YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==RITALIN ALTERNATIVES== 5 AUTHOR Wroblewski B AUTHOR Glenn MB AUTHOR Cornblatt R AUTHOR Joseph AB AUTHOR Suduikis S TITLE Protriptyline as an alternative stimulant medication in patients with brain injury: a series of case reports. SOURCE Brain Inj; VOL 7, ISS 4, 1993, P353-62 ABSTRACT The results of a series of eight individual case reports in which protriptyline, an activating tricyclic antidepressant, was used as a 'stimulant' medication are presented. For some patients with head injury, traditional stimulants, such as methylphenidate, or dopaminergic stimulants, such as levodopa-carbidopa, amantadine, or bromocriptine, may be partially or totally ineffective or not tolerated. Protriptyline can be a very effective alternative and, for some patients, may be the most effective stimulant tried. In low to moderate doses, protriptyline should be considered for trials as an activating/stimulant medication in patients with head injury. 3 AUTHOR Fernandez F AUTHOR Levy JK AUTHOR Samley HR AUTHOR Pirozzolo FJ AUTHOR Lachar D AUTHOR Crowley J AUTHOR Adams S AUTHOR Ross B AUTHOR Ruiz P TITLE Effects of methylphenidate in HIV-related depression: a comparative trial with desipramine. SOURCE Int J Psychiatry Med; VOL 25, ISS 1, 1995, P53-67 ABSTRACT This report is a randomized, double-blind, comparative trial of desipramine with the psychomotor stimulant methylphenidate. Twenty HIV antibody-positive patients with depressive symptoms were randomly assigned to either drug. After individual dose titration, the mean daily dose of desipramine was 150 mg. and methylphenidate 30 mg. daily. The differences in responses between desipramine and methylphenidate were not statistically significant on various measures of depression. The antidepressant effect of methylphenidate did not occur any faster than that of desipramine. Both significantly reduced depressive and anxious symptomatology over the blinded portion of the treatments. Thus, methylphenidate relieves depressive symptomatology with efficacy similar to that of desipramine, offering an alternative to patients who are unable to tolerate standard tricyclic antidepressant therapy. The dopaminergic effects of methylphenidate are likely to mediate its antidepressant effects. 4 AUTHOR Dollfus S TITLE [Indications for clonidine in child psychiatry] SOURCE Encephale; VOL 19, ISS 2, 1993, P83-7 (REF: 16) ABSTRACT The two principal indications of clonidine in child psychiatry are the "attention-deficit hyperactivity disorder" (ADHD) and Tourette's disorder. In the first case (ADHD), clonidine (4 to 5 micrograms/kg/day) is efficient (25 to 50% of improvement) with minimal untoward effects. The comparison between clonidine and methylphenidate (MPH) in this disease showed different actions of these two drugs on target symptoms: MPH preferentially acts in children with major attention-deficit and moderate hyperactivity whereas clonidine is more advocated in ADHD children with hyperarousal, hyperactivity and aggressivity symptoms. In Tourette's disorder, clonidine improves 30-50% of cases. Many studies have compared the efficiency of clonidine, neuroleptics and clonazepam. Clonidine is less efficient than neuroleptics such as haloperidol or fluphenazine but it is more efficient than clonazepam. Clonidine seems to be a good alternative to neuroleptics when these are not tolerated. Some authors recommend the association clonidine-clonazepam. Clonidine is very useful in Tourette's disorder associated with other syndromes such as obsessive-compulsive disorder, ADHD or withdrawal symptoms of neuroleptics. In contrast, clonidine has to be avoided in a depressive child. Clonidine in other psychiatric disorders such as infantile psychosis with hyperactivity, bipolar disorder, panic disorder, aggressivity and post-traumatic stress disorder has not been studied in children, but could be worth investigating.