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ADHD Medications and Treatments
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ADHD affects an estimated 3% to 5% of children and adults in the U.S.
Dr. Richard Sogn shares information and advice about attention deficit
hyperactivity disorder, including its causes, diagnosis, and promising
ADHD treatments
WebMD Blog Expert View
Tuesday, December 20, 2005
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ADHD and Neurofeedback
Until recently, there have been no well-done studies on the use of
neurofeedback for ADHD. However, the January 2005 edition of, "Child
and Adolescent Psychiatric Clinics of North America," had an excellent
review in the article, "Elelectroencephalographic Biofeedback
(Neurotherapy) as a Treatment for Attention Deficit Hyperactivity
Disorder: Rationale and Empirical Foundation," by Vincent Monastra.
Although there have been many single case studies, there have now been
four controlled group studies. Response was comparable to response to
medications, with about 75% responding positively. Approximately 50 -
80 % of responders to neurofeedback were able to reduce (not stop)
their medications.
While neurofeedback is more enduring, with decreased symptoms
persisting much longer after discontinuation of treatment than after
discontinuation of medications, it is not "permanent," and many people
return for intermittent "booster" sessions. Just as with the use of
medications, the children who did the best were part of a
comprehensive treatment program that included nutritional counseling,
medications, parent counseling to improve parenting skills and improve
social functioning at home, individual educational plans with the
schools, and social skills training. Neurofeedback or medications
should be just one small part of a comprehensive treatment plan.
I have an associate who is an ADHD expert and uses neurofeedback. We
sometimes share patients. My impressions are that if someone is
cooperative with it (all children aren't) and complete the required
number of sessions, that about 70% have some response. However, as
with medications, a certain percentage don't respond, and of those
that do it might be a small, medium, or significant response. Those
with a minimal or moderate response often respond better to the
combination of a medication and neurofeedback.
There are other new treatments that are promising but not yet proven.
Cerebellar stimulation, such as with the Interactive Metronome, is
promising, and we're learning that the cerebellum is more involved
with ADHD than once believed. Some studies show that omega-3 fatty
acids help, while others don't, and the same is true for antioxidants
such as super blue-green algae. Dr. Hallowell's new book, "Delivered
from Distraction," addresses many of these treatments.
If you want to try neurofeedback yourself, I believe there is a home
version available.
Related Topics: Vitamins for ADHD?, Effects of ADHD Treatment May Vary
Over Time
Tags: ADHD,neurofeedback,biofeedback,omega-3
// posted by Richard Sogn, MD, 1:54 AM
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Friday, December 16, 2005
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Strattera and ED
The FDA approval of Strattera, a non-stimulant medication for ADHD,
was an exciting breakthrough in treatment. Nevertheless, some patients
experience sexual side effects when they begin to take Strattera for
their ADHD.
Often, sexual side effects to Strattera are transient, and improve
after a few weeks. However, if it continues on a long-term basis
improvement isn't expected. Medications that increase norepinephrine
can cause sexual side effects (although less frequently than
antidepressants that increase serotonin). Strattera primarily
increases norepinephrine, while methylphenidate (Ritalin, Concerta,
Metadate CD) and Adderall primarily increase dopamine and only to a
small degree increase norepinephrine. When people experience sexual
side effects to methylphenidate or Adderall, I give them a trial of
Dexedrine, as it's the only stimulant that only increases dopamine.
Stimulants treat symptoms of ADHD in a greater percentage of people
than Strattera, and often treat inattention and distractibility more
robustly than Strattera. Strattera isn't safer than a stimulant, and
if effective a stimulant alone would be a far better choice than
adding a medication such as Viagra.
Related Topics: Change Meds to Reverse Sagging Sex Life, Dealing with
Erectile Dysfunction (ED)
// posted by Richard Sogn, MD, 1:38 AM
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Wednesday, December 14, 2005
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ADHD Book Recommendation
The author of the excellent book, ""The Link Between A.D.D. &
Addiction,"" Wendy Richardson, MA, has just released an updated
version, "When Too Much Isn't Enough: Ending The Destructive Cycle of
AD/HD and Addictive Behavior"
It covers the gamut of addictions: alcohol, marijuana, gambling,
internet, food, sex, shopping. I highly recommend this book to anyone
who struggles with ADHD and addictive behavior or anyone with a friend
or loved one with these problems.
Related Topics: Instant Gratification, Gamblers and Substance Abusers
Share Traits
// posted by Richard Sogn, MD, 11:30 PM
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Monday, December 12, 2005
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Drug Holidays
Around this time of year I start to see lots of questions about
whether or not parents should give their children a "drug holiday"
over the school break. The usual reasoning is that because their
children are not in school, they shouldn't take their ADHD
medications.
ADHD often affects many aspects of life, including academic
performance, relationships with peers, family life, and participation
in sports and other activities. It is a "life" disorder, not a school
disorder. Medications should be used as one would for any other
medical disorder. One wouldn't stop using an asthma inhaler at 3:00
when school gets out, on weekends, or on holidays. On the other hand,
if one weren't wheezing, there would be no need to use an inhaler, no
matter what day it was. What I'm getting at is that ADHD is a
neurologically based disorder, and when to use medications has more to
do with how well someone is functioning than the day on the calendar.
ADHD symptoms may be more obvious during the holiday season, as
parents' and children's schedules become more hectic and daily
routines are disrupted.
There are many kids who primarily have problems with inattention, are
not hyperactive, impulsive, or disruptive, and do not have
difficulties with peers or within the family, who may do well over the
holiday off medications. For other kids, life may be a constant
struggle, and they may benefit from being on medications whenever they
are awake, seven days a week.
Occasionally there is a child who has a decreased appetite with
significant weight loss and a decrease in the rate of growth when on
stimulant medications. When other measures fail, such as eating before
they take their medications and after medications have worn off, or
using supplements such as Ensure, drug holidays may need to be
implemented.
An excellent resource on medications is, "Straight Talk about
Psychiatric Medications for Kids," by Timothy E. Wilens, M.D.
Related Topics: Docs Overlook After-School Treatment of ADHD, Tips to
Reduce the Side Effects of ADHD Medications
// posted by Richard Sogn, MD, 10:12 PM
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Wednesday, December 07, 2005
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Stimulants for Life?
Many visitors to my ADHD Message Board are concerned about starting
their children on stimulant medications, because they have heard that
stimulants lead to addiction, and are also concerned that they will
never stop taking medications.
About 60 - 70% of children with ADHD continue to have symptoms in
adulthood, and the majority would continue to benefit from
medications. However, "forever" is a long time, and as rapidly as our
knowledge of the brain, genetics, and science is changing, I don't
have any idea how ADHD will be treated 10 years from now, let alone a
"lifetime" from now.
Dependence on amphetamines develops when large doses are used in a
manner that causes a rapid increase of the drug in the brain, which is
primarily obtained by snorting or injecting the drug. Although abuse
of amphetamines is a problem in the United States, it's extremely rare
for someone with AD/HD to abuse their medications. I'm more concerned
about a teenager selling or giving their medications to friends than I
am to them abusing it.In 25 years of practice I've never had a child
come into my office and say, "Give me more of that medication doc,
it's good stuff." Instead, most children don't want to take
medications and parents find pills that have been spit out and hidden
behind the couch.
Several excellent studies have found that children who have been
treated for ADHD with medications such as Adderall, have a much lower
incidence of drug use in adolescence and young adulthood than those
with untreated AD/HD. The better a child does in school and in life
the less chance they will hang out with the "losers" or "dopers," in
school, and the greater chance their friends will be involved with
sports or other activities. If you're concerned about the potential
for drug use, continue treatment rather than stop it.
Related Topics: Choosing the Right ADHD Medication for Your Child,
ADHD Drugs Don't Lead to Drug Abuse
WebMD Abstracts: A CDC report shows how common ADHD has become in the
U.S. and how many children are receiving treatment for ADHD. The CDC
research confirms ADHD is more common in boys than girls and more than
half are taking medication for ADHD. New research on ADHD published by
the American Medical Association's Archives of Pediatric and
Adolescent Medicine is exploring potential causes, treatment and
quality of life issues for ADHD children and their families.
// posted by Richard Sogn, MD, 9:39 AM
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