Thursday, 1 May 2014

Treating Adult ADHD

WebMD Feature

Reviewed by Joseph Goldberg, MD

Attention deficit hyperactivity disorder (ADHD) is a childhood condition that can last into adulthood in about one-third of cases.

If you've been diagnosed with ADHD as an adult, chances are good that your doctor has prescribed a medication -- typically a stimulant -- and suggested cognitive behavioral therapy or even a life coach. She might also have suggested a good pocket planner.

Treating ADHD in adults requires a multi-pronged approach. Symptoms are generally treated with medicine.

But it's not just a matter of taking a pill. There is work to be done on practical stuff, such as getting organized, and on other emotional issues that often come with the territory.

What Kind of Medication, and for How Long?

The same kinds of medications used for childhood ADHD work in adults, says Lenard Adler, MD, a psychiatry professor at New York University Langone Medical Center and director of the Adult ADHD program at the NYU School of Medicine.

Stimulants such as Adderall, Concerta, Focalin, Vyvanse, Quillivant, and Ritalin in long-acting form are often prescribed for symptoms. Strattera, a nonstimulant approved for treatment of adult ADHD, is also widely prescribed, he says.

Other medicines used to treat childhood ADHD may also help adults, such as Catapres (clonidine), Intuniv (guanfacine), and the antidepressant Wellbutrin (bupropion).

Choosing the right medication for a patient with ADHD is often about avoiding worsening other health problems. For instance, Adler says he wouldn't prescribe a stimulant to a patient who has a substance abuse problem, because stimulants have a high potential for abuse.

Your history of taking ADHD drugs also matters. Adler finds out what the patient has taken previously and, because ADHD has a strong genetic link, what family members with ADHD have taken and tolerated.

Adler, a psychiatry professor at NYU's School of Medicine, has received grant/research support from various makers of ADHD drugs.

What Kind of Side Effects Might Occur?

Adults with ADHD and a family history of heart disease and fainting should consider the effect of ADHD drugs, both stimulants and nonstimulants, although they are considered safe in the short term.

"They are generally safe medications," Adler says. But even patients taking Strattera need to have their blood pressure and pulse monitored. He starts patients on the lowest dose to gauge their tolerance.

Side effects that are common in stimulants include agitation, insomnia, and changes in blood pressure and pulse. Potential side effects of Strattera are similar and may also include nausea, Adler says.

How Long Should I Take the Medication?

That depends on your particular case.

"With kids, we recommend they stay on it throughout the school year. It helps them learn better. That's true for college students, too. Post-college, it's going to depend on the situation, the stressors, how they're handling them. Will you always stay on medication? It's an individual decision," says Angela Tzelepis, PhD, a psychiatry professor at Wayne State University who also runs a clinic in Grosse Pointe, MI.

"Our focus is now on assisting patients in maintaining these improvements and continuing to make meaningful, positive changes in their lives," Adler says.

source : Treating Adult ADHD

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