My Scottsdale Practice Treats a Lot of ADHD
ADHD, in and of itself solely, could be considered one of the easiest mental disorders to treat with nothing short of a miracle effectiveness with the first treatment dose of the medication most commonly used to treat it. My patients routinely tell me on their second visit that it was “a miracle” what happened to them even on the first day. This is one of the reasons why I love treating ADHD.
ADHD or Attention Deficit Hyper-activity Disorder is now the term that covers both ADHD and ADD, in that, one is considered to have the combination of inattentive symptoms plus hyperactive/impulsive symptoms or predominantly the hyperactive/impulsive component alone; and the other tends to have predominantly the inattentive symptoms to meet the diagnostic criteria. We just specify the predominant symptoms are. Nevertheless, the treatment is the same. So, don’t let the nosology confuse you.
ADHD is Ususally Very Responsive To The First Line Medication
The primary and first order medication usually used to treat ADHD is a class of medication, called stimulants. In my practice, I would say, possibly 80% of my patients will respond to the first mediation that I prescribe. That may well be a conservative percentage too. The effects from this medication will be experienced within generally one to two hours after taking the prescribed medication. So, knowing whether to stay with this mediation or try a different one is a relatively quick process. You don’t need to wait two to four weeks as with antidepressant medication to know if it is working. Among the benefits of ADHD treatment, people don’t usually experience any weight gain or decreased libido that can more commonly occur with antidepressant medications; in fact, patients tent to loose weight on stimulants due to the suppression of appetite that the stimulants cause as a side effect. It can take a few weeks to a few months to get to the right dose of medication that will help you throughout the day; but again the effects of ADHD medications are apparent within the first day of use and treatment.
What if The First Medication Doesn’t Work?
If my patient is not responding to the medication or having adverse side effects, we will discuss with the patient and then try several other stimulants until one is found to be effective. If for some reason the stimulants are not effective, (which is not very common) I will often prescribe a relatively newer (though this medication will go generic at the beginning of 2014) medication on the market, named Strattera. Strattera is a medication that we are using to treat ADHD in adults; and it is not an anti-anxiety or anti-depressant medication. Strattera is sui generis or in a class of its own. It inhibits the reuptake of the neurotransmitter norepinephrine. This is one of the neurotransmitters that is also inhibited in it’s reuptake in antidepressants, such as Effexor XR, Wellbutrin XR, and Pristiq, along with Remeron. We thought that it was going to be a potent antidepressant with this mechanism of action; but it turned out in the research that it was not; but instead, when it was compared to Ritalin in the studies, Strattera was equal in it’s efficacy of treating ADHD symptoms! I see in my Scottsdale practice it’s efficacy among some of my patients. Strattera is also a good alternative for patients who do not want to try a medication that is potentially addictive i.e. Stimulants, (which usually doesn’t happen) or in patients who become more anxious while on stimulants. Strattera does take longer to show it’s full effect, more along the lines of the antidepressant medications, about 4 to 6 weeks. So, that can be a draw-back along with its increased risk of sexual dysfunction. Nevertheless, Strattera isn’t in the controlled substance class as with the stimulants; therefore, I can prescribe multiple refills that I can not do with the stimulants. There are certainly pros and cons of both types of medications.
Once my patients are on the stimulant that is most effective, we will titrate to a level that is most therapeutic and then begin a maintenance routine of medication refills and office visits every 3 months. This frequency is due to the need for me to monitor blood pressure while patients are on these medications, since they can increase blood pressure readings; and on occasion necessitate the use of antihypertensive medication, usually via your PCP. I also need to monitor the patient’s sleep since the stimulants can cause insomnia, albeit usually transient in nature (because stimulants tend to have a calming affect on those with ADHD).
If for some reason my patients are experiencing a growing tolerance to the medication, we can increase the amounts or switch between medications so that when one medication begins to lose its efficaciousness we go to another medication and back and forth, sometimes on a monthly or every two month basis; but generally speaking, the patients’ maximum dose is reached that achieves efficacy; and they stay on that dose indefinitely so this going between medications is not done to frequently.
Patients Would Be Prudent in Seeing Their PCP or Cardiologist Before Going On Stimulants
I recommend that before my patients be put on any stimulant if they don’t know their heart status, that they see a cardiologist or their primary care physician for an EKG. In rare cases patients can die of sudden death either with use of stimulants or Strattera, due to an underlying heart condition such as a structural or physiological heart abnormality.
None the less, ADHD is typically one of the easiest mental illnesses to treat and one of the most satisfying results reportedly by my patients. Therefore, there is really no reason why anyone should suffer from the consequences of this illness. ADHD can affect every aspect of our lives from family relationships, performance in school and at work, and even driving with an increased prevalence of accidents among people with untreated ADHD. With such high success rates of treatment, ADHD should not be an issue in today’s society. If you are seeking ADHD treatment in Scottsdale or you think that you may have it, please check my contact page for scheduling an appointment for an evaluation and treatment.