Selegiline for ADHD

Selegiline: L-deprenyl; C13H17N

Brand names: Movergan, Antiparkin, Xilopar and as a generic drug

• 1. Mechanisms of action of Selegiline
• 2. Selegiline for ADHD
• 3. Side effects of Selegiline
• 4. Contraindications of Selegiline

1. Mechanisms of action of Selegiline¶

Selegiline is an MAO inhibitor that is primarily used for Parkinson’s disease. In low doses, it is a selective MAO-B inhibitor.
Selegiline irreversibly inhibits MAO-B, which reduces the breakdown of dopamine. Selegiline itself is metabolized to amphetamines or methamphetamines.
At higher doses (over 20 mg/day), selegiline also inhibits MAO-A, which increases serotonin and noradrenaline levels in the brain.

Selegiline also acts as a dopamine reuptake inhibitor.

2. Selegiline for ADHD¶

A study comparing 20 mg and 60 mg selegiline against placebo found no improvement in ADHD symptoms in the subjects’ self-report.¹ Another study of 24 children with ADHD and comorbid Tourette’s found only slight improvements in ADHD symptoms with a high dropout rate among participants²

An older study found a good improvement in ADHD symptoms with selegiline in children with ADHD and comorbid tic disorder over a test period of more than 6 months. Only 2 of the 29 subjects reported an exacerbation of tics. The side effects were minor.³
Three smaller studies found no differences in effect between selegiline and methylphenidate in the parent report of 15 families,⁴ in the parent and teacher report of 28 children,⁵ and in the parent and teacher report of 40 children.⁶
In another small placebo-controlled study, selegiline only improved inattention, but not hyperactivity/impulsivity.⁷ In animal studies, a significant reduction in impulsivity was found in SHR (animal model for ADHD-C) at 0.25 mg/kg⁸

Selegiline sometimes appears to be used off-label for ADHD.⁹¹⁰

3. Side effects of Selegiline¶

• Dizziness
• Nausea
• Vomiting
• Dry mouth
• Movement disorders
• Psychoses
• Drop in blood pressure
• moderate increase in liver enzymes

The side effects of

• Loss of appetite
• Sleep problems
• Headache

were somewhat rarer with selegiline than with methylphenidate, with an otherwise comparable number of side effects.⁵

4. Contraindications of Selegiline¶

• Extrapyramidal syndromes that are not due to dopamine deficiency
• Impaired kidney or liver function
• Stomach or intestinal ulcers
• Pregnancy and breastfeeding

Selegiline must not be combined with:

• SSRI
• SNRI
• tricyclic antidepressants
• Sympathomimetics
• Pethidine
• Opioids
• Serotonin agonists
• Bupropion

A study on the comedication of stimulants and MAO inhibitors in depression found no problems.¹¹ Another study reported successful comedication of selegiline and lisdexamfetamine (Elvanse) in ADHD and comorbid depression¹²
Thus, a combination medication of selegiline with stimulants can also be considered for ADHD.