Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder with three main symptoms: poor attention, impulsivity and hyperactivity. This condition can be present with other disorders and is sometimes found in patients with aggression problems. Between 40 and 70 percent of ADHD patients have oppositional defiance disorder (ODD) or conduct disorder (CD), according to Thomas E. Brown in "ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults." Several treatments are available.
According to Brown, stimulants such as methylphenidate (Ritalin) and dextroamphetamine and amphetamine (Adderall) are not normally recommended for ADHD with aggression. Stimulants may increase anxiety and aggression, and they have the potential for addiction.
Antidepressants can help to stabilize mood and reduce aggressive behavior. Classes of antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine reuptake inhibitors (NRIs), tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). An atypical antidepressant, bupropion hydrochloride (also known as Wellbutrin), may not be the best choice for those with ADHD and aggression, as Wellbutrin inhibits the reuptake of the neurotransmitter dopamine back into the brain cells, therefore acting as a stimulant.
Antihypertensives, including clonidine (Catapres), guanfacine (Tenex and Intuniv) and propranolol (Inderal) are most commonly used to treat high blood pressure but also are used to treat ADHD. Antihypertensives are the ideal treatment for patients with ADHD and aggression, according to Sam Goldstein and Anne Teeter Ellison in a "Clinicians' Guide to Adult ADHD: Assessment and Intervention." A 1986 study by J. A. Mattes, published in the Journal of Clinical Psychopharmacology, found high doses of propranolol were 85 percent effective in reducing ADHD symptoms and temper outbursts in ADHD patients with aggression. The antihypertensives may work by inhibiting norepinephrine release from the locus ceruleus, a brain region associated with aggressive behaviors, explains Phyllis Teeter, author of "Interventions for ADHD: Treatment in Developmental Context."
Benzodiazepines are normally prescribed to treat anxiety and can be useful in conjunction with stimulants to treat patients with ADHD and aggression. Benzodiazepines include clonazepam, diazepam (Valium) and triazolam (Halcion).
- "ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults;" Thomas E. Brown; 2009
- Novartis: Ritalin Prescribing Information
- "Clinicians' Guide to Adult ADHD: Assessment and Intervention;" Sam Goldstein and Anne Teeter Ellison; 2002
- "Interventions for ADHD: Treatment in Developmental Context;" Phyllis Anne Teeter; 1998
- "Journal of Clinical Psychopharmacology;" Propranolol for Adults With Temper Outbursts and Residual Attention Deficit Disorder; J.A. Mattes; 1986