Monday, June 1, 2009

Attention Deficit Hyperactivity Disorder part 4

I want to talk a little bit about medication treatment for Attention Deficit Hyperactivity Disorder (ADHD). First of all, medications are effective at improving not only symptoms of the disorder but also can increase the level of functioning and complications of the associated features such as poor academic performance, decreased self esteem and demoralization, anger outbursts and mood problems as well as decreasing the likelihood of development of Oppositional Defiant Disorder and Conduct Disorder. Secondly as I mentioned before the psychosocial and behavioral interventions for this disorder are generally not very effective in the absence of medication treatment. Thirdly, any medication is not without it's hazards and difficulty and the medications used to treat ADHD are no different.

A number of medications have been tried and used for ADHD including antidepressants, anti hypertensives, and stimulants but there are two groups of medications that have current FDA approval for the treatment of this disorder. The first are the stimulants. These are amphetamines or amphetamine like drugs. Some commonly known ones are methlyphenidate (Ritalin), and the amphetamines Adderall and Dexedrine. Methlyphenidate now comes in various extended release forms for ease of use which include Concerta, Focalin, and the transdermal patch Daytrana. In addition to the amphetamines Dexedrine and Adderall there is a relatively new medication, Vyvanse, which when first metabolized becomes dextroamphetamine. All of these medications work by increasing the availability of the neurotransmitter dopamine. The second type of medication FDA approved for the treatment of ADHD has only one drug, atomoxatine (Strattera) which works by increasing the availability of the neurotransmitter norepinephrine. Both dopamine and norepinephrine are neurotransmitters that are necessary for many brain functions and include the functioning of the prefrontal cortex which is responsible for planning and foresight, monitoring and error correction, delayed gratification, impulse inhibition ,decision making, abstract thinking, attention shifting, information manipulation and social functioning all of which are impaired in ADHD.

Like all medications the use of the stimulants and atomoxatine carry some risks as well as benefits and these must be carefully weighed in each individual situation. I will outline some of these tomorrow.

Thought for the day

" Sometimes and ending can be the beginning of something wonderful".

Winnie Haller

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