[chaotic13]

Here is a link to an randomized control trial for the use of Adderall (dextroamphetamine sulfate) for the treatment of ADHD in adults.

Arch Gen Psychiatry

[chaotic13]

Here is a Case Report highlighting the diagnosis and treatment of a 36 yr old female. Although the strength of this evidence is low, I really liked this article because it was easy to understand and covered a patient from diagnosis through a successful intervention. It also has a assessment tool in the article.

This article was one that I copied for my GP when I asked for treatment for ADHD.

Assessment and management of attention-deficit hyperactivity disorder in adults

[chaotic13]

Just to make sure I am being balanced here is an double-blinded cross-over design study comparing methylphenidate (Ritalin) with atomoxetine (Strattera). This is a good study design but the number of subjects was very small (only 9). This may be why there was no significant difference found. Also this study measured the effect on the brain, and not on the subjects' actual symptoms. So unless you are interested in brain neurophysiology you might want to skip this link.

I needed a double does of my Adderall to get through this one :-)

Comparison of the inhibitory and excitatory effects of ADHD Medications Methylphenidate and Atomoxetine on Motor Cortex

[chaotic13]

Here is a nice article to use to defend yourself against the physician that refuses to give you or your child a stimulant medication for fear it will increase your chances of developing a substance abuse problem. Again the level of evidence needs to be questioned because it is just a review of literature article. You can alway pull the references and look at them individually.

New Research in Adult ADHD

We may not be a very healthy, well adjusted group of people but stimulants are considered a safe and effective treatment option.

[sunrise]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
mckell13 said:
Here is a nice article to use to defend yourself against the physician that refuses to give you or your child a stimulant medication for fear it will increase your chances of developing a substance abuse problem. Again the level of evidence needs to be questioned because it is just a review of literature article. You can alway pull the references and look at them individually.

New Research in Adult ADHD

We may not be a very healthy, well adjusted group of people but stimulants are considered a safe and effective treatment option.

</div></font></blockquote><font class="post">
McKell, I am unable to access this one. It gives me a login page that requires a user name and password. Can you post the reference info (journal, author, etc.) and maybe I can find it online? Is the actual title, "New Research in Adult ADHD"?

Thanks so much for posting all these articles. I really appreciate it.

[sunrise]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
mckell13 said:
Just to make sure I am being balanced here is an double-blinded cross-over design study comparing methylphenidate (Ritalin) with atomoxetine (Strattera). This is a good study design but the number of subjects was very small (only 9). This may be why there was no significant difference found. Also this study measured the effect on the brain, and not on the subjects' actual symptoms. So unless you are interested in brain neurophysiology you might want to skip this link.

I needed a double does of my Adderall to get through this one :-)

Comparison of the inhibitory and excitatory effects of ADHD Medications Methylphenidate and Atomoxetine on Motor Cortex

</div></font></blockquote><font class="post">
Do you know of any articles comparing Strattera to either Ritalin or Adderall in which the Strattera did poorly by comparison? That is the sort of article I would like to show my doctor just in case she suggests Strattera instead of a stimulant.

[chaotic13]

New Research in Adult ADHD

This article can be accessed for free. Medscape is a good general medical information Web site. You just need to create an account to view some of the good articles. Accounts are free, they just require you to register.

[chaotic13]

Sunrise,
I'm posting posting here some details about my experience with getting diagnosed. Maybe you and others will find it a little helped as you navigate through this process yourself.

Dealing with GP can be challenging and my 1st attempt ended in my losing the doctor I had for 15 years. So think hard and prepare for your visit. Here's what I did the 2nd time around and it turned out to be a really good outcome. Disclaimer: I am simply sharing my personal experience here.

What do you say to the receptionist when you call for the appointment:
I simply told her I wanted an appointment, period. In my case I was switching GP so it was a new patient visit. I would just say you want come in for a basic health check-up.

How can you start the conversation:
When he/she enters the room, you can say that you are interested in being evaluated for possible ADHD. If your GP is like mine, he/she will likely not know much about the condition other than the basics. This is where your articles come in.

Do you have to tell your GP that you are in therapy or being treated for other "mental" issues?
I did disclosed this but I don't think you have to. I had several reasons for disclosing. 1) I wanted my new GP to oversee my overall medical care. I had just lost my old GP, and I was done messing around, I wanted quality comprehensive medical care which means I needed to have an informed MD treating the whole me. 2) I was done kissing ***, I wanted open and direct communication. I disclosed to him that I had just left my old GP, because I was not satisfied by he me over this medical concern. This really got my new GP attention and cued him into the fact that I expected that my medical care was going to be a collaborative effort, not just him telling me what to do. 3) I thought having a therapists opinion would strengthen my case. I personally told my GP that started therapy because of "family issues" and that after several sessions the therapist thought I had some clear symptoms of ADHD. I did not elaborate on what the family issue were. Since I knew he had very little personal experience with treating ADHD patient, I felt this disclosure strengthened my position a bit because psychologists see ADHD patients all the time. Also since ADHD is often not a stand alone condition, adult's often have other issues such as anxiety and depression and my GP was likely going to want evidence that these issues had been ruled out or were being treated. I will also share that I was very careful in how I phased this conversation. I did not want him to think she (a lowly psychologist) had made a diagnosis. I instead said that she had noted that I had symptoms consistent with this disorder and recommended that I consult you (my GP) to discuss this condition and possible treatment options. In my state physicians like to think they are the ones who make diagnoses.

Having said all that I think you don't necessarily have to tell the GP that you are in therapy. You can say that you've had these symptoms for a long time, were talking to a friend and that lead you to look up information on the condition...bah...bah...bah...

How to raise the medication issue
This is again a very touchy topic. You may not want to bring up your desire for medication up front. My first GP was really pissed when I requested Adderall directly, I guess he thought I was playing MD and telling him how to treat me. With my new GP I did not want to seem like I was there just to get some speed. I am overweight and I was worried that he would just think I wanted to get a stimulant for weight loss. Also, this gave me an opportunity to recognize that I WASN"T a doctor and that I did not know the best course of action. I have slight hypertension and this is a concern when choosing which medications I can take. Letting my doctor know that I respected that HE was the most qualified to make the Rx decide was important. If I wanted a collaborative relationship I had to show that I was willing to listen too.

Here is what I did. I shared my symptoms and the self assessment I found online and completed. I gave him this assessment to him for my medical file. I also openly and honestly answered his all of this questions. I explained that I had alway had these symptoms, that I had problems in school, that I am embarrassed by them and go to great length to hide them from others, etc.. And I explained why now at 42 I wanted to pursue diagnosis and treatment. I explained that I felt I had developed some good coping skills over the years but that at this point in my life I needed a little help. He asked me some very direct questions about this point in my life and I answered them honestly, including that I started therapy because I was afraid I was beginning to suffer from depression. I think the fact that I was open and showed I was serious about him overseeing my overall medical care (not necessary getting into private details of my therapy sessions) and that I would not hide important information from him. I think GP is really great about showing concern but not prying. The last time I saw him he asked me about therapy and if I needed anything else from him that could augment it. I really like my new MD :-)

Stimulant vs. Non-stimulant Medication
I let the him know that I had done some homework and reviewed different treatment plans for ADHD. Although he was not well informed on ADHD I kind of let him raise the issue of medications. I then said that the information I found seemed to indication that there are two types of medications commonly prescribed. I was well prepared but not pushy. If you really want to try the stimulant med, be prepared for the argument that it is a "controlled-substance" that is potentially addictive....bah...bah...bah.. My response to this was, I have never demonstrated addictive tendencies, I am willing to be followed closely by you, I understand the potential risks. The information I've found acknowledges that addiction is a possibility, but that stimulants such as Adderall and Ritalin have been studied for years and have been repeatedly reported to be safe and effective. I'm not asking for a year's supply, I am asking for a trial Rx for a week to see if it helps me. You and I can then decide if this is appropriate for me to continue.

This is where I made a mistake with my first physician. I did not research the non-stimulant medications so when my 1st GP suggest this, I was not well-prepared to counter it. I was the second time around! Although it may feel it is safer, I had real reservations about the Strattera. The long list of side-effect and the fact that you have to take it for a while before you realize any benefit, really turned me off.

I also didn't understand that there maybe some pressure within the medical community on GP not to prescribe stimulants. I had to accept that my GP may seek to refer me. Which in my case both GPs I dealt with were not willing to Rx a stimulant.

Dealing yet another doctor
This fact was very difficult for me because I had hid my ADHD for so long and I did not want to talk about being mentally defective to more strangers. However, my GP did not feel he was qualified to deal with ADHD alone. He listened to me, said he would act as my personal "medical director' but that he did not feel comfortable Rx medication for this condition. I live in a somewhat rural area and psychiatrists are few and far between. I did not like the idea of seeing someone just for medications. In my case my GP is part of a large medical practice and referred me a neurologist within the practice. I feel my neurologist is just a middle man (my sugar daddy). I don't know why it is OK for him to Rx me the Adderall and not my GP; but I am just dealing with it. It was simply another $15 copay that I incurred every 3-4 months. It was something I have to life with in order to get the treatment I wanted.

Well sorry for the length of this post. I am currently on Adderall XL and my symptoms are much better. It is not a cure all but it does help me. At this point I would say that my medical care has been successful.

[chaotic13]

Sunrise,
No I would not necessarily used the Comparison article I posted in my office visit. Mainly because of the variable measured--cerebral cortex EMG activity @!#??. I could careless what chemical reactions are going on in my brain, I just want to function better. Also this is not a good one for arguing Stimulant Over non- stimulant. I will look later today for a good systematic review or RCT for you to use. I had two separate RCT articles that each showed Strattera and Adderall to effective in treating ADHD. However the success overall success rate and % of symptom reduction in the Adderall study was much higher than the Strattera. I don't know where I saved these files. I try and find them again. It is my (laypersons) understanding that Strattera was originally studied as an anti-depressant medication but when the results fail to show significant positive effects they switched gears and went after the ADHD market. There is a lot of evidence that stimulants are effective in treating ADHD and with the exception of the potential for addiction and some other minor side-effects, it was more appealing to me to try a stimulant medication.

The Strattera side-effects listed as one of them abnormal orgasms . WTF does that mean?

Although I would really love to be reminded of what an orgasm feels like, I certainly have no interest in experiencing an "abnormal" one.

I'll try to find a good article for you. If it is not free I will email it to you.

Hope your are doing OK.

[sunrise]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
mckell13 said:

New Research in Adult ADHD

This article can be accessed for free. Medscape is a good general medical information Web site. You just need to create an account to view some of the good articles. Accounts are free, they just require you to register.

</div></font></blockquote><font class="post">So this is the actual title of the article? The reason I asked for title and authors is because I thought it would be easier for me to find on my own rather than use that link you provided that just goes to a login page. I can access PubMed at work without having to sign up for anything, so that' s why I wanted that information--I thought if I knew the reference, I could get it at work. Thanks.

[sunrise]

McKell, thanks so much for the detailed info on your experience getting treated for ADHD. I was wondering about whether going to the GP after I go to my T is a good idea, since it sounds like the GPs can't really help. I will approach my T first . If he thinks I might have ADD, wouldn't he give me a referral to a doctor (pdoc or neurologist?) who could help instead of making me go first to a GP who couldn't help? I'm just not sure how it works as I have never been to a pdoc, but my previous therapist did give me a direct referral to a pdoc at one time (although I didn't use it). I would love to be able to skip "the middle man" GP and go straight to someone who can help me.

</font><blockquote><div id="quote"><font class="small">Quote:</font>
I will look later today for a good systematic review or RCT for you to use. I had two separate RCT articles that each showed Strattera and Adderall to effective in treating ADHD. However the success overall success rate and % of symptom reduction in the Adderall study was much higher than the Strattera.

</div></font></blockquote><font class="post">Yes, this is the sort of article I would like! If you find the ones you are thinking of, please let me know. What is RCT?

Yes, I agree, "abnormal orgasms" sound scary!

Thanks again for all your great info.

[chaotic13]

OK Sunrise the more I look at the stuff available on Medscape the more I like it.

There is a lot of good stuff at this site and it is not to researchy.
Go to medcape.com and create a free account. I've had my account for a long time to I can't really remember but I think they ask you to choose a specialty. I don't think it matter other than they offer different homepages related to your specialty and send you email with article abstract if you select his option. Each homepage may be slightly different. The specialty I chose is Orthropeadics and at the top of my homepage is a search option.

I used "Adult ADHD" as my search string. If you want to search just the Medscape site select, the Medscape radio button below the search field. This search return 478 hits (the default ALL search yield 488).

The New Reseach on Adult ADHD is like the 9th link.

What I like about this resource is that it is designed as a continuing education module for physicians so it has several articles. This particular module also include an article on Pharmacotherapy of Adult ADHD which is good.

Did you get the other stuff I emailed you. I figured out how to save this particular article in HTML without need need of the supporting graphics files. I will try to send you a copy of it too via email.

[chaotic13]

SUNRISE,
I just found an excellent article for your trip to your GP.

Adults With Attention-Deficit/Hyperactivity Disorder: Assessment and Treatment Strategies. Wadsworth, John S.; Harper, Dennis C.; Journal of Counseling & Development, Vol 85(1), Win 2007. pp. 101-108.

I'm sending this one to your email as a PDF file.

BTW, if anyone else is lurking on this thread and would like an article let me know. My search skills are not at the librarian level, but I have developed some electronic search skills.

[chaotic13]

Not sure if this will help anyone or not but just thought I'd share it.

Tip for people searching pubmed.

http://pubmed.gov

If you have never used PubMed before here is what I did to locate some good ADHD sources.

1. Look at the blue area on the left-hand side of the page. Half way down there is a section called PubMed Services. In this area click on the link called Clinical Queries.

2. Search by Clinical Study Category or Systematic Reviews (SR) both lead to good, credible references.

3. I did a quick search using the the Clinical Study field and limited my search by using the Category and Scope buttons below the search field to limit your search. I selected the Therapy and Narrow specific search options

3. I used a simple search string like "ADHD and Adults"

4. This returned 112 hits, which is manageable.

5. The references with the orange and green stripped icon indicate that the full text is available.

I would love to know if anyone else has any tips for locating sources.

[chaotic13]

Here is another source to share with your doctor. What I like about it is that it is short and too the point. It has some very basic research highlights and several case study highlights.

Even better you could just give the URL to your doctor and he/she can get some CME credit for it.

Understanding the Complexities in the Differential Diagnosis of Adult ADHD

[sunrise]

Thanks so much for the references for the new articles, McKell. By the titles, they sound like they will be really useful.

</font><blockquote><div id="quote"><font class="small">Quote:</font>
mckell13 said:
The New Reseach on Adult ADHD is like the 9th link.

</div></font></blockquote><font class="post">So the actual title is "New Research on Adult ADHD"? Sorry I keep asking this, but I want to find the article using PubMed (since that medscape link requires you to be registered), and it helps to have the title or authors or journal or something. I don't need to do what you suggested about registering for MedScape as I already have PubMed access. I just need to know the article titles and so on so that I can find them when I search PubMed at work. I'm a scientist so I don't mind if the articles are too researchy. We love that stuff!

I'm going to print out some of these papers, and you know how I'll be spending my weekend.... (if I can focus long enough, that is) We should read the articles and then have "book club" (with beer and chips, of course).

Sounds good, I'll join I have ADD and take the stimulant Provigil which is not in the class of Adderall. I am prone to becoming addicted to stimulants, which is why I no longer take Adderall, although it helped immensely. I see a T and a Pdoc who work closely together. Provigil has been a life saver for me. It isn't in the class of Adderall but is effective (although not AS effective). If I didn't have this history, my Pdoc would have had no qualms about prescribing me stimulants. It's sad that people have to work so hard to get the help they need. Provigil helps me so much at work, when I don't have it I can barely function. I still have absolutely no organizational skills but am trying to learn to accept myself as I am even if I do lose everything. Take care!

[chaotic13]

I just watched a short PBS program that was somewhat interesting called Change your Brain Change your LIfe. Change Your Brain Change Your Life The author of this book is Dr. David Amen who is a child and adult psychiatrist.

The recommendation presented in this brief program where:

* Exercise: In particular moderate to high intensity aerobic exercise and activities that require balance and coordination. These are thought to require focus and concentration increasing the activity of the PFC. There is a lot of evidence to support the use of aerobic exercise to improve mood and overall brain function.

* High protein, Low Carb. Diet: I'm not sure about this one. Seems like supporting evidence is limited. Does any one else know of credible evidence to support this recommendation?

* Take Omega-3 fish oil supplements. I found this recommendation interesting. My H's cardiologist recommended he take this supplement following his heart surgery. I know it was thought to be effective in lower triglycerides and help prevent atherosclerosis. According to the Mayo clinic there is "C" level evidence supporting the use of this supplement in treating ADHD problems. Omega-3 FA Info from the Mayo Clinic

* Stimulate the brain by learning NEW skills. [i] I did not look for evidence on this one mainly because it simply made sense. It seems consistent with the "use it or lose it" concept.

[sunrise]

Both my T and my PNP spoke to me about Dr. Amen. He has a web site with assessment tools for ADHD and they both wanted me to take these. I did the first test and then the second to fine tune my diagnosis according to Amen. Then when I was done, it gave me the results and there were 4 different categories. These corresponded to which part of your brain was involved in your particular presenting symptoms. Based on that, a different diet, nutritional supplements, and medications were recommended. For example, one of the 4 subtypes did best on a high protein diet, and another on high carbs, etc. So according to Amen, there would not be just one size fits all for a best diet. Similarly, supplements and meds.

I don't know if there is anything to this or not, but his meds recommendations for the different types made some sense to me.

[chaotic13]

Yes I did not read his book but his quirkiness caught my attention while flipping through the channels yesterday and I actually stayed and watched the program... even enduring the PBS repeated requests for donations

I wrote down his basic recommendation and then did a quick search to see if they were supportable and most of them were.

Did your PNP or T mention anything about diet to you? This was the only thing that I really didn't see much evidence for. Also with my other CV issues I don't think a high PHO, low Carb diet is a good option for me. The Omega-3 supplement was interesting, I might try this.

[sunrise]

chaotic, no, I didn't speak about diet with my practitioners, that was just from the Amen website. I try to include things in my diet high in omega 3s for reasons of blood pressure and cholesterol (they help if you are low on the "good" cholesterol). Flax seed oil is very high in omega 3s and a good substitute for fish oil. I don't take flax seed or fish oil, but I try to eat salmon once a week and foods high in flax, such as certains muffins, etc. Also, the "Berries Go-Mega" fruit juice drink from Odwalla is very high in plant-based omegas; it contains 720 mg flax seed omegas. (It's also kind of pricy.) That is one of the highest sources I have found besides drinking the pure oil (mixed with some juice of course!).

I think I would do well on a high protein low carbs diet. I really like high protein foods, and carbs tend to make me blimp out. I have tried in the last couple of years to eat more red meat as I am chronically anemic and don't do well on iron supplements. My doctor once said, "eat more meat!" (for gosh sake).

I wish I had printed out the diet recommendations for the different types of brain problems from the Amen website. You can only get to it from the results of your test, so I would have to pay money again to get to that page. One thing that makes me suspicious of the somewhat quirky Amen is that he sells all these nutritional supplements and vitamins on his website. So I think there's a significant conflict of interest there on what his recommendations are. My mom was watching those Amen shows on PBS also, and was interested. She said he was making an appearance locally and she would have been interested to go hear him speak but it cost $75. Again, something that makes me suspicious. He has quite an empire going.