Treatments for ADHD

by Food and Drug Administration (FDA)

(Page 3 of 4)

A number of FDA-approved medications are available to help treat the symptoms of ADHD. Some people have better results from one drug, some from another. "But treatments need to involve a behavior modification program," says Andreason. "Medicine is only an adjunct to behavior modification."

Children with ADHD may require emotional counseling and behavioral management involving parents, teachers, and health professionals. Adults with ADHD may benefit from counseling, vocational guidance, and professional coaching done by specialists who help individuals develop coping skills and methods for organization and time management.

Jergen has developed his own coping strategies, and daily exercise is an important one. "When my mind is in a fog, I get on the treadmill and break a sweat, the fog parts, and I can concentrate," he says. He's also set up his office environment with special lighting and soft music to help him relax and concentrate.

People with ADHD may be hyperactive, but, surprisingly, they are often prescribed a stimulant to help treat the symptoms. Stimulants can improve alertness and attention without making the hyperactivity worse.

FDA-approved stimulants for children ages 6 and older include products containing various forms of methylphenidate, amphetamine, and methamphetamine.

In August 2004, the extended-release form of the stimulant Adderall (Adderall XR), previously approved to treat children with ADHD, was also approved to treat adults with ADHD. An extended-release form of a drug works in the body over a longer time than an immediate-release form, allowing the medication to be taken less frequently.

Adderall or other stimulants should not be taken by people with certain conditions, including hyperthyroidism, glaucoma, moderate-to-severe hypertension, other heart-related conditions, or a history of drug abuse. Some common side effects of stimulants are insomnia, decreased appetite, and increased anxiety or irritability. Children who take stimulants may grow and gain weight more slowly, and growth should be monitored by their pediatricians.

Because stimulant medicines have a high potential for abuse, the U.S. Drug Enforcement Administration has placed stringent controls on them. For example, the DEA requires special licenses to manufacture, distribute, and prescribe these controlled substances, and prescription refills aren't allowed.

One other drug, Strattera (atomoxetine), is FDA-approved for use in adults with ADHD as well as in adolescents and children ages 6 and older. Strattera is not classified as a stimulant and does not seem to have a potential for abuse. It is not classified as a controlled substance, so it can be prescribed with refills. Strattera increases the levels of the neurotransmitter norepinephrine in the brain, whereas the stimulants work primarily on the neurotransmitter dopamine. Strattera may take three or four weeks for its full effectiveness to kick in; stimulants can have a nearly immediate effect in some patients.

Strattera causes an increase in heart rate and blood pressure and should be used with caution in people with hypertension or heart-related conditions. In clinical studies, the most common side effects of Strattera in adults were dry mouth, headache, insomnia, nausea, decreased appetite, and constipation. In children and adolescents, common side effects were stomachache, headache, and decreased appetite. Like stimulants, Strattera may slow weight gain and growth in children, and these measures should be monitored by a pediatrician.

Treatment Decisions

Galil, who treats both children and adults with ADHD, says she doesn't use medications as frequently in adults. Parents bring children to her because they're not doing well at school or their behavior is disruptive, she says, but adults who haven't been diagnosed as children often "have found ways to cope without medication for years." Sometimes, she'll prescribe a stimulant as needed for specific tasks, such as for an events planner who was "marvelous at events with a headset on and 4,000 people around her, putting out a fire a minute," but didn't do well sitting back at the home office doing paperwork. So she'd take medication on a day that she needed to spend time on paperwork.

"With children, it's different," says Galil. "They often benefit from medication seven days a week. Adults, by and large, don't want to be on medication all the time." But with diagnosis and treatment, "some who never finished college or graduate school now have the tools to go back and finish."

Wood is one of these. Since she's been on medication, she went back to college and earned a second degree. "I saw such a difference," she says. "College was so much easier" and so were routine household tasks, like paying bills. Wood is now an ADHD coach, helping other people cope with the disorder. Once he was diagnosed with ADHD at age 24, Jergen said it took about two years of trying different medications and dosages to find out what worked best for him. Like Wood, he found that tasks became easier for him. He got his doctorate in special education, published five books in two years, and became an associate professor at the University of Wisconsin-Oshkosh. "I have a lot of energy and I don't sleep a lot," says Jergen, who recounts his experiences with ADHD in his book, The Little Monster: Growing Up With ADHD. Jergen urges parents of children with ADHD to help them use the energy to be productive instead of making them slow down.

After 10 years of taking various stimulants, antidepressants, and mood stabilizers, Jergen went off medications in 2002 because of their sexual side effects and the development of a vocal tic that caused him to make involuntary noises. He continues teaching and writing, recently got married, and says, "My life is just fantastic."

"I'm still hyperactive, impulsive, and inattentive," adds Jergen. "If I were an air traffic controller, planes would be crashing." But Jergen, known as a dynamic speaker, says he's in his element in front of a class.

About the Author

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