; D017367:Selective Serotonin Reuptake Inhibitors; D013876:Thiophenes; D000069470:Venlafaxine Hydrochloride
keywords: attention-deficit hyperactivity disorder; duloxetine; pediatric; serotonin norepinephrine reuptake inhibitor; venlafaxine