ADHD-Stimulant Medications-Intro Q and A
Do you have any opening thoughts on ADHD its diagnosis and treatment?
The diagnosis of ADHD should not be missed or go untreated because of the ease and safety of the treatment with resultant excellent prognosis. The benefits of treatment with stimulants far outweigh risks, and can be done at any age from a pre school child to the geriatric age group.
Why are you starting with ADHD to illustrate medication management?
First there is no more dramatic response in all of medicine of seeing a child or a person who is properly diagnosed and treated with a stimulant to see tremendous and quick improvement in the core symptoms of paying attention, thinking before talking or doing, and being able to be still when it is required and needed.
The person with ADHD routinely has trouble sitting still at school or at work or in the home setting, and having major troubles with learning, or being as productive as they should be, or not being able to full enjoy home life or leisure time, because they cannot not optimally stay focused on what is happening, and not thinking about the consequences makes mistake after mistake. Two other core problems not in the usual diagnostic criteria are not learning from life’s experiences making the same mistakes over and over, and emotional excitability , irritability, the short fuse, which can make these people difficult to live with at times.
All of these problems can be quickly and safely treated with neurostimulant medications.
The second reason is this simple and safe treatment for this a disorder of brain neurochemistry can change the course of one’s life in terms of quality of life and productivity. This is truly the prototype of a common mental health problem that is biologically based that shouldn’t be missed diagnostically and should have a trial of neurostimulants to see what improvements can occur.
The third reason though this is a relatively easy disorder to treat, it is still misunderstood and simultaneously is under diagnosed and just missed at times, and at other times people are over diagnosed with this problem because the symptom triad of hyperactivity, impulsivity and distractibility [HID] is overly attributed to ADHD rather than some other disorder with vastly different brain chemistry, which would be appropriately treated with another class of medications or perhaps no medication at all. Because of this problem often the true biochemistry of the underlying problem is either not addressed for years or slowly made worse. This critical problem I have discussed elsewhere.
Assuming we have the right diagnosis that one has Classical Uncomplicated ADHD why are neurostimulants used? ADHDtheDiagnosis
Neurostimulants are the medications of choice [MOC]. This is because it is believed that the basic brain chemistry problem of ADHD is one of not having enough dopamine and less so norepinephrine in parts of the brain and the neurostimulants work by helping this relative deficiency. They do this quickly, in a predictable and reliable manner , consistently and safely and help all the core symptoms. There is almost a lock and key response, and when it doesn’t occur one should question the diagnosis.
How do you address the stigma of diagnosis and treatment?
This is a disorder so biologically based so easily treated successful , easily and safely that that to not make the diagnosis and properly treat it is a loss for everyone. There should be no more stigma than the need to wear glasses of contacts for problems with eye focus. The problem here is “mind focus” easily treated with Neuro stimulant medications. The analogy of eye focus compared to mind focus fits especially with using medication. Would you deny your child or your self or anybody corrective lens to help their eyes focus, or would it be better to just squint, develop eye strain, hold the reading closer or farther away. Would you punish them for not seeing correctly. The analogy with hearing impairment is similar would you just yell at the person or tell to listen better, when what they need is hearing enhancement easily corrected by using a hearing aid. As the eye sees, and the ear hears so the mind may need help in paying attention and staying focused.
The beauty of the treatment is that once the proper medication is found at the proper dosage you can see the effects just as dramatically as the person who has the right corrective lenses or hearing aid. Often the unfocused overly active not thinking person within one hour of taking the right medicine and dose, can sit still pay attention and think out the consequences of what previously was an excessive chore or nearly impossible to do with effectiveness and ease.
What are the medications that do this?
They include two groups the amphetamine group [ Dexedrine, Adderal, and Vyvanse] and those methylphenidate based [ Ritalin, Metadate, Methylin, Concerta, Focalin and Daytrana-transdermal patch].
Is one more effective than the others?
They are all equally effective, though one product may work better for a specific individual, and more than one is worth trying to see which can give optimal results.
What are the differences between these products?
The differences are in the delivery systems that statistically mean little in terms of effectiveness , but considering the uniqueness of brain chemistry and the way an individual my use or metabolize the medication, each has its own advantage depending on the individual, and is worth knowing about and trying if optimal results is not achieved with the first product tried.
What do you mean optimal results?
Rather than focus on individual products whose biochemical mechanism are all the same, and has been the same for over 70 years, it is more important to focus on making sure the diagnosis is correct, and the treatment trials are done correctly to achieve optimal results which means that the core symptoms of hyperactivity, impulsivity and distractability are adequately treated, as are the two associated features of not learning from life experiences and the mood issue of excitability, irritability and a short fuse.
What if you not getting the result you expect with stimulants and ADHD?
At least four possibilities come to mind, 1. either the diagnosis is wrong, or 2. it is complicated by another disorder that has not been diagnosed, 3. Or the stimulant may not have been titrated to the proper dose to address all the symptoms, or 4. it may non stimulant or only partially stimulant responsive ADHD.
1. If you think the diagnosis is off, look at the other six medication responsive clusters to see if some symptoms were missed, and that could explain the ADHD like symptoms.
2. Sometimes the stimulants act like a diagnostic probe and may bring out symptoms of other disorders that my explain the symptoms, or there are two or more disorders with the ADHD, and when this occurs you need to address the other disorders brain chemistry to get optimal results.
3. Some prescribers don’t increase or adjust the medication high enough and only some of the symptoms are helped, and the prescriber and the patient aren’t aware that the results are not optimal, but because there is some improvement, everyone is happier , but the treatment is still not adequate.
4. There are cases of ADHD that just don’t respond in the expected manner, and these require another medication approach, or adjunctive medication.
Is this worth repeating?
Yes, if that lock and key treatment effect isn’t there and giving you optimal symptom control , these four things need to be considered and re considered over and over, totally wrong diagnosis, or there is another diagnosis present, or the medication is too low in dosage, or another medicine needs to used or added.
What is the bottom line here?
ADHD is the proto type of the biologically base mental health problems due to problems with dopamine and norepinephrine that can be easily and safely treated with stimulant medication. If the expected results don’t occur the diagnosis should be suspect or the present treatment may not be adequate with high enough doses being used, or another medication may be needed. More specifics about diagnosis and medications including what to expect and side effects are discussed elsewhere. ADHD Fact Sheet