Janet recalls with a shudder the first time she took medication as a treatment for attention deficit hyperactivity disorder (ADD/ADHD). “I was glued to the sofa, unable to move for two days,” says the 37-year-old mother of two, and a marketing manager for a Silicon Valley software company. “I looked and felt like a zombie. It scared me off medication.” For Janet’s husband, the incident confirmed his long-held belief that giving ADD/ADHD medications to their 10-year-old son would be tantamount to drugging him.
When Janet later attended a local adult ADD/ADHD discussion group, she learned that some people who reported great results from taking medication said it took weeks for most patients to tolerate the dosage the doctor had prescribed her -- and that many were taking half that amount.
“I should have educated myself first, instead of trusting the physician,” Janet says. “Now my husband gets upset if I talk about trying medication again. It created a wedge between us; I’m giving up higher functioning for myself and my son because of my husband’s fears.”
Janet’s experience is becoming less common. Increasingly, physicians are learning how to use medication to treat adults with ADD/ADHD, although many adults still encounter professionals whose knowledge of meds management is spotty, including psychiatrists who claim special expertise.
“You might call adult ADD/ADHD an ‘orphan’ disorder,” says Margaret Weiss, M.D., Ph.D., a preeminent ADD/ADHD clinician scientist, based in Vancouver, British Columbia. “That’s because most professionals with the expertise to recognize and treat ADD/ADHD work in child services; they are not working in adult centers or seeing adults.”
The bottom line for adults with ADD/ADHD is: Be a smart health-care consumer, and learn as much as you can about medication before you start taking it. The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDRA), a coalition of ADD/ADHD experts, has created comprehensive treatment guidelines for patients, parents, and physicians. The practice guidelines, including charts of medications, are available as a free download on CADDRA.ca. My own book, Is It You, Me, or Adult A.D.D.? is another good source, as is the e-book “ADHD Treatments,” from ADDitudeMag.com.
In the meantime, if your prescribing physician makes any of the following 10 statements, share a copy of the CADDRA guidelines with her and talk things over, or find a new doctor.
1. “My adult ADD/ADHD patients do best on this stimulant medication.”
Physicians who “play favorites” with stimulant medications -- the first-line treatment for ADD/ADHD -- don’t have an empirical basis for doing so, and are gambling with your chances of success. Here’s why.
There are two major classes of stimulant medications: methylphenidate, or MPH (Ritalin, Focalin, Concerta, Daytrana, and others), and amphetamine, or AMP (Dexedrine, Adderall, Vyvanse, and others). The MPH class works best for some people who have been diagnosed with ADD/ADHD, but has no effect, or a negative effect, on others. The same is true for the AMP class. There is no way to predict how you will respond to each class until you try it.
Physician and ADD/ADHD specialist Patricia Quinn, M.D., suggests trying both classes of stimulants (MPH and AMP) before deciding that stimulants won’t work for you and moving on to a nonstimulant medication: “You might even try several meds within the same class before switching to another stimulant class.” For example, Ritalin LA and Concerta are both long-acting medications in the same class (MPH). Due to their different delivery mechanisms, however, each brings different results.
This article appeared in the Fall 2011 issue of ADDitude. SUBSCRIBE TODAY to ensure you don't miss a single issue.