This review evaluates the treatment of attention deficit hyperactivity disorder. Current evidence supports the belief that stimulants are the most effective and least toxic of the drugs used in the treatment of hyperactivity. Tricyclic antidepressants (TCAs), however, are preferable in subpopulations with concomitant anxiety or depressive disorders. Studies comparing stimulants with TCAs are evaluated and studies that have examined other antidepressants are summarized. In addition, TCAs and stimulants are compared according to adverse-effect profiles, pharmacokinetic properties, and subgroup responses. Based on these data and the recently reported sudden deaths in children receiving desipramine, treatment recommendations are made.
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