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ADHD TREATMENT STRATEGIES--IT'S A JUNGLE OUT THERE- PART III

This is the 3rd article in this series, discussing in some detail the most common ADHD Treatments. In Parts I & II, I have discussed 14 different treatments being used for ADD/ADHD.

If you missed Part I: http://www.ADHDStrategies.com/RxJunglePt1.asp
If you missed Part II: http://www.ADHDStrategies.com/RxJunglePt2.asp

Continuing now with Part III of ADHD Treatment:

15. MEDICATION IN ADHD TREATMENT

Medication works very well for treating the Core Symptoms of ADHD-- hyperactivity, impulsiveness, and inattention .

The GOOD about Medication for ADHD Treatment

• Very effective in treating core symptoms (each med is effective ~70 - 75% of the time.
• If one medication fails, there is a good chance a different one will help.
• Works very quickly--most drugs work the same day (Strattera takes about 3 wk)
• Many doses available and can be carefully titrated to the individual.
• Can often quickly help a child turn around from failing several classes to passing.
• Helps stop disruptive behavior, if it stems from hyperactivity or impulsiveness.
• Most children have few side effects, and these can be easily managed.
• Effects of the medication lasts 8 - 12 hours for most meds (up to 24 hours for Strattera)
• By reducing impulsiveness and inattention, helps reduce accidents for ADHD drivers.
• May reduce accidents and injuries in general in ADHD kids.
• ADHD treatment through childhood results in reduced substance abuse in later teen years
  

The BAD about Medication for ADHD Treatment

• It does not cure ADHD, it only works while the child takes it.
• It falls woefully short in helping the associated conditions which often accompany ADHD/ADD.
• It often has side effects--loss of app[etite, weight loss, stomach upset, and insomnia. These can often be managed by reduction in dosage.
• If dosage is too high, it can result in a blunting of the child's personality. It takes away his smile and the "sparkle" in his eye, so that he is no longer himself. This is to be avoided at all costs and monitoring is the responsibility of the physician and the parent.
• Occasionally can cause tics, or make these worse if they are already present.
• There is a big concern that ADHD treatment medication taken over a number of years will stunt the growth, and result in overall height being less than it would be otherwise. Careful monitoring in my practice has shown that this does not happen. Any weight losss seems to go away when med is stopped.
• Worries in the past about problems with the White Blood Cells, platelets, liver function tests have been resolved and are no longer considered a problem.
• Back in the early 1990's, 5 deaths in children on Clonidine were extensively reviewed and were found to be from causes other than the Clonidine. Clonidine is still safe to use.
• Some of the medication--especially the older, short acting Ritalin, Adderall, and Dexadrene--if used inappropriately could have an abuse potential. Kids sometimes crush the tablets and inject themselves IV for a rush. The drugs are sold in some schools, along with other abused substances. The newer, long acting drugs have compounds bound to the core drug, so that they cannot be crushed and injected IV.
• Strong concern that since many of the drugs used for ADHD treatment are stimulants, they may cause kids taking them to become dependent on them and increase the chance that they would be Substance Abusers in the future. This was extensively studied by University Centers--not funded by the drug companies--and showed absolutely no evidence of increased substance abuse later in kids on stimulants for ADHD. As a matter of fact, there was a higher incidence in those who were untreated for their ADHD.
  
  
  The UGLY about Medication for ADHD Treatment

• There is a theoretical potential that in a child with severe hypertension or pre-existing heart disease, a stimulant could make that heart disease or hypertension worse. This could result in a fatal arrythmia, heart attack, or stroke. This has never been reported, but a warning has been placed on the stimulant class of drugs because of this possibility. Therefore, if you or your child has heart disease or uncontrolled hypertension, do not use stimulants as an ADHD treatment.

Medication Commonly Used

• Ritalin-Based Drugs--Ritalin, Ritalin LA, Concerta, Metadate CD, Focalin XR
• Amphetamine Salts--Adderall XR and Dexadrine
• Strattera--non stimulant, primarily for inattention
• Modafinil = Provigil--second-line for inattention
• Alpha-Blockers--(high BP med); used as add-on; Tenex, Clonidine
• Antidepressants--Wellbutrin, Prozac, Zoloft, Paxil, Effexor, Cymbalta, Lexapro. Good for depression; not much help for core symptoms.

WOW! That's a lot of treatments for ADD/ADHD. So many treatments often means no one treatment is the ideal.

In my opinion, state-of-the art ADHD Treatment requires the use of two or more of these treatment options. And--this is very important-- the treatment must be slowly titrated and tailored to the individual child or adult being treated

Back to Part I

Back to Part II

If you have any comments of ideas of things that would really help you, email me at:

DrJerry@ADHDStrategies.com

I want to help you "be the best person you can be"

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Jerry Rodgers, M.D.