Comorbid depression does not appear to alter the effectiveness
of stimulant medication. The Children's Medication Algorithm
Project (CMAP)
concluded that as ADHD symptoms respond quickly to stimulant
medication and because their treatment may ameliorate depressive
symptoms in some cases, it is reasonable in most cases to perform a
trial of stimulant medication prior to treating the depression
(unless the child is acutely suicidal when prompt treatment of
depression is clearly required).
Following this if ADHD symptoms remit but depression continues
the group suggest that they be started on an SSRI in addition to
the stimulant. This strategy is supported by one open trial
(
Gammon & Brown, 1993). In
the event that neither ADHD nor depressive symptoms remit after a
trial of stimulants, they suggest starting the child on the major
depression algorithm (
Hughes
et al, 1999). Persisting ADHD symptoms after the
remission of depression may be treated with a further trial of
stimulants. An acceptable alternative may be an initial trial of
tricyclic antidepressants.