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ADHD medication

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New Study: Benefits of Rx Increase Over Time

February 22, 2013 in ADHD in the News, ADHD medication, The Basics | 15 comments

A new study offers good news about the cumulative benefits of ADHD medications taken over time:

Results showed that adult ADHD patients who received drug treatment for more than two years had fewer symptoms and less psychological distress compared to those treated for two years or less.

Just yesterday, a consulting client asked me, “How long will it take after starting medication for my ADHD to start seeing the benefit?” My answer was the same as given in my book:

  • Symptoms tend to get better within weeks.
  • Functioning gets better within months.
  • Perhaps most important, careful observation may identify changes in development taking place over years. For example, the individual who never had a friend now makes and keeps them. Another who could not keep a job has now kept one for a year.

In other words, this study seems to confirm that the “higher-order” functioning does not happen immediately after starting medication, even if you miraculously happen upon the best type of medication for you in the early days of treatment. Rather, it happens more gradually over time. Of course, some symptoms can be alleviated immediately — suddenly, you “see” that sock lying on the floor or how to clear that garage of longstanding clutter. But the more complex Executive Functions? Those connections might take longer to develop. Read the rest of this entry »

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The Tragic Truth Of Adderall, or “Madderall”

February 3, 2013 in ADHD in the News, ADHD medication, The Basics | 24 comments

Yesterday, given a back-channel tip, I steeled myself for the next anti-ADHD screed from the The New York Times, fully expecting yet another stigma-producing attack on the diagnosis itself and the medications so often successful in treating it. Yet, last night, when I read online the story by reporter Alan Schwarz (“Drowned in a Sea of Prescriptions”), my reaction was both grief and relief.

Grief that yet another person fell victim to a medication that, even though helpful for many people, can create severe reactions in many others. Relief that finally The New York Times got it right: The manner in which medications for ADHD are prescribed in this country largely resembles a giant game of “Pin the Rx on the ADDer” or even worse — a “test the spaghetti” equivalent of throwing chemicals at someone’s brain and seeing what sticks. (Below, I offer an excerpt from my book‘s chapter on medication, written precisely to help people avoid such tragic and unnecessary outcomes; there is also a sidebar on the important distinctions between the two classes of stimulants: methylphenidate, or MPH, and amphetamine, or AMP).

Yes, I am angry, and I’ve been angry for a long time about the medication I’ve come to call “Madderall.” For 15 years, I’ve collected first-person stories about the potential dangers of Adderall, including the fallout from prescribing physicians who view it as the “go to” medication for people with ADHD without knowing to be watchful for its potential side effects. If they did as they should do and gathered reports from family or close friends as to how the medication seemed to be affecting the person, they might know about these side effects. But most don’t bother or even deem it important.

Because Adderall so often can cause problems, I encourage people to consider it only after trying the methylphenidate class stimulants (Ritalin, Focalin, Concerta, Daytrana, etc.) and some newer delivery systems in the amphetamine class (such as Vyvanse). (Ideally, a trial should be given of both the amphetamine and methylphenidate classes, to see which works best. Sometimes even a combination of the two proves optimal.) Yet, so many physicians prefer starting new patients with Adderall, even though it is mostly an old and outdated option, given superior delivery systems available today that release the medication more evenly, creating less of a “rollercoaster” for neurotransmitters. Still, the ignorance around Adderall is only one piece in a very problematic and often tragic puzzle: Read the rest of this entry »

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A New “Ritalin”: Extended-Release Liquid

January 17, 2013 in ADHD medication | 12 comments

“The good news is that there has never been a better time to have ADHD,” I said last night to a client consulting with me about her new diagnosis. Yes, I sought to boost her optimism about making the life changes she desired. But it’s the truth. Never has there been such a huge number of ADHD-related published studies, of evidence-based strategies, of support sources, and of medications.

Case in point: I mentioned to her a new medication I learned about at the CHADD conference exhibit hall: Quillivant XR. It is based on the oldest, most well-studied medical treatment for ADHD: the stimulant called methlyphenidate. (Other methylphenidate medications include Ritalin, Concerta, and the Daytrana patch.)

With the recent introduction of Quillivant XR, we now have a liquid, extended-release formulation designed to last 12 hours (as always, your mileage may vary, given your unique neurochemistry). Basically, it comes as a powder that your pharmacist will mix for you into a liquid. You will be given 1 bottle (containing the liquid), 1 oral dosing dispenser, and 1 bottle adapter. The question-and-answer page on this product is here.

One obvious appeal for this liquid stimulant option is for children who have a hard time swallowing pills or capsules. But a liquid also enables more  precise and individualized dosing – for children, teens, or adults. After all, sometimes a person’s ideal dose lies somewhere between the available dosage strengths of the pills or capsules. This isn’t the first liquid-stimulant formulation, but it’s the most sophisticated in its extended-release profile. Read the rest of this entry »

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Talkin’ Trash: Targeting ADHD Challenges

January 11, 2013 in ADHD medication, The Basics | 4 comments


Oh yes it’s garbage night
And the feeling’s right
Oh yes it’s garbage night
Oh what a night (oh what a night)

People who know my husband only as a serious-minded scientist could hardly imagine, come Tuesday trash-taking-out night, his jaunty rendition of Kool & the Gang’s Ladies Night.

Ten years ago, neither my husband nor I could have imagined it, either. He’s actually happy to be taking out the garbage and recycling instead of working himself up into a Klingon-warrior-inspired snit about it? Yes, it’s true. Just one of the miracles of medication. And a few attitudinal adjustments.

I was reminded of that remarkable transformation today. In talking with some adults who have ADHD, I mentioned the importance of establishing treatment targets before starting to take medication; otherwise, how will you know if it’s working? Meg agreed: “The first big clue I had that my meds were working was when, instead of thinking about how much I hated taking out the trash and recycling, I just took out the trash and recycling.”  A woman after my husband’s heart! Read the rest of this entry »

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Benzedrine in Mrs. Murphy’s Ovaltine?

June 16, 2012 in ADHD medication, Just for Fun | 2 comments

With all the fuss in the headlines recently about stimulant abuse, you’d think that medications for ADHD had caused the phenomenon. But it’s not true.  As long as humans have had access to substances, there has been abuse. Stimulants have been abused at least since 1928 and perhaps earlier. But for all we know, many cases of “abuse” were simply people with ADHD finding benefit from the stimulant. Today, however, there is no question that millions benefit from responsible ADHD treatment using stimulants.

The New York Times seems to be hyperfocused on shamefully boosting its website’s traffic by publishing irresponsible screeds about all aspects of ADHD that only compound public confusion and stigma. (I refuse to link to the stories, because that only encourages the trend.) The ADHD diagnosis and the legitimate medications used to treat it, however, haven’t caused these abuse problems.

If you’re too young to have heard the song, “Who Put the Benzedrine in Mrs. Murphy’s Ovaltine,” I’ve provided the video above. (Lyrics at the end of this post.) In my book, I write briefly about the history of neurostimulants , including the accidental discovery with Benzedrine that led to stimulants being developed as a treatment for ADHD.

Meanwhile, here is information adapted from Wikipedia on Benzedrine‘s history: Read the rest of this entry »

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A Pharmacist Explains Generics and More

June 15, 2012 in ADHD medication, The Basics | 14 comments

A pharmacist has written an informative comment to my last post on generic-same-as-brand Concerta. (Thank you, RL in Florida!)  I am re-posting it here to make sure more readers have a chance to read this helpful information. Your comments and questions, welcome. – Gina

Hello Gina and everyone.

I’m chiming in on behalf of the pharmacists. Just a little background on me. I live and work in Florida at a Walgreens pharmacy. I’ve been in the profession for 8 years now; we  have a large base of ADHD patients and we keep a large stock of every medication for a large population.

After reading all of the posts here, I am sorry that everyone has experienced the problems they have written about here. I’m providing a little bit more information that may help some people even though some others may not accept it. Read the rest of this entry »

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How’s Your Vitamin B-12 Level?

May 17, 2012 in ADHD and Health, ADHD medication, Brain Storming | 3 comments

David Edelberg, MD

Before I present this guest post from physician David Edelberg on how Vitamin B-12 deficiency can cause “brain fog,” depression, and more, let me tell you how I first came to know him as a physician-sleuth who makes important connections.

“How could I not have known about adult ADHD before?” Dr. Edelberg remembers asking himself after attending a lecture in the late 1990s. When he related this story, I was interviewing him not about ADHD but about fibromyalgia. I had identified him as a national expert on this debilitating condition that seemed to be targeting the partners of adults with untreated ADHD in higher-than-average numbers. Dr. Edelberg had made the connection, too. Read the rest of this entry »

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Update on Generic Concerta: Counterfeits?

February 20, 2012 in ADHD in the News, ADHD medication | 11 comments

Several comments to my previous post on the new Concerta generic (made available only in the U.S., not Canada) suggest that this “authorized generic” might not be exactly the same as the brand name, as claimed by the manufacturer. Then again, a news report this morning leaves me wondering if some people have received counterfeit pharmaceuticals.

A recap from the previous post:

The U.S. generic for Concerta is methylphenidate hydrochloride extended-release tablets. It is a co-licensed product by exclusive agreement — that is, a deal between the original manufacturer (Ortho-McNeil) and the pharmaceutical marketing arm of Watson Laboratories.

Both brand-name Concerta and the so-called “authorized generic” are manufactured in the same plant, said the Ortho-McNeil spokesperson by phone. And, this authorized generic is both bioequivalent and clinically equivalent. Does that mean it’s the exact same medication? I think so, but I cannot be absolutely sure at this point.

This morning, the California Report’s Sarah Varney explained a California law designed to protect consumers from counterfeit medications (the law has been fought by trade groups for years):

A state law meant to thwart counterfeit prescription drugs is finally set to go into effect 16 years after it first passed. The electronic tracking system will make business harder for those who sell fake drugs. (Listen to this short report here.)

I’ve found no data documenting counterfeit problems with the more expensive stimulant medications (Concerta, Vyvanse, etc.). And readers’ comments offer no details on where the medication was purchased.  Stay tuned. And please share any tidbits you learn.

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Neurofeedback for ADHD: State of the Science

January 30, 2012 in ADHD medication, science of ADHD, The Basics | No comments

People often ask me if neurofeedback is an effective treatment for ADHD. Given that the expert consensus is “maybe” or “sometimes,” I try to answer along those lines, pointing out that many factors should be considered. For example:

  • How quickly do you need results (is a child about to fail a grade or an adult about to lose a job or relationship)?
  • How plentiful are your resources (if you try neurofeedback and it doesn’t work, is there money left in the budget for traditional treatment)?
  • What are the credentials and reputation of the clinician providing the neurofeedback?

Some people assume that neurofeedback is safer than medication, but the fact is that potential for its side effects has never been studied.

Thanks to David Rabiner,  Associate Research Professor at Duke University’s Department of Psychology  Neuroscience, I can share with you (below) a sophisticated analysis of the research.  Dr. Rabiner has long performed the excellent service of parsing the research around ADHD in his newsletter, Attention Research Update. You can subscribe to his free newsletter here, and read through the substantial archives once you are subscribed

As a layperson, I appreciate his clear writing style, but research terminology can be complex and this analysis might be “too much information” for some of us. Please consider that clear-cut answers aren’t always easy to give on complex subjects.

The bottom line, as Dr. Rabiner writes below:

“The research reviewed here indicates that if parents obtain high quality neurofeedback treatment for their child there is a reasonable basis for expecting that benefits will occur. The decision to do so should be made with the knowledge that medication treatment and behavioral therapy would be regarded as having stronger research support at this time.” Read the rest of this entry »

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Vitamin B12 and Cognitive Function

November 30, 2011 in ADHD and Health, ADHD medication | 3 comments

A quick note to share with you this important article on Vitamin B12 in The New York Times.

I lived for many decades not knowing I had borderline pernicious anemia. Finally, a smart physician directed me to supplement B12 with injections. So every week (or when I remember), I stab myself with the required ccs of the red stuff.

But you needn’t have such an obvious condition to question if your B12 stores are all they should be, especially if you eat a mostly vegetarian diet, you take an antacid, or your meals are haphazard.

Other signs of B12 deficiency include muscle weakness,  fatigue, shakiness, unsteady gait, incontinence, low blood pressure, depression and other mood disorders, and cognitive problems like poor memory. Remember that the nervous system (including brain cells) relies on an adequate supply of key vitamins and minerals. Moreover, some medications will increase your need for these nutrients. Read the rest of this entry »

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