ADHD medication

When I talk about “optimizing medication” in my presentations on Adult ADHD, some faces in the audience look puzzled. That’s not surprising, given the stories I’ve heard for years of careless prescribing patterns that result not only in unnecesary side effects but also sub-sub-optimal positive effects.   Often, I’d vent my frustration via e-mail to Dr. Charles Parker.

Now, I can’t take credit for Dr. Parker deciding to produce a long-awaited comprehensive guide, ADHD Medication Rules: The Meds For Paying Attention, but no one is more thrilled than I am to have this as a resource.  (It’s an e-book, complete with hyperlinks and search function. Very handy!)  Readers of his Corepsychblog have long appreciated his breadth and depth of knowledge (in posts as well as video and audio and podcasts), and now they can benefit from his comprehensive strategy for the medical treatment of ADHD. Read the rest of this entry »

You’ve probably heard the term mental-health parity. But do you know what it means? Many people do not.

It’s important, because  recent healthcare reforms have called for mental-health parity. That is, reform provisions are designed to address the disparity between the limits insurance coverage sets for medical conditions involving the body  versus much more limited coverage for “mental health” conditions involving the brain.

Hey, but last I looked, the brain is part of the body!  Change happens slowly, it seems.

Mental health advocacy groups such as CHADD, the national non-profit serving the ADHD community, have long lobbied that medical conditions affecting the brain should be treated no differently than medical conditions affecting the heart, limbs, lungs, and so on. (Click here to review CHADD’s updates on this topic over the past few years.) Read the rest of this entry »

“….And you want it because it releases dopamine,” explains the short video below.

“Things are important and valuable only if they activate your dopamine…..

“Being unfocused and easily distracted means you’re low on dopamine.”

Bottom line: If you don’t have “enough” dopamine, or your dopamine is activated only by over-the-top pleasures (or anticipation of pleasures)? Caution ahead.

Part I of “All About Medications for ADHD” focused on common questions and answers provided by ADHD specialist Ted Mandelkorn, MD, of Puget Sound Behavioral Health, a Seattle-based clinic that treats teens, children and adults with Attention-Deficit/Hyperactivity Disorder and related conditions.

In Part II, below, Dr. Mandelkorn details the categories of medications along with dosing, pros, cons, and potential side effects.  The more you know about your choices, the better you can choose a knowledgeable prescribing physician and work with that physician for the best possible treatment outcome for yourself or your loved one.

A PHYSICIAN’S PERSPECTIVE

Theodore Mandelkorn, MD

2010

PART TWO: OVERVIEW OF MEDICATIONS Read the rest of this entry »

It’s hard to overstate it: Please be a smart mental healthcare consumer when it comes to ADHD medical treatment.

That means not simply assuming that your prescribing physician, no matter how much ADHD expertise is professed, truly knows what’s what.  Learn the basics so you can “Trust but Verify.”

Ted Mandelkorn, MD

For all the information flooding the Internet  now about Adult ADHD, it’s still hard to find a solid overview of the medications used to treat it. So, I contacted Ted Mandelkorn, M.D. (pictured right).  Had he updated the excellent handout from a lecture I’d attended years ago? Indeed he had. Even better: He gave me permission to share it with ADHD Roller Coaster readers.  The first installment is below. Part II will follow shortly.

An “early adapter” of ADHD expertise and treatment, Dr. Mandelkorn is the parent of a child with ADHD and has ADHD himself. He trained in pediatrics and adolescent medicine, and he was a mental health fellow under Dr. Michael Rothenberg at the University of Washington. He has been in practice for 35 years, since 2001 at his clinic, Puget Sound Behavioral Medicine.

A PHYSICIAN’S PERSPECTIVE

Theodore Mandelkorn, MD

2010

PART ONE

• INTRODUCTION
• WHO SHOULD TAKE MEDICATIONS, AND WHY?
• WHAT IMPROVEMENT SHOULD BE SEEN?
• WHO SHOULD PRESCRIBE MEDICATIONS?
• MEDICAL TRIALS
• WHAT IS THE CORRECT MEDICATION?
• WHAT IS THE CORRECT DOSAGE?
• WHAT ABOUT “NATURAL” THERAPIES?
• SUMMARY

Read the rest of this entry »

Who knew that wearing my new t-shirt to the farmer’s market would cause such a fuss?  Instead of my usual sharing of brief assessments about sugar-snap peas or shitake mushrooms with other shoppers, I was drawn into a “debate” about ADHD.

Sure, I’m accustomed to ranting ADHD-denyers on the rough-and-tumble Internet, but not while strolling amid the produce vendors on a sunny Saturday morning.  Still, it was good to know that my verbal “gaslight-proof” skills match my written ones.

First, what does “gaslight” mean?  It harkens to the 1944 film Gaslight, wherein Charles Boyer’s character cravenly manipulates Ingrid Bergman’s character  to believe that she is insane. In psychological terms, “gaslighters” say and do things to make their victims question their perceptions, their knowledge, and their beliefs – all in an attempt to fulfill the gaslighter’s egocentric needs (financial gain, need to control others or to force others to conform to the gaslighter’s beliefs and perceptions, etc.).

Second, this wasn’t just any t-shirt. It was a strikingly good-looking t-shirt created for a Stride for ADHD Pride.  My friend Natalie Knochenhauer, founder of the Philadelphia non-profit ADHD Aware, does all such things with style and substance. Read the rest of this entry »

Welcome to a new department here at the ADHD Roller Coaster blog: ADHD in the News Monthly Roundup.   In this spot,  you”ll find  links and summaries to key ADHD-related news stories, starting now with the March 2010 headlines. (Please note: Some sources might require registration or a fee.)

Topics include: Vision therapy for ADHD, Adderall abuse on college campuses, sensory integration disorder, George Will’s opinion on the new DSM, requiring health insurance policies to cover mental health treatment, and  more.

As always, your comments welcome!

The Washington Post:

Parity law requires mental health benefits comparable to physical care benefits

Summary: An estimated 140 million Americans, most of them covered by employer-provided group insurance plans, are the beneficiaries of a new federal law designed to guarantee mental-health parity in insurance coverage.  In other words, the brain is finally being acknowledged as a physical body part!

Excerpt:

Denise Camp was resigned to the double standard that had long applied to her medical bills, forcing her to skimp on other expenses so she could pay for mental health treatment. While visits to her internist for physical problems required a $20 co-pay, her weekly therapy sessions with a social worker cost $50 and trips to the psychiatrist who prescribed her medication were $75. A similar disparity applied to medicines: Drugs to treat the crippling depression that ended her engineering career cost her twice what she paid for an antibiotic. Click here to read the rest of the story.

Science Daily:

Mouse Model Reveals a Cause of ADHD

Summary: To better understand the mechanisms of ADHD, particularly the dopamine pathway, scientists created genetically modified mice.

Excerpt:

Although it’s typically considered an adolescent curse, ADHD actually affects about five percent of adults as well. New research in a mouse model of attention deficit/hyperactivity disorder suggests that the root of the psychiatric disorder might be the over-activity of a protein that regulates dopaminergic pathways. The work suggests a path toward new treatments for symptoms including inattentiveness, over-activity and impulsivity. Read the rest of this entry »

To save money, many people with ADHD take generic medications. Most have received assurances from  their physicians that “bioequivalence” with the brand-name version is required and assured. Unfortunately, that is not always the case. Increasingly, patients who do notice a significant difference between brand-name and generic are making their voices heard.

The ADHD Roller Coaster covered this topic a few months ago, after I read an outrageous Consumer Reports press release that  even warned consumers away from brand-name medications for ADHD as being too costly and unnecessary.  I countered with this blog post on the potential dangers of generic medications for treating ADHD and co-existing conditions.

With other readers, I left comments at the Consumer Reports blog post (“Parents: Don’t rush Children to Adderall, Concerta, Strattera”).

Today’s New York Times article (“Not All Drugs Are the Same After All”) today backs up my points on generics. Some snippets: Read the rest of this entry »

Only Harry Potter fans have awaited a book as I’ve awaited Dr. Charles Parker’s forthcoming book on ADHD medication treatment strategies. Nothing has frustrated me more in ten years of advocacy than hearing meds-gone-awry stories. A solid getting-the-meds-right guide for patients and clinicians is long overdue.

With the full book still in the editing stage, Dr. Parker has made this abbreviated e-book available free: Predictable Solutions for the 10 Most Common Challenges with ADHD Medications. To download the book, visit this page on Dr. Parker’s Corepsychblog webite.

A sampling of challenges addressed in this booklet:

• Problem #1: Overlooking Targets – Beyond Diagnostic Labels
• Problem #2: Neglecting the Evidence of Metabolic Rate
• Problem #3: Multiple Diagnoses, Emotional Baggage, and ADHD
• Problem #5: Overlooking Bipolar with ADHD
• Problem #7: Overlooking the Therapeutic Window

Read it and reap!

Since I posted this blog entry on recent research from neuroscientist Nora Volkow and colleagues, more detailed stories interpreting the study’s findings have become available. In particular, this report from MedPage today targets clinicians. That site also includes an audio interview with Dr. Volkow, below (despite a strong Spanish accent, Dr. Volkow does a good job of making complex concepts understandable to the layperson, in my opinion).

Introducing: The ADHD Hall of Shame, a new ADHD Roller Coaster department.

Inaugural inductees: HBO show host Bill Maher and his guests Arianna Huffington, Rep. Jack Kingston (R-GA), and Rep. Darrell Issa (R-CA). Two liberals and two conservatives who could agree on one thing only: It’s okay to bash ADHD.

“Paddling a child is inhumane but drugging a child is the way to go?” began an indignant Kingston (R-GA), implying that there’s nothing about ADHD that a good whupping won’t cure. Read the rest of this entry »

Live a few decades not knowing that you have ADHD, and chances are you’re lugging around not only emotional baggage but also physical baggage — sleep debt, adrenal exhaustion, off-kilter hormones, allergies, and more. Yet, in our specialist-dominated healthcare “system,” finding a physician who can assemble all the puzzle pieces is a challenge.

When’s the last time your personal physician, not to mention ADHD-treating psychiatrist, closely scrutinized lab results for your complete blood panel, adrenal function, or hormones and could properly answer your questions about, say, potential gluten sensitivity? Yet, if you’re suffering from any of these allied health challenges, your brain function could be suffering in ways that will never be sufficiently addressed by psychotropic medications alone.

A few years ago, I scoured the Internet for a “big picture” physician who was sharing information (on a blog or website) not only about ADHD and its commonly co-occurring conditions but also the many other biomarkers that affect brain health. Fortunately, I found CorePsychBlog , written by physician, author, neuroscientist, and psychiatric consultant Dr. Charles Parker (pictured, above right). (Regular readers of this blog have seen Dr. Parker’s comments. For the record, he and I have never met and have no business association.) Pick your media preference: written posts, radio shows, or videos. CorePsychBlog is packed with information. So packed that I’ve picked out a few highlights to get you started (in a follow-up post, I’ll share links to some of Dr. Parker’s highly informative videos): Read the rest of this entry »

Like me, you’ve probably consulted Consumer Reports when it comes to purchasing appliances. But would you trust them for advice on medically treating your ADHD? Given their latest press release, I certainly hope not!

It starts with this (and just gets worse): Read the rest of this entry »