Can a patient with Attention Deficit Hyperactivity Disorder (ADHD) and anxiety take Adderall (amphetamine and dextroamphetamine) and Sertraline (selective serotonin reuptake inhibitor)?

From the Guidelines

Yes, a patient with ADHD and anxiety can take both Adderall (amphetamine/dextroamphetamine) and sertraline (Zoloft) together, as this combination is commonly prescribed for individuals with co-occurring ADHD and anxiety disorders. According to the most recent study 1, Adderall addresses the ADHD symptoms by increasing dopamine and norepinephrine in the brain, improving focus and reducing hyperactivity, while sertraline, an SSRI antidepressant, helps manage anxiety by increasing serotonin levels. However, this combination should only be taken under close medical supervision, as there is potential for drug interactions that may increase the risk of serotonin syndrome in rare cases.

Some key considerations when prescribing this combination include:

• Starting with a low dose of the second medication and gradually increasing it to minimize the risk of adverse effects
• Monitoring for symptoms of serotonin syndrome, especially in the first 24 to 48 hours after dosage changes
• Being aware of potential drug interactions, such as those involving CYP2D6 or CYP3A4
• Considering the use of standardized symptom rating scales to assess treatment response

Typically, a doctor might start with one medication first (often treating the condition causing the most impairment), stabilize the dose, then add the second medication gradually. Patients should be aware that Adderall might temporarily worsen anxiety symptoms in some individuals, and both medications may require dosage adjustments to find the optimal balance. Common starting doses might be 5-10mg of Adderall once or twice daily and 25-50mg of sertraline once daily, but proper dosing is highly individualized and should be determined by a healthcare provider 1.

It's also important to note that medical education, training, and experience are necessary to safely and effectively prescribe antidepressant medications, and parental oversight of medication regimens is of paramount importance in children and adolescents 1. Additionally, the clinician should consult the AACAP parameters on the treatment of anxiety disorders for further information on this topic 1.

In terms of specific guidance, the study by 1 suggests that a conservative medication trial for mild to moderate anxiety presentations may entail increasing the dose as tolerated within the therapeutic dosage range in the smallest available increments at approximately 1- to 2-week intervals when prescribing shorter half-life SSRIs, such as sertraline. Faster up-titration may be indicated as tolerated for more severe anxiety presentations.

Overall, while there are potential risks and considerations associated with this combination, the benefits of treating both ADHD and anxiety with Adderall and sertraline can be significant, and this combination is commonly used in clinical practice 1.

From the Research

Combination Therapy for ADHD and Anxiety

• The use of combination pharmacotherapy for adult ADHD is a common practice among clinicians, particularly in cases where patients have associated disorders or comorbid diagnoses 2.
• Studies have shown that adjunctive treatment with certain medications can be effective in reducing symptoms of ADHD and anxiety 3.
• For example, a study found that atomoxetine can be used as an adjunctive treatment in adult patients with ADHD and comorbid partially responsive anxiety symptoms 3.

Amphetamines for ADHD

• Amphetamines are commonly used to treat ADHD in adults and children, and have been shown to be effective in reducing the severity of ADHD symptoms 4, 5.
• However, amphetamines can be associated with adverse events, such as decreased appetite, insomnia, and abdominal pain 4, 5.
• The use of amphetamines in combination with other medications, such as selective serotonin reuptake inhibitors (SSRIs), may be effective in treating ADHD and anxiety 3.

Sertraline for Anxiety

• Sertraline is an SSRI that is commonly used to treat anxiety disorders, but its use in combination with amphetamines for ADHD has not been extensively studied 6.
• One study found that adjunctive treatment with atomoxetine, a non-stimulant medication, was effective in reducing symptoms of anxiety in adult patients with ADHD and comorbid partially responsive anxiety symptoms 3.
• However, the use of sertraline in combination with amphetamines, such as Adderall, may be considered in clinical practice, particularly in cases where patients have comorbid anxiety disorders 2.

Clinical Considerations

• The use of combination pharmacotherapy for ADHD and anxiety requires careful consideration of the potential benefits and risks, as well as the individual patient's medical history and response to treatment 2, 4, 3.
• Clinicians should monitor patients closely for adverse events and adjust treatment as needed to minimize risks and optimize benefits 4, 5.