In my last couple health tips we’ve been discussing Claire, a woman in her thirties with attention deficit disorder (ADD). Last week we reviewed Claire’s non-medication approach. This week, I’ll go over the conventional medications used for this very common condition.
Let me start by saying that untreated ADD in children can prevent very bright kids from living up to their potential. With ADD meds, there’s no “lifetime commitment” or even the need to take a pill every day. Children with ADD often skip their meds over summer vacation or on weekends if there’s no homework. Many adults with mild ADD use the meds on an as-needed basis.
By far the largest group of medications for ADD are the stimulants, literally “waking up” the inefficient ADD brain by boosting levels of the neurotransmitter dopamine. The two stimulants are the amphetamines (Adderall, Vyvanse) and methylphenidates (Ritalin, Concerta) and they’re all available in extended-release form, lasting (not surprisingly) a little longer than a school day.
Keep in mind that the average age of the people taking any of these meds is about 11.
All the stimulants, taken in the morning, begin to work within an hour and start fading in the late afternoon. People with more severe ADD often take a second dose mid-afternoon to last them until about 9 PM. The main side effects are jitteriness (resolved by reducing the dose), insomnia (ditto), and appetite suppression (goes away in about two weeks). I generally start my ADD patients on Vyvanse because it has a very smooth effect, with a subtle onset of action and gentle decline in the afternoon.
I reserve the single non-stimulant ADD medication, Strattera, for patients who report not feeling well on the stimulants, or those with a history of anxiety whose symptoms might worsen if stimulated.
The best description of Strattera is “subtle.” There’s no epiphany like that experienced by someone with ADD given one of the stimulant drugs for the first time. But there’s such a difference between that effect and the non-stimulant effect of Straterra that when patients switch from the first to the second, they’re often convinced it isn’t working.
Strattera requires patience.
It works by slowly increasing the brain’s level of norepinephrine, which, like dopamine, can enhance focus and concentration. It usually takes a month to appreciate Strattera’s effect, but once in place its two main advantages are: no stimulant symptoms (some people just feel physically uncomfortable taking stimulants) and it works around the clock. You’re just as focused at 8 AM as at 8 PM with one capsule a day. The main side effect, stomach upset, can be completely prevented by taking Strattera with food.
The natural therapies Claire had been using were helping a little, she told me, but she was curious about how she’d feel without any ADD symptoms at all. After some discussion, Claire chose Vyvanse. I also recommended two books: Scattered Minds for her and Is It You, Me, or ADD? for her husband. The second is an excellent book about living with someone who has ADD.
Claire was back in a week to talk about what she’d experienced. “It’s amazing,” she began. “I now know what memory is. I can read lists and two hours later, recite the list. I actually read a whole book, cover to cover, and can tell you what it was about. It’s like my mind was given eyeglasses.”
The big test, she said, would be the following month when she’d be re-taking her real estate license exam, which she’d failed twice in the past.
Although she kept in touch by e-mail regarding some minor Vyvanse dose adjustments, it wasn’t until one of her e-mails held photos of a condo she “thought I might be interested in” that I learned the ultimate results of her treatment.