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ADHD medications

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After advising caution regarding generic medications for ADHD here and here, I’m now hearing that Concerta is recently available in a generic form in the United States. (A generic has been available in Canada for some time, but it is a different type of generic.) The question: Does this generic perform as reliably as Concerta? Maybe. In fact, it might be the exact same medication.

Original Concerta, 54 mg

The details are hard to come by in a field swimming with lingo: co-licensed product, single-source generic, authorized generic, bioequivalent and clinically equivalent. My conversations with pharmacists and the manufacturer’s scientific liaison leave me thirsting for straight talk with no tricky qualifiers. Internet searches and first-person reports in online forums are made murky by the apparently marked difference between Canada’s generic Concerta and that in the U.S.. (Forum participants seldom specify where they live, presumably because most don’t realize there is a difference between the two countries’ generic versions of Concerta.)

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. Read the rest of this entry »

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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 »

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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 »

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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 »

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Pressured by Congress to crack down  on performance-enhancing drugs and “false claims of A.D.D.,”  Major League Baseball is pleased to report that the number of exemptions for ADHD medications are tapering off.  Is this really news worth celebrating?  I’m not so sure.baseball

In 2007, the number of players receiving exemptions for ADHD rose to 108, from 28 in 2006.  That figure strikes me as reasonable, not alarming, given increasing public awareness during that time period.

After all, the players receiving exemptions represent about 9 percent of total players, which number  1,200 or so.  Extremely conservative estimates place the percentage of adults with ADHD in the general population at about 4 percent, but experts acknowledge that using more realistic criteria bumps the figure as high as 16 percent.

Yet, as reported in a previous post (“Anti-Doper Doc Dopey about ADHD?”), this spike created quite the rhubarb among sports officials, including non-savvy ADHD physicians. (“This is incredible. This is quite spectacular. There seems to be an epidemic of ADD in major league baseball,” said Dr. Gary Wadler, chairman of the committee that determines the banned-substances list for the World Anti-Doping Agency.)

This recent article in The New York Times article (“Number of M.L.B. Players Given Drug Exemptions Up Slightly“) explains the latest report on all medication exemptions.

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Live a few decades not knowing that you have ADHD, and chances are you’re lugging around not onlyDr.  Charles Parker 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 »

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