Posted by: counselorcarmella | August 24, 2011

ADD and Medication

With  ADD, most times,  meds are  a vital part of treatment because of what’s going on in the brain.  Some GPs are comfortable prescribing meds for ADD and some will refer patients to a psychiatrist. Research has shown that around 80% of individuals who take stimulants have positive results. Frequently prescribed stimulants include:

 

Methylphenidates (e.g., Ritalin, Concerta, Metadate, Focalin) – This family of stimulants is used to treat both ADHD and narcolepsy.

Dextroamphetamines (e.g., Dexedrine, Vyvanse)

Amphetamines (e.g., Adderall). Adderall was approved by the FDA in the 1960’s for the treatment of obesity and ADHD. Adoral XR was the first  stimulant to be specifically approved for use in adults diagnosed with ADD. That means  studies were actually conducted to prove that it was beneficial. That was in 2004.  Concerta and Vyvanse have also been approved for adults now.     

 

Right now,  since several of these meds are available in time release formulations, those are considered a better choice than the  shorter acting formulations that only lasted three or four hours.  Its harder for people to remember to take meds several times a day and  shorter acting stimulants have more of an abuse  potential. Time release formulations last8 to 12hrs and have less abuse potential.

 

Elevated  BP or cardiac issues can  be brought on by stimulants.  Insomnia and lack of  appetite are other  commonly reported side effects.  Stimulants are considered schedule 2 controlled substances.  The Dr can’t call in a prescription so scripts have to be  taken to the pharmacy by the patient. This means having to go  pick them up once a month. When Vyvanse came out, in 2007, the hope was that it wouldn’t be classified as a schedule II substance due to  how it  was metabolized in  a way that made it less likely than other stimulants to be abused. But the US DEA decided to   make it a schedule  II with the other stimulants.

 

Daytrana was approved in early 2006.  It is  a patch that delivers  stimulant medication through the skin. Strattera was the first nonstimulant med to be  approved by the FDA specifically for the treatment of ADD.   Also, the first  medication of any sort to be specifically approved for the treatment of ADD in adults. It was approved in early 2003. Strattera is a  norepenephrin reuptake inhibitor as opposed to stimulants, which  impact brain dopamine metabolism. Strattera is more convenient as it doesn’t require picking up a script every month. It is usually recommended that stimulants be tried first. If stimulants  can’t be used because of side effects, addiction history, or other issues,  Strattera is recommended. It may up to4to 6 weeks for patients for it to begin to  impact symptoms whereas stimulants work immediately.

 

Another useful category of drugs for adults with ADHD are the antidepressants, either alongside or instead of stimulants. Antidepressants which target the brain chemicals dopamine and norepinephrine are the most effective. These include the older form of antidepressant known as the tricyclics. In addition, the newer antidepressant drug Venlafaxine (Effexor) may be helpful. The antidepressant Bupropion (Wellbutrin) has been found useful in trials of adult ADHD, and may also help reduce nicotine cravings.

 

Newest medication = Intuniv approved in Sept 2009

Intuniv  is a non stimulant. It is a long acting form of a blood pressure medication that has been used off label for treating ADD for some time.  It is  not  a controlled substance so getting prescriptions is easier. At this point, Intuniv is only approved for use in children and teens   but that doesn’t mean  doctors aren’t using it for adults. It only has to be taken once a day and is another good option for  those who can’t tolerate stimulants or  when  Drs don’t want to prescribe  a stimulant for whatever reason. 

 

Findings suggest that adults with ADHD are more likely to require polypharmacy than children with ADHD. Using SSRIs with stimulants can help adults with ADHD and comorbid anxiety or depression. These comorbid conditions are quite common. Any SSRI can be safely combined with stimulants.

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Responses

  1. Most therapists think SSRI’s for depression, because that is its meds class. However, in the ADD field, many of us take, in addition to a stimulant, a subclinical dose of an SSRI (Zoloft – sertraline most commonly) to help with the “shifting focus at will” dynamic of attending. That’s been my personal meds regimen for almost 20 years now.

    Does an SSRI elevate mood as well? Well, duh! Since we can more easily get back on track, we are no longer chronically irritated by the many distractions of modern life, so OF COURSE our mood improves!

    In my experience, only the highly ADD-literate doctors understand that they are NOT medicating depression. (i.e., there would be something WRONG with us if we were NOT “depressed” by a life chronically off-track – but that’s situational depression, which is v-e-r-y different from major depressive disorder).
    xx,
    mgh (Madelyn Griffith-Haynie, SCAC, MCC – blogging at ADDandSoMuchMore and ADDerWorld – dot com!)

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    Madelyn Griffith-Haynie, SCAC, MCC – (blogging at ADDandSoMuchMore and on ADDerWorld – dot com!)


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