Gabapentin for ADHD

Attention deficit disorder (ADD) is characterized by inattentiveness, easy distractibility, impul-siveness, and difficulty completing tasks; excessive activity may or may not be seen. The person can appear to others as forgetful or careless. It begins in childhood and persists into adulthood for fifteen to fifty percent of children. The symptoms may be more subtle in an adult, and may not be easily diagnosed, particularly if hyperactivity is not seen. Those with attention deficit disorder develop more self-restraint and attention span in adulthood. By adulthood it is usually seen in its incomplete form (the modifier, “in partial remission,” is added).

ADHD SIGNS AND SYMPTOMS

  • Squirms in seat; fidgets with hands or feet.
  • Unable to stay seated when required to do so.
  • Easily distracted.
  • Blurts out answers before a question is finished.
  • Difficulty waiting turn in games and lines.
  • Difficulty following instructions.
  • Unable to sustain attention in work or play activities.
  • Shifts from one uncompleted project to another.
  • Difficulty playing quietly.
  • Talks excessively.
  • Interrupts or intrudes on others.
  • Doesn’t appear to listen.
  • Loses items necessary for tasks.
  • Often engages in dangerous activities without considering consequences.

Gabapentin is an anticonvulsant drug released in the United States in 1993 for use as adjunctive therapy in refractory partial epilepsy. The mechanism of action of gabapentin is unknown, but the drug has very favorable pharmacokinetics and a good safety profile, which allows its use in high-risk patients. Several reports have described the successful use of gabapentin for bipolar disorders in adults, but there are no controlled studies in the use of gabapentin in children and adolescents.

We describe a 12-year-old boy with a history of attention deficient hyperactivity disorder (ADHD), reading disorder, mixed receptive and expressive language disorder, encopresis, and bipolar disorder II who was treated with gabapentin 200 mg/day added to methylphenidate 30 mg/day. Within 3 weeks the improvement and stabilization of mood symptoms was remarkable, as noted by mother, teacher, and clinician, and remained so for 6 months of follow-up.

Comorbid bipolar disorder and ADHD is a hotly debated topic in the child and adolescent psychiatric literature, with rates of comorbid ADHD and bipolar disorder ranging from 22% to 90%. Controlled studies are needed to evaluate the possible antimanic mood stabilizing and/or antidepressant properties or gabapentin in youths.