Does desipramine cause sudden, unexplained death in children? No!
This question was raised as a hypothesis in about 1990. Sadly, even though the notion that desipramine does cause sudden death in children has never been substantiated statistically, it is commonly believed to be an established fact by many practicing physicians, and the concern is still often used to justify the argument in current ADD/ADHD medical literature that stimulant treatment should be the treatment of choice.
The incorrectness of the assertion aside, the notion that desipramine can cause sudden death in children provokes horrible anxiety in prescribing physicians and emotional terror in the parents of ADD/ADHD children. This emotional rejection of desipramine continues even though there is still no convincing, definitive scientific documentation supporting the hypothesis that desipramine in the doses used for treating ADD/ADHD causes sudden death in children aged 5 to 14.
Sadly, this desipramine concern can still be found in the medical literature even though Wayne H. Green, M.D., in 1995, published that "The American Academy of Child and Adolescent Psychiatry's Ad Hoc Committee on Desipramine and Sudden Death, established to investigate these concerns, reported at a members' forum at the 1992 Annual Convention that the risk of sudden death for children 5 to 14 years old who are treated with desipramine in therapeutic doses is approximately the same as the risk of sudden death for similarly aged children in the general population, between 1.5 and 4.2 [deaths per] million/year (P>0.23).
The American Academy of Pediatrics found it necessary to publish in 2004 in their "ADHD A Complete and Authoritative Guide" that "A few reports of sudden and unexplained deaths in children treated with desipramine have raised some questions about its safety --- though the findings were imprecise and uncertain, and thus there is no proof that this medication actually caused the deaths."
What, then, is the cause of sudden death in children if not desipramine? While not necessarily true in all cases, there is good scientific reason to believe that the cause of sudden death in otherwise healthy children is ion-channel abnormality of the heart, a genetically programmed aberration evident by ECG study that is manifest as a prolonged QTc electrical interval. This heart abnormality can cause sudden death without obvious cause. There is no good reason to believe that a normal heart exposed to therapeutic doses of desipramine will cause fatal arrhythmia. To be as safe as possible, however, I believe that desipramine should not be started in any individual before a pretreatment electrocardiographic study is completed and shows a normal QTc electrical interval.
In addition, in 1993, Dr. Biederman et al. studied the effects of desipramine on the heart of children and concluded that the changes were "quite benign." And, in 1995, Dr. Biederman's group estimated that "the evidence for an association between desipramine and sudden death in children aged 5 to 14 appears weak."
Why all this fuss about treatment with desipramine, you may ask. Why prescribe desipramine when so many other ADD/ADHD medications are available? Well, there are lots of reasons to do so. Please look at the Drug Treatment Chart in another section of this website. Desipramine can be given as a single, once-a-day dose, helps ADD/ADHD children fall asleep normally at night and wake up bright and cheery in the morning, is effective in about 80% of children, is not addicting, does not cause and may stop established tic behavior, does not stunt growth, causes no letdown or crash, and even stops bedwetting if present with about a 90% chance of success. It is an excellent ADD/ADHD treatment medication.