Note: Much of the research on ADD medications is carried out by researchers who have financial relationships with the pharmaceutical firms that produce these medications. Furthermore, the Food and Drug Administration, which oversees the acceptance and manufacture of the drugs currently accepts money from pharmaceutical firms to support its work. For these reasons, a degree of skepticism is warranted in evaluating the findings of this research.
Table of contents
Stimulants appear to be helpful for bipolar patients with ADD
Women have more
problems with ADD than men do.
Melatonin
for Treating Insomnia in Children with ADHD
Patients with ADHD report more sleep problems than those without ADHD
Who Gets Prescribed Atomoxetine (Strattera)?
A patch for taking methylphenidate
A new stimulant that can't be abused by taking it by vein
Brain activity patterns in ADHD
Stimulants appear to be helpful in bipolar patients with ADD
Over the years, there has been a concern that stimulant medications might trigger manic symptoms in bipolar patients with ADD. There is a growing body of evidence suggesting that this is not true. A recent study of 16 children with ADHD (mean age 10) who were receiving divalproex and/or lithium for bipolar disorder found that methylphenidate significantly reduced the severity of the ADHD symptoms and improved the patients' overall condition.
Women May Have
More Problems with ADD Than Men Do
Some research indicates that women with ADD suffer more from temper problems,
mood swings, and emotional over-reactivity than do men with ADD (J Clinical
Psychiatry 2008:69). This often makes it more difficult for clinicians
evaluating them to identify their ADD, which can be overshadowed by their other
problems. It is not yet clear whether the ADHD causes these problems or
merely co-exists with them. It appears that women benefit more from
treatment with stimulants than do men, particularly in the area of social
functioning.
Melatonin for Treating Insomnia in Children with ADHD
In a placebo controlled trial, melatonin appeared to improve sleep but not
behavior in children (6-12 years old) with at least one year history of
difficulty falling asleep at least four nights a week. The children were
not taking any other medication during the study. Each evening at 7 PM they took 3 mg or 6 mg
of melatonin (depending on body weight). Those taking melatonin,
compared to those taking placebo, fell asleep 30 minutes earlier, slept 20
minutes more, got to sleep sooner after going to bed. and were less restless in
bed. However, there was no improvement in core problems of
ADD, including behavioral or emotional problems, attention, or quality of life.
On follow up two years after the study was completed, 19 of 24 patients were
found to be continuing to take melatonin. Melatonin should be used only
for severe and persistent insomnia. Its long term effects on puberty have
not been studied. It should be used with caution in children with epilepsy. It is not known whether
the benefits found in this study apply to adults with ADHD.
Patients with ADHD report more sleep problems than those without ADD.
In
one study, half experienced daytime sleepiness, and more than two thirds had
difficulty falling asleep, going to bed on time, and getting out of bed.
In addition, their sleep was less "efficient" - that is, they awakened more
often during the night and for longer periods of time and awakenings were more
frequent. Methylphenidate had some predictable negative effects: it delayed the
onset of sleep and reduced the amount of sleep. On the other hand, it had
some surprising positive effects: patients had fewer awakenings during the
night, and their average uninterrupted sleep time increased. The overall
effect was to improve overall sleep quality and reduce daytime sleepiness.
My reading of these findings suggests that physicians who are experienced in treating ADD first prescribe stimulants unless there is a contraindication to doing so, or unless the patient had a previous good response to atomoxatine.
A methylphenidate patch has been approved for prescription use.
The patch contains the same medication that is in Ritalin, Methylin, and others.
It can be used by those who prefer not to take a pill. It works for
about ten hours. Research suggests that its effect is the same as that of
the pill. It is sold under the trade name Daytrana.
A recently approved stimulant medication for children aged 6 to 12
(generic name LDX, brand name Vyvanse) does not have the abuse
potential that current forms of stimulants have, at least in part because it
does not produce as much of a high when taken intravenously. Nevertheless, it is
categorized as a controlled drug and must be prescribed using the same strict
rules as the other stimulant medications.
The medication appears to be as effective as existing stimulant medications and
has about the same range and severity of side effects. As long as the
active ingredient in it, d-amphetamine, is bound to an amino acid, L-lysine, the
drug is inactive. This amino acid is removed by the liver during digestion.
If the drug is taken by vein, only a small portion of it gets activated in the
liver since blood from the non-digestive parts of the body by-passes the liver
on its way to the heart. While LDX was tested on and approved only for
children, physicians may prescribe it for adults. It became
available for prescription use in the late Spring of 2007. (Why a drug
designed to avoid IV (intravenous) use was tested on children is not clear.)
There are differences in brain activity patterns between patients with ADD and patients without ADD. However, stimulant medication does not appear to change these patterns. This means that, though we know stimulants work, we still do not know where in the brain they work.