Stimulants and adult ADD

[McDoctor]

---

Members don't see this ad.

Increasingly in FP we see patients either diagnosed with ADD in childhood and on stimulants or adults who present with typical characteristics of ADD that had previously been unrecognized. I tend to shy away from stimulants in adults especially after age approx. 35 yrs or so secondary to concerns about cardiovascular effects and lack of long term safety data.

I thought this forum would be a good place to post a general inquiry regarding current opinions in stimulant use in adults. Are the benefits worth the theoreticial risk? Do most people with ADD absolutely need pharmacologic treatment? Many patients not on meds seem to be doing fairly well professionally and socially despite having characteristics of ADD.

 

[Triathlon]

I like Adderall! As an adult diagnosed with ADD I finally feel normal. That was my first impression. I have heard this occasionally from patients and I understand them. Others probably don't have the disorder and abuse the meds either intenionally or not. I am taking the drug despite the "risk". The benefits are great. I am not a super human now by no means, but I can function now at a "normal" level. I keep my dose low, almost imperceptibly(?) low. It is just enough to boost me from scatter-brained, detached, impatient with tasks, unable to follow through, urgent only action to a state of "less all those things". I can now study. I can actually sit down and engage a topic for more than 5-10 minutes. I can't sit for hours at a time zombie like (I could at first when I was taking too high of a dose). But I wish I had realized I wasn't "disinterested", "lazy", "undisciplined", or "just this way" before I crammed my way through the first two years of medical school and (barely) passed boards with a total of (seriously)24 hours of study time in two months. So will I take stimulants forever? No, because it just isn't worth it. At this time of my life when things are changing so much and it is imperative that I perform well for the next few years I will continue. When I settle into a routine lifestyle practicing medicine on my own terms I will stop. I like how was before when I sought my own forms of NE to focus, through thrill seeking (outdoor sports). I was able to bounce around and do what I felt like at the moment. I will just adapt a practice around my deficit. I think most people with ADD should take as low a dose as possible if at all. But we do live in a PERFECTION expecting society.

 

[Anasazi23]

There are tons of studies on adult ADHD and the effectiveness of psychostimulants. With the explosion in diagnosis of this condition in the recent past, psychiatrists are increasingly finding that their child ADHD population is growing up fast, and becoming, often, adults with ADHD. While there is some truth to the phenomena that children with ADHD will "grow out of it," the fact is that many do not. Adults with ADHD have increased rates of comorbid conditions, such as alcohol and substance abuse, and higher rates of criminal behavior than controls.

Recent studies give credence to the dopamine transporter theory as targets of psychostimulants in adult ADHD. (specific binding in the striatum was decreased compared to matched controls using SPECT examination after methylhenidate.)

24 deaths have occured from patients taking Adderal through 2003. When weighing the risk/benefit ratio, one must seriously consider cardiac history and other comorbid medical problems. Even then, you might get unlucky. There was a thread some time back about psychiatrists getting upset over this black box warning, stating that the research was inconclusive. What we'll likely wind up seeing is the insistance of psychiatrists on having ekgs or even ultrasounds prior to starting a stimulant of this class....defensive medicine again. 👎

 

[Doc Samson]

There is no evidence for the black box warning. The FDA panel actually stated that there was no evidence. Here's the link to the article in Psychiatric News. I'll copy-and-paste my favorite parts:

http://pn.psychiatryonline.org/cgi/content/short/41/5/1

A panel of Food and Drug Administration (FDA) advisors last month voted 8 to 7 (with one abstention) to endorse a recommendation for a black-box warning regarding cardiovascular adverse events on the labels of all stimulant medications used to treat attention-deficit/hyperactivity disorder (ADHD). Several advisors said they voted for the warning not because they were particularly worried about safety issues relating to the potential of increased risk of heart attack, stroke, and sudden death, but because they were alarmed about the recent sharp rise in the number of prescriptions for the medications written for both children and adults.

"I want to cause people's hands to tremble a little bit before they write that prescription" for an ADHD medication, said Cleveland Clinic cardiologist Steven Nissen, M.D., a consultant to the advisory committee. Indeed, it was Nissen who suggested the committee consider endorsing a black-box warning because he saw a need "to slow the growth of utilization."

At the February 9 meeting, FDA staff medical reviewer Kate Gelperin, M.D., told advisory panel members that between 1992 and 2004, the agency's MedWatch adverse-event reporting system logged 27 reports of deaths of children younger than 18 and 12 reports of deaths of adults that the agency had determined were "possibly linked" to ADHD medications. Most reports involved adults and children with underlying structural heart disease who suffered sudden cardiac death, presumably due to arrhythmias.

Gelperin said those 39 reports were a subset of the 81 MedWatch reports of deaths in patients taking at least one stimulant medication. However, she said, most of the reports involved multiple medications and other possible causes of deaths and so were discounted. Gelperin also warned that the 39 death reports in her analysis were not definitively tied to an ADHD medication, but "are simply associated."

Ultimately, it's BS, though I don't really mind. Another drug with a black box is another drug non-physicians won't prescribe.

 

[pschmom1]

Would adderall be comparible to phentermine, concidering they both stimulate the central nervous system and Adderall was once prescribed for short term weight loss in obese people? For anyone that doesn't know, phentermine is an appetite supresant and stimulant. I have read a lot about both meds and they seem very similar. I actually am taking phentermine right now, and even though I've never been on any adhd meds, it seems to treat my add symptoms like adderall is said too. I am positive I have add but I've never actually been tested, however, I have a doctor's app this week so we shall see. All as I know is that it is litterally like night and day when I'm taking the phentermine. I originally started taking it to loose a little weight, but then I noticed a huge change in my attention span, ability to focus, motivation, and so on. This is my last week taking it b/c it's not good for you, but I wonder if there is a big difference between the two?