Posted by friendofbillw on September 16, 2003, at 19:53:36
In reply to Re: Addiction Adult ADD, posted by Arrianna on September 13, 2003, at 16:31:05
Just saw this in the paper and this may help all of us...
Adults with ADHD now have new treatment
Donna Halvorsen, Star Tribune
Published September 16, 2003 HALV16Robin Kemp saw herself as bright and capable, and although it took a long time, she pushed herself through college. Then she landed a plum job as a writer for CNN in Atlanta, where she lives.
But life was difficult, and she knew something was wrong. She was messy and disorganized, unable to create and maintain any real order in her life. She had a tendency to break into conversations while someone else was talking, making her seem pushy and obnoxious. She couldn't focus or follow through on tasks. She had little self-esteem.
Still, she enrolled in graduate school, and shortly after she received a master's degree, a psychiatrist told her: "I think there's a chance that you have attention deficit disorder."
"I just lit up like a Christmas tree," she said. "I said, 'That's it!' All of the little pieces fell together, and there's so many of these little pieces."
Since March Kemp has been taking Strattera, a new prescription drug for adults with attention deficit/hyperactivity disorder (ADHD), a condition once thought to affect only children.
After only a few months on the drug, she said she's making "really good and rapid progress."
Others aren't so lucky. Researchers estimate that nearly 8 million adults in the United States have ADHD, but many don't know it. Unaware of their condition and untreated, they lack an explanation for the difficulties in their lives.
The U.S. Food and Drug Administration (FDA) approved Strattera last year as the first non-stimulant for ADHD. It's also the first new drug approved to treat ADHD in 30 years, according to the FDA. Physicians wrote $1.2 million worth of prescriptions for it in its first six months on the market, according to Eli Lilly & Company, its maker.
Despite its dramatic surge in sales, Strattera is not a cure-all, but rather an alternative to widely used stimulant drugs, according to ADHD experts.
"It's the new kid on the block and everybody wants to try it," said Dr. George Realmuto, associate professor of psychiatry at the University of Minnesota. But, he said, "it doesn't have as robust an effect and will not be as effective in as wide a group as the standard drugs."
Realmuto said Strattera can be a good medication for ADHD patients who also are substance abusers. He said some patients have doubled or tripled their doses of ADHD stimulant medications to get high. Strattera is not a stimulant or a controlled substance.
Dr. Gerald August, interim director of child and adolescent psychiatric services at Fairview-University Medical Center in Minneapolis, said there is no evidence yet that Strattera is more effective than existing ADHD drugs, which include Ritalin, Adderall, Concerta, Metadate, Dextrostat and Dexedrine, all brain stimulants and controlled substances.
Mark, who asked that his real name not be used to protect his privacy, is a medical researcher in his 50s who lives in Plymouth. He said Ritalin has helped his ADHD for more than a decade. Before he began taking the drug, he was easily frustrated and angered, and could work at his desk only a few minutes before he had to get up and do something else. Ritalin calms his restlessness and allows him to focus on tasks, he said, and he has had no side effects.
Only Mark's immediate family knows that he has ADHD. "It's not a secret so much as a nonissue with me," he said. "It's not something you talk about."
It's not known exactly how Strattera works, but in six clinical trials, it significantly reduced ADHD symptoms, according to Lilly. The most common side effects in adults were constipation, dry mouth, nausea, decreased appetite, dizziness, problems sleeping, sexual side effects, problems urinating and menstrual cramps. But most people were not bothered enough by the side effects to stop using the drug, Lilly said.
'Misunderstood' problem
One of the difficulties for adult patients is that ADHD is "misunderstood and is frankly thought to be a fabrication by some people, including physicians," said Dr. Bill Nelson, a Crystal psychiatrist who specializes in treating adults with ADHD.
An ADHD-like disorder was known to be a problem in children a century ago, but it wasn't until the 1970s that ADHD was known to persist into adulthood, said Dr. Lenard Adler, head of the adult ADHD program in the Department of Psychiatry and Neurology at New York University (NYU).
"Somehow it was supposed to magically go away as kids went through adolescence, which didn't make a lot of sense, actually," Adler said. "If it's a neurological disorder, why is it all of a sudden going away? It turns out that probably 60 percent of kids who have ADHD go on to be adults with ADHD, which means that about 4 percent of the American population probably has ADHD."
It wasn't until the 1980s, after diagnostic criteria had been developed, that psychiatrists could diagnose the disorder in adults. More than two decades later, many adults still don't seek help. And if they did, they might not receive ADHD diagnoses. In a NYU survey, 92 percent of 400 primary care doctors said they felt "very" or "extremely" knowledgeable in treating depression, compared with 34 percent in treating ADHD.
Although Strattera is the first ADHD medication tailored specifically to adults, children and adolescents can take it, too. It requires one daily pill.
Adults with ADHD, however, have symptoms different from those of children. The running and climbing that are characteristic of children with ADHD become "a sense of internal restlessness as adults," Adler said. Adults "know it's not appropriate to climb on top of their desks."
He added, "Successful adults may have not only Palm Pilots but also an executive assistant to help them organize. They may select active careers where they have an outlet for some of their restlessness. They have trouble waiting, so they try to have control of their day so they don't have to be in situations where they have to wait."
Adler said the consequences of not diagnosing ADHD in adults and treating it are significant: They're more likely to be separated or divorced, to underperform on the job or change jobs more frequently, to abuse substances, to have more motor vehicle accidents and tickets.
For an ADHD diagnosis, the patient must display multiple, enduring symptoms that have caused trouble in the patient's life, and the symptoms must date to childhood.
Kemp said she can date her symptoms to seventh grade, when she got D's and F's instead of the A's she was capable of getting. She is not one to look back, but wonders if she would have been a tenured professor by now or if she would have gone to medical school, "which is what I thought I was going to do."
Kemp left CNN to go to graduate school. Now she's a poet who also teaches poetry and is happy about her life. She appeals to the public to understand a little-known adult disorder that can be so damaging to otherwise capable, healthy people.
"People need to understand that this is not a failure of character or laziness, because it comes off that way; it does look like that," she said.
Strattera is not a cure-all, Kemp said, but it has allowed her to follow through on tasks needed to function in everyday life.
"It's helped me to be my best self," she said.
poster:friendofbillw
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