Desipramine for ADHD

Desipramine is a metabolite of imipramine
Trade names: Pertofran, Petylyl

Desipramine is no longer available in Switzerland.¹

• 1. Mechanism of action of desipramine:
• 2. Desipramine for ADHD
• 3. Side effects of desipramine

1. Mechanism of action of desipramine:¶

• Noradrenaline reuptake inhibitors
• Serotonin reuptake inhibitors
• Dopamine reuptake inhibitors
• Alpha-Adrenerg
• Acts as FIASMA (functional inhibitor of acid sphingomyelinase)
• Antinociceptive: suppresses the perception of pain by acting on the nociceptors

Acts as an alpha-2-adrenoreceptor agonist and thus facilitates dopamine metabolism in the mesolimbic system (reward center).²
The binding of the serotonin and dopamine transporters is stronger than with imipramine, nortriptyline, protriptyline, amitriptyline or doxepin.³
According to another opinion, the noradrenergic effect predominates.⁴

2. Desipramine for ADHD¶

A Cochrane meta-study on the effect of tricyclic antidepressants in ADHD found a good evaluation of desipramine in the teacher rating and in the physician rating compared to placebo.⁵ The same was found in comparison with clonidine for comorbid Tourette’s in the parent rating.

Desipramine is recommended for comorbid tics.⁶

Cortisol reduces ACTH production and thus inhibits the HPA axis, which triggers the release of cortisol (negative feedback loop). Desipramine reverses this negative feedback into a positive one, while Resipin reverses this in Cushing’s disease.⁷
We do not consider inhibition of HPA axis deactivation to be beneficial in ADHD.

3. Side effects of desipramine¶

The treatment discontinuations with desipramine corresponded to those with placebo.⁵

• Weight loss
• Can prolong QT time
• Micturition disorders (urination disorders)
• Inner restlessness
• Feeling thirsty
• Sedative (weak)
• States of confusion (occasionally)
• Intestinal paralysis / intestinal obstruction (occasionally)
• Urinary retention (occasionally)