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Ask the Mental Health Expert Archives 2001-2004

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Trileptal for ADHD/ODD

Q. My son was diagnosed with ADHD (attention deficit hyperactivity disorder) at the age of 6. He is now 11 and was recently diagnosed with ODD (oppositional defiant disorder) as well.

He was currently taking Straterra 50 mg, but now with the ODD, Trileptal has been prescribed to take at bed time. I haven't really been able to get any good answers online about this medication and it's effects on ADHD/ODD children. Can you offer any insight about this medication and it's effects?

A. Trileptal (oxcarbazepine) is currently FDA-approved only for use in treating certain types of seizure disorders. However, for many years, this drug has been used in Europe as a mood-stabilizer for patients with bipolar disorder. Trileptal's effectiveness has been shown in a few controlled studies of manic patients (Emrich HM. Studies with oxcarbazepine (Trileptal) in acute mania. Int Clin Psychopharmacol 1990;5:83-8).

There is much less evidence supporting the use of Trileptal in either the depressed phase of bipolar disorder, or in prophylaxis of bipolar disorder. Now, what does all this have to do with oppositional defiant disorder (ODD), attention deficit hyperactivity disorder (ADHD) and your son? That's a good question to discuss with your son's doctor.

On the one hand, to my knowledge, there are no controlled studies showing Trileptal to be effective in either ADHD or ODD. On the other hand, another anticonvulsant (anti-seizure medication) called valproate (Depakote and others) has been found useful in children with various types of aggressive behaviors. This includes a few studies in children with ODD. An excellent review of this is Dr. Hans Steiner's article in the April 2003 issue of CNS Spectrums. (You can contact Dr. Steiner at Steiner@stanford.edu).

There is considerable controversy with respect to the overlap in symptoms between, or co-occurrence of, ADHD and bipolar disorder. Some clinicians also believe that bipolar children with aggressive behavior mistakenly wind up with a diagnosis of either ADHD or ODD. Thus, it's very important to make sure that your son has been accurately diagnosed. The use of Trileptal for ADHD or ODD may be reasonable, based on the valproate studies mentioned above, if the patient shows significant and persistent aggressive behaviors. However, there is very little direct evidence bearing on Trileptal for such patients, and this medication may have side effects, such as drowsiness.

If a discussion with your son's doctor doesn't clear up some of these issues, you may want to ask him or her to assist in obtaining a second opinion on your son's diagnosis and treatment. This is not a criticism of your son's doctor--these conditions are often very hard to tease apart in children, and nobody has all the answers.

October 2003

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