CPAN Case of the Month – July 2024

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Each month, PCPs call CPAN with a wide variety of mental health questions. Find out how CPAN helped a pediatrician during this consultation.

Patient: 17-year-old female

Reason for CPAN Consultation: To receive support with medication and diagnosis

Explanation of the Case and Outcome of the Call:

A 17-year-old female with Generalized Anxiety Disorder, Depression and Migraines. Was stable on Sertraline 125 mg and Topiramate but was assessed and ultimately diagnosed with ADHD through a neuropsychological evaluation in the context of a concussion in the spring 2023. 

The patient was prescribed Focalin XR 5 mg eventually increasing to 10 mg with significant improvement based on Vanderbilt rating scales. However, concerns related to memory and alertness were discovered during SAT testing and performance after school in theater. The family stopped the Focalin but felt the concerns remained with her memory and alertness as well as problems with attention.  

First the discussion focused on Topiramate given that can cause psychomotor slowing, dizziness, fatigue, confusion, somnolence, and cognitive problems.  Sertraline may cause fatigue, dizziness and somnolence, but these are not as common side effects as with Topiramate.  

Second, Focalin can increase the effects of both the Topiramate and the Sertraline by decreasing their metabolism.   It is possible that the addition of the Focalin XR caused an increase in the effect of Topiramate.  We reviewed that perhaps a change in migraine treatment may be necessary or utilization of a different stimulant to assist with their ADHD symptoms that would not interact with Topiramate if that medication continued. A short acting Methylphenidate was posed as an option.