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KMID : 0605720060120020268
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Journal of the Korean Society of Biological Therapies in Psychiatry
2006 Volume.12 No. 2 p.268 ~ p.273
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Mirtazapine Effect in Methylphenidate Associated Secondary Insomnia Patient with Attention Deficit Hyperactivity Disorder
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Lim Myung-Ho
Lee Woo-Chul
Lee Sang-Koo
Lee Chang-Min
Kim Hyun-Woo
Wang Seong-Keun
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Abstract
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Objectives：This case presents a 6 year-old-boy diagnosed with ADHD. The patient was hospitalized under the chief complaint of hyperactivity behavior and distracted inattention. A secondary sleep disorder was found after 10㎎ qd of methylphenidate was started, administering mirtazapine revealed improvement of sleep disorder.
Case：On July 9 2005, the child was hit by a small vehicle on the road between his apartment and a shopping mall. After this accident a child was referred for treatment of hyperactivity and distractibility. After adding 10mg qd of methylphenidate IR, his PSQI global score was 9 and his ISI total score was 15 which are consistent with moderate stage of insomnia. Polysomnography was performed to detect the objective sleep disorder. As a result of the increase of REM sleep and the decrease of REM latent period further investigation was carried out. From the 16th day of hospitalization 15㎎ of mirtazapine was given hs for a week. Soon after starting mirtazapine the child fell a sleep without whining time and his shouting were much improved. On a 7th day of mirtazapine administration, PSQI global score of 2 and ISI total score of 3 was noted which represented a significant improvement. Polysomnography was reperformed on the 10th day as a result the delay of REM latent period and the decrease of REM sleep as a normal range, The normalization of REM sleep rhythm and the increase of slow wave were objectively improved.
Discussion：When methylphenidate is used in the treatment for ADHD, Clinical course shows a sleep disorder in 29~64% of ADHD subjects. mirtazapine(Remeron), the antidepressant, has an antagonistic effect for 5HT2a receptor and is recently used for its effect in the improvement of sleep disorder. The Author hereby report that mirtazapine objectively improves sleeping disorders which often results from giving methylphenidate in ADHD.
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KEYWORD
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Mirtazapine, Methylphenidate, ADHD(Attention deficit hyperactivity disorder), Insomnia(Sleep disorder)
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