The efficacy of the stimulant drugs in treating attention-deficit/hyperactivity disorder (ADHD) is well established. The tricyclics, especially desipramine, also appear to be of value. In one study, desipramine, given at doses greater than 4 mg/kg for 3-4 weeks, was effective in two-thirds of the children, whereas placebo was effective in only 10% (Biederman et al. 1989). Desipramine was also found to be more effective than placebo in adults with ADHD (Wilens et al. 1996). One of the advantages of desipramine is its low potential for abuse. Unfortunately, five cases of sudden death were reported in the early 1990s in children being treated with desipramine (Riddle et al. 1991, 1993). All were under the age of 12 years. As a result, desipramine is now contraindicated in children younger than 12 years (discussed in greater detail below; see section "Side Effects and Toxicology"). Given that tricyclics as a group share the same adverse cardiac effects, there is reason to be concerned that other tricyclics might also have safety issues in young children.
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