TREATMENT FOR ADHD IN SCOTTSDALE AZ

I specialize in ADHD treatment at my office in Scottsdale AZ. Attention Deficit Hyper-activity Disorder is considered one of the easiest mental health issues to treat. Nobody should have to suffer the effects from this disorder. Treatment is extremely effective and results are almost immediate with the first treatment dose of the medication first-line medications. These stimulants work very well and fast. There are other medications used to treat ADHD which are non-addictive which include Clonidine, Guanfacine, Atomoxetine, Buproprion; and some of the antidepressants and alpha-blockers. These medications usually don’t work as fast as the stimulants, but may be necessary due to health or addiction concerns. ADHD treatment can also be augmented with behavior modification therapy.

Types of ADHD and Treatment

There are three different types of ADHD, each with different symptoms: predominantly inattentive, predominantly hyperactive/impulsive and combined.

Predominantly Inattentive Type:

  • Fail to pay close attention to details or make careless mistakes in schoolwork, work or other activities
  • Have difficulty sustaining attention to tasks or leisure activities
  • Do not seem to listen when spoken to directly
  • Do not follow through on instructions and fail to finish schoolwork, chores or duties in the workplace
  • Have difficulty organizing tasks and activities
  • Avoid, dislike or reluctant to engage in tasks that require sustained mental effort
  • Lose things necessary for tasks or activities
  • Are easily distracted from doing the task at hand and sometimes mistaken with poor hearing
  • Are forgetful in daily activities and disorganized inability to learn due to a clouded mind

Predominantly Hyperactive/Impulsive Type:

  • Fidget with their hands or feet or squirm in their seat, ants in their pants
  • Leave their seat in situations in which remaining seated is expected
  • Move excessively or feel restless during situations in which such behavior is inappropriate
  • Have difficulty engaging in leisure activities quietly
  • Always on the go
  • Talk excessively – tough to get a word in edgewise
  • Blurt out answers complete your sentences for you
  • Have difficulty awaiting their turn
  • Interrupt or intrude on others

Those with the combined type, the most common type of ADHD, have a combination of the inattentive and hyperactive/impulsive symptoms.

Primary Causes of ADHD

ADHD is most often a genetic issue, which is grounded in neuro-chemistry. A complete medical workup should always be done when checking for ADHD to rule out any other illness that might be causing the symptoms. Thyroid diseases and other conditions can produce the same symptoms as ADHD. Diet and exercise can play a substantial role in managing the symptoms of ADHD. Once diagnosed with ADHD the individual usually responds very well to medication and behavioral modification. This is an important condition to treat because those with ADHD like to multi-task however, studies have shown that multi-tasking over a long period can do damage to the protective sheathing of the nerves and possibly trigger early-Alzheimer’s. The implications of untreated ADHD are further reaching than a disorganized life. ADHD often occurs with a comorbid disorder.

Treatment Process for ADHD

Once patients are on the stimulant which is effective for them, we will increase the dose to a level that is most therapeutic. We then begin a maintenance routine of medication refills and office visits every 3 months. This frequency is due to the need to monitor blood pressure while patients are on these medications. Stimulants can increase blood pressure and on occasion necessitate the use of anti-hypertensive 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 effect on those with ADHD).

If for some reason a patient is experiencing a growing tolerance to the medication, we can increase the amounts or switch between medications. When one medication begins to lose its effectiveness, we can go to another medication, and back and forth, sometimes on a monthly or every two-month basis. Generally speaking, when the patients’ maximum dose is reached that achieves efficacy; they stay on that dose indefinitely.

Before a patients is put on a stimulant, if they don’t know their cardiac status, they should see a cardiologist or their primary care physician for an EKG. In rare cases patients can die of sudden death syndrome with use of stimulants; due to an underlying heart condition.

Treating ADHD & Comorbid Disorders

ADHD is often accompanied with another disorder, specifically adult ADHD. 50% of all people with ADHD have learning disorders.  Up to 38% of people with ADHD may also have a mood disorder or depression. 47% of individuals with ADHD have an anxiety disorder, OCD and TIC disorders occur less frequently at 11%. All which are secondary to the ADHD. This distinction is important with regards to the treatment.

The primary goal is to discern which of the illnesses is the primary illness driving the comorbid illness to implement an effective treatment program. If the ADHD  is the primary illness, treating the secondary illness will not be effective, nor will it resolve. A careful distinction between the primary and secondary illness must be made to ensure both conditions are treated. Usually after people have begun their treatment for ADHD, we then treat the secondary illness or it remits as the ADHD treatment has begun

First-line Medications

The first-line medications used to treat ADHD are the stimulants. Secondly the SNRI antidepressants will do the job as well, and an alpha-blocker. In my practice, I would say 80% of many patients will respond to the first mediation that is prescribed. That may well be a conservative percentage. The effects from this medication will be experienced within generally one to two hours after taking the prescribed medication. 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 medications are no weight gain or decreased libido which are more common with antidepressant medications. Patients tend to lose weight on stimulants due to the suppression of appetite that stimulants cause. 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 the effects of ADHD medications are apparent within the first day of use and treatment.

If a 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 medication namely Strattera. Strattera is a medication that we are using to treat ADHD in adults.

Strattera (atomoxetine) is a SNRI. It inhibits the reuptake of the neurotransmitter norepinephrine and is not addictive. Initially developed as a potent antidepressant; but instead, when it was compared to Ritalin in the studies, Strattera was equal in its efficacy of treating ADHD symptoms. Other non-addictive medications are available as well.

Non-Addictive Medications

Alpha-blockers were developed to control blood pressure; however, they are also used to treat ADHD. Strattera is also a good alternative for patients who do not want to try a medication that is a stimulant, namely cardiac patients, or in patients who become more anxious while on stimulants. Strattera does take longer to show its 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, can be prescribed with multiple refills.

ADHD Treatment – High Success Rate

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, except for the abuses of the medications. If you are seeking ADHD treatment in Scottsdale, please contact my office to schedule an appointment for an evaluation and treatment. Read more on ADHD treatment

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