Saturday, April 23, 2011

Dr Hege - Cheap medicine update April 2011


Here is an improved way to get cheap medicine. Click on this link, USA Drug Plan , to take you to a website to print out your discount card. There is also a link on this page to find out the price of the medication of your choosing in the ZIP code you choose. Most of the time in my ZIP code, 30338, the Kroger pharmacies have the cheapest prices. These prices usually compete with Costco pharmacy, which are usually the lowest price medications here in the Atlanta area.

Most of my patients prefer to go to Kroger rather than Costco because Kroger pharmacies are open longer hours and seven days per week, Kroger is usually closer geographically, it usually isn't as far from your parking space into the store and inside the store to the pharmacy, and usually you don't have to wait as long to get your prescription filled.

A couple examples of the prices at Kroger pharmacy with this discount card are generic Adderall short acting for $.35 per pill and generic Lamictal, lamotrigine, for $.40 per pill. The discounts for generic medications are usually much more dramatic than the small discounts that may be obtained on brand medications.

Call 770-458-0007 today for an appointment with Dr. Hege. Dr. Hege has a lot of experience in selecting psychiatric medications cost-consciously because 50% of his patients have no insurance. He specializes in the evaluation and medication treatment of ADHD, Suboxone and Subutex opioid replacement therapy, panic disorder and other anxiety disorders, bipolar II disorder, depression, and alcohol and other substance abuse problems.

Affordable fees for psychiatric services by Dr. Hege
is a webpage on Dr. Hege's website.

Affordable ADHD medications is a previous blog by Dr. Hege about other ways to save money on ADHD medications.

Monday, February 8, 2010


Is ADHD a real medical condition that justifies treatment with medication? The popular media quite also describe it as a questionable diagnosis, or overdiagnosed, or treated with unnecessary medication. Critics suggest the symptoms of hyperactivity, inattention, and impulsivity are merely extreme variations of normal human traits. Their criticism further attributes the cause to over demanding parents, poor teachers skills, and an over competitive society.
In scientific literature the majority view ADHD as a valid and common psychiatric disorder of childhood. A set of criteria for establishing in a psychiatric condition as a valid psychiatric disorder was established by Robins and Guze in 1970. This became the framework for how all diagnoses get included in the American Psychiatric Association’s diagnostic manual. These criteria all require that scientific studies have had been done and support every one of the six criteria.
Following are the six criteria required to make a classification of a cluster of signs and symptoms as a valid psychiatric condition:
“A valid diagnosis needs to be reliably identified through a consistent pattern of signs and symptoms demarcating it from other disorders and from psychiatric wellness.”
This means that if a group of doctors independently evaluated the same group of patients and use the same test to diagnose the patients, there is high agreement as to which patients did have the disorder and which did not have ADHD. Numerous scientific studies have established the high reliability of different rating scales for the diagnosis of ADHD.

Also, a diagnosis of a condition cannot be made if the symptoms of that condition do not cause significant impairments. Studies have documented inferior academic performance, reduced social skills, inattention in the duration of focus on a single task, impulsivity disrupting schoolwork, and hyperactivity causing fidgeting and talking excessively. Impairments continue into adolescence with high rates of delinquency, more arrests, and higher risk of substance abuse disorders. Other studies document higher rates of injury, cycling injuries, and pedestrian injuries. Driving performance impairment leads to higher accident rates and traffic citations.

This means that ADHD is a condition that is separate from other diagnoses. It isn’t a cluster of signs and symptoms and impairments that is actually part of another diagnosis. Symptoms of major depression, generalized anxiety, and bipolar disorder often include symptoms that overlap with ADHD. For example, hyperactivity and reduced concentration are common in major depression. However, when patients that are diagnosed with major depression and ADHD have the symptoms that are part of major depression subtracted from their ADHD diagnosis, the majority of these dual diagnosed patients still meet the criteria for ADHD. Also, when the symptoms of ADHD were removed from patients with a dual diagnosis that included major depression, most of them still met the criteria for major depression.

This overlapping or comorbid occurrence of two or more psychiatric diagnoses in an individual is common. Interestingly, when family studies are done, some conditions such as ADHD and depression tend to run together in families. Other conditions as anxiety disorders and ADHD run independent of each other.

Impairments and other negative consequences in ADHD patients cannot be all explained away by coexisting conditions of conduct disorder, major depression, and learning disabilities. For example, rates of arrest, drug abuse, and executive dysfunction are elevated in ADHD. These problems are further elevated it conduct disorder is also present.

A valid psychiatric disorder needs to have a characteristic course and outcome. Long-term studies showed childhood ADHD is a chronic disorder that survived into adulthood in a significant number of patients. While many fail to meet the full strict criteria for the condition in adulthood, 90% retained significant symptoms to have persistent significant clinical impairments. Numerous studies report that ADHD has a natural course that provides another method ofdelimiting it from other disorders. For example, if symptoms of ADHD occur intermittently along with episodes of another disorder, this would not be viewed as evidence of ADHD because of lack of chronic persistence of symptoms.

ADHD meets the criteria for being a scientifically based disorder on neurologic grounds of being heritable. Numerous family studies and genetic studies provide evidence.

Family studies found parents and siblings of ADHD children have a 2-8 fold increased risk of being ADHD. All 15 twin studies showed increased risk in the twin of an ADHD child. The risk was 75% for familial status of having ADHD. Consequently, only 25% of this is due to environmental factors. The studies came from families from around the world (US, UK, Australia and Sweden). Studies from all of these countries are in agreement that there is an inherited risk for ADHD.

Adoption studies provide further evidence of the genetic influence on risks for ADHD. Biologic relatives of ADHD children have higher rates of ADHD than adopted relatives.

Molecular genetics studies found strong association between several neurotransmitter genes and ADHD. These neurotransmitters are dopamine, norepinephrine, and serotonin. They are implicated in causing ADHD and are involved in the therapeutic effects of ADHD medications.

Another method of developing evidence to support a neurobiological connection of ADHD diagnoses is laboratory studies. PET scan studies found evidence of defective dopamine transporter function in the striatal region of the brain of ADHD patients. These were performed on live patients with real-time images of metabolic activity. Scientifically controlled studies of the physical structure of brain of ADHD patients compared to normal found evidence of abnormal structures in parts of the brain. Ten controlled studies of brain function found abnormalities in multiple areas of the brain of ADHD patients. While the particular parts of the brain were not consistently involved in the different ADHD patients, the findings were consistent with their knowledge of brain pathways and systems involved in the regulation of complex behaviors that may be involved in the motor control, in attention, and executive function deficits seen in ADHD.

The validity of a diagnosis is bolstered if patients with a defined condition respond to a particular medication treatment. Many controlled studies provide evidence of the high rate of treatment response of methylphenidate in reducing overactivity, impulsiveness, and inattentiveness. In addition to improving ADHD symptoms, many studies provide strong evidence of the medication effectiveness in reducing ADHD-related impairments in children and adults. Other medications besides stimulants have been proven to be effective in ADHD patients. These include tricyclics and atomoxetine(Strattera). All of these medications have been shown to block norepinephrine and/or dopamine reuptake at receptor site. While this data provides additional evidence of the validity of the ADHD diagnosis, they do not mean that this treatment response should be used as a method to make the diagnosis. Stimulant medications can improve cognition and attention in non-ADHD individuals just as high blood pressure medicine may reduce blood pressure in people with normal blood pressure .

Numerous studies provide enough evidence that ADHD meets the six criteria of Robinson and Guze standard criteria:
1) ADHD patients show a characteristic pattern of hyperactivity, inattention, and impulsivity that lead to adverse outcomes.
2) ADHD can be distinguished from other psychiatric disorders including those with which it is frequently comorbid.
3) Longitudinal studies show ADHD is not an episodic disorder. It is always chronic and sometimes remits in adolescence or adulthood.
4) Twin studies show ADHD is a highly heritable disorder, as heritable as schizophrenia or bipolar disorder. And molecular genetic studies have discovered genes that explain some of the disorder’s genetic transmission.
5) Neuroimaging studies show that ADHD patients have abnormalities in the motor control frontal-cortical-cerebellar pathways involved in the control of attention, inhibition, and motor behavior.
6) Most ADHD patients show a therapeutic response to medications that block the dopamine or norepinephrine transporter.

One concern is that most studies have been done with the most severe examples of ADHD who are referred to doctors and clinics.Thus, the studied populations may not represent the whole spectrum of severity of symptoms and impairments. Therefore, it would not be valid to generalize the facts about these patients to nonreferred ADHD patients in the community. However, two of the criteria for the diagnosis of ADHD are based on wide population studies. (1) Several epidemiologic studies have been supportive because they found the clinical features of ADHD in these community population samples. (2) and several studies were done with population samples demonstrating the high heritability of ADHD in cases that are not necessarily the most severe cases.

Another group of critics argue that ADHD signs and symptoms are better viewed as a normal continuous varying spectrum of traits rather than a disorder. The problem with this argument is that even normal variation can be a disorder if the more extreme cases suffer distress or disability. An example is how the normal variations of blood pressure and serum cholesterol level become medically urgent disorders in the more extreme levels.

Other critics argue that because there is not 100% agreement of results among different studies, a diagnosis is not valid. However, the preponderance of the evidence is overwhelmingly supports that ADHD is a valid diagnosis, especially when careful reviews of the different studies and meta-analysis studies were done.

Some critics hold the opinion that ADHD impairments are due to a highly competitive society, failure of parenting and teaching, or societal intolerance of extreme but normal symptoms. However, the genetic and neurobiological evidence is too strong to totally discount. There obviously are environmental factors that contribute to whether or not a person develops ADHD. There Is much evidence that ADHD’s causes are multifactorial, caused by the addition and interplay of genes and environmental risk factors.

Parents and patients with ADHD often have misgivings about accepting help and medication for ADHD. When they encounter misunderstanding about the diagnostic validity of ADHD, their resistance grows. Corrective education from medical and mental-health professionals may be the first step in helping distressed ADHD patients to get help that will bring them relief and success in their lives.

Written by Dr. Darvin Hege, M.D. on January 8, 2010 with content drawn heavily from the following article:

The scientific foundation for understanding attention-deficit/hyperactivity disorder as a valid psychiatric disorder. Faraone SV. Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY 13210, USA.

Dr. Darvin Hege has 25 years of experience dealing with patients who may fit the criteria for ADHD and may need a medication like Adderall for ADHD. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770-458-0007 to discuss getting an ADHD evaluation and for help deciding the most effective and safest treatment.

Friday, January 15, 2010


Can chronic use of therapeutic doses of Adderall, Vyvanse, or Dexedrine (amphetamines) cause brain damage?

The bottom line is we don't know. However there is a body of research that raises some concerns but gives no strong conclusive evidence either way. A comprehensive review article was published in February of 2009 "Literature Review: Update on Amphetamine Neurotoxicity and Its Relevance to the Treatment of ADHD" and is available free (1).

A worrisome study in monkeys in 2005 by Ricaurte found some evidence suggesting dopamine nerve damage in areas of the brain involved in ADHD dysregulation and amphetamine therapeutic effects (2). Some of the monkeys were given doses that are normally given to humans. However, multiple similar studies in rodents did not find evidence of this damage in usual dosage ranges that are given to humans. In contrast to amphetamines, high dose methylphenidate (Ritalin, Concerta, Focalin, Daytrana) studies appeared to have lower risk for brain toxic effects (3, 4).

Stimulant treatment of ADHD during childhood appears to reduce the risk of substance abuse that is otherwise associated with ADHD.(5, 6) Also children with ADHD who had not been treated with stimulants have smaller brain white matter volume than children with ADHD who had been medicated or children without ADHD. Stimulant treatment in children may actually increase brain growth and development.(7) However, older rodents, when given methamphetamine in doses that are known to be toxic to younger rodents and humans, had more toxic brain reactions than younger rodents. They also had brain levels of amphetamine that was twice as high as the levels in younger rodents when given the same dose. Natural aging processes reduce dopamine production greatly. Older humans may be at greater risk of toxic effects of amphetamine

No controlled studies have examined the adverse behavioral, cognitive, neurophysiological effects of years, much less decades, of chronic amphetamine treatment. Neuroimaging with PET and MRI techniques are becoming increasingly useful in measuring brain anatomy and function in living human beings to explore for brain damage in humans treated with amphetamine. We look forward to the coming evidence to make more informed treatment recommendations to our patients with ADHD.

1.(Free) Literature Review: Update on Amphetamine Neurotoxicity and Its Relevance to the Treatment of ADHD

Wednesday, December 31, 2008

Adderall For ADHD

Currently, 4.4% of the adult population has ADHD (Attention Deficit Hyperactivity Disorder). This disorder is present from childhood, but many times it is not diagnosed until the person reaches adulthood and takes on more responsibility such as what is required when managing finances and jobs, and when interacting with spouses or significant others or their children. Under these additional demands, the attributes of ADHD (inattention, distractibility, and impulsivity) may become more prevalent.

Dr. Darvin Hege, an Atlanta psychiatrist, says it is important for people who have become depressed, overly anxious, or have turned to alcohol, drug, or medication abuse to help them deal with the stresses of life, be evaluated for ADHD. Many times if a patient seeks help for these concerns, " the overlying problem of depression, anxiety, or substance abuse may be diagnosed and treated. However, the foundational problem of ADHD may be missed. Unless the ADHD is successfully treated, the person may improve temporarily but still struggle unnecessarily and be more prone to relapsing to another bout of depression, anxiety, or substance abuse".

How could it be that the foundational problem of ADHD may be missed? Dr. Hege advises that the symptoms of ADHD can change from childhood to adulthood. Since the hyperactivity portion of ADHD tends to diminish in adults, the diagnosis of ADHD may be missed in an adult. Inattentiveness generally remains from childhood, however, and this is the predominant symptom of adult ADHD. The medications that are prescribed for ADHD help the inattentiveness of ADHD more than the hyperactivity of the disorder, so these medications can be very successful in helping with core symptoms. One of the medications he commonly prescribes for ADHD is Adderall.

Adderall has been around for about 20 years and was first marketed as a weight loss and diet control drug called Obetrol. In 1996, the FDA approved Adderall for ADHD treatment and it has since become one of the more widely prescribed medications for the treatment of the disorder. Doctors and patients who use the drug say it has less "peaks and valleys" than Ritalin, so it is more user-friendly.

Adderall is a psychostimulant. In other words, it is a central nervous system stimulant or an amphetamine. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control.

One reason Dr. Hege uses Adderall for ADHD is that it is a mixture of four drugs from the amphetamine family that provides a broad spectrum of coverage. He notes that there are several pros to this group of drugs:

  • they take effect quickly (in about one hour).

  • they leave the blood quickly (in about 4-12 hours). Because of this, you do not need to take the medication every day so you can take them on a day when you'll need the extra assistance.

  • 75-80% of people who have ADHD improve when taking Adderall for ADHD or something from the psychostimulant group of medications.

Anything with a "pro" has to have a "con" and there are some cons to consider when taking Adderall for ADHD:

  • Because the medicine only works for 4-12 hours, work or study in the afternoon or evening may require additional doses.

  • Because it takes about one hour for the medication to take effect, if you have trouble getting up for the alarm clock or getting organized in the morning, you will have to wait for the medication to take effect.

  • If you have used an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam) within the past 14 days, you should not take Adderall. Serious, life-threatening side effects can occur if you take Adderall before the MAO inhibitor has cleared from your body.

  • It has a significant risk for abuse and/or addiction.

The most common side effects of Adderall are restlessness, dizziness, insomnia, headache, dryness of the mouth, and weight loss.

Dr. Hege recommends an ADHD evaluation if you or those around you have concerns about your inattention, impulsiveness, and distractibility.

Dr. Darvin Hege has 25 years of experience dealing with patients who may fit the criteria for ADHD and may need a medication like Adderall for ADHD. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770-458-0007 to discuss getting an ADHD evaluation and for help deciding the most effective and safest treatment. 

Wednesday, December 10, 2008

Help For Anxiety And Panic Attacks

To a certain degree, most people experience a mild bit of panic during every day life. For example, if you have to give a speech, you may be anxious about not embarrassing yourself or not forgetting the speech material. If you are starting a new job, you may be anxious about making a good impression and may worry about learning new procedures. If you are going out on a first date, you may worry about how you look or if you'll like the person you are dating. But, many people routinely suffer from panic or anxiety that keeps them from living a "normal" life. If you are one of the more than 6 million Americans who frequently experience an overwhelming degree of anxiety, you may need help for your anxiety and panic attacks.

The first thing to do after experiencing a panic attack is to go through a medical evaluation so physical conditions can be ruled out as the cause of the panic attack. Thyroid disorders, anemia, pheochromocytoma, heart problems, fluctuating hormones caused by pregnancy or menopause, too much nicotine or caffeine, and certain medications can cause symptoms similar to panic attacks. The physical symptoms of a panic attack include a sense of impending doom combined with a pounding and rapid heart beat, sweating, shakiness or dizziness, a feeling of shortness of breath or hyperventilating, and sometimes either chills or flushing. The sense of panic during an attack is increased by the knowledge that these same symptoms can be signs of more serious conditions, such as a heart attack, which raises the person's level of anxiety.Although scientists aren't sure what causes true panic attacks, they suspect that they may be caused by chemical imbalances in the brain. Also panic attacks can be an inherited condition. Many times there is no physical reason for an attack, but it is best to get medical help to rule out physical causes first when taking steps to get help for anxiety and panic attacks.

If you routinely experience several of these symptoms, you may be living with an anxiety disorder:

  • Do you feel like every day experiences make you anxious (driving, social interactions, etc)?

  • Does your anxiety interfere with your work, school, or family responsibilities?

  • Do you experience fears that you know are irrational, but can’t shake?

  • Do you believe that something bad will happen if certain things aren’t done a certain way?

  • Do you experience sudden, unexpected attacks of heart-pounding panic?

  • Do you feel like danger and catastrophe are around every corner?

So, how can you get help for anxiety and panic attacks? Sometimes you can get relief through natural methods and sometimes you need to seek help through counseling and medication. If the natural route is what you would like to try first, you should think about learning and practicing tai chi, yoga, or meditation to help you relax and reduce stress. Healthy eating habits and an exercise program can also help to reduce the stress of the day. Deep breathing exercises practiced during stressful times of the day (the commute, after a talk with the boss, etc) can help calm and center your mind.

If these techniques are not enough to provide help for your panic attacks and anxiety, counseling and medication are an important next step. Find a therapist who has experience in dealing with panic attacks and can provide help for your anxiety. Treatment such as cognitive behavior therapy can alleviate or eliminate panic attacks for many people. Cognitive behavioral therapy helps you change the way you "see" things and helps you alter behaviors that contribute to panic attacks or keeps them going. It helps you see your fears more realistically. Exposure therapy can also help you with panic attacks and anxiety. This type of therapy mimics the sensations you feel when you have a panic attack. For example, you might hold your breath or be asked to hyperventilate with a counselor present and while in a safe environment. In this way, you can learn how to cope with the feelings you experience so that you have more control over the sensations and your reaction to them.

Anti-anxiety medications can also help for anxiety and panic attacks. Dr. Darvin Hege provides help for panic attacks in the Atlanta area. Dr. Hege most commonly prescribes Xanax XR, Klonopin, Zoloft, Prozac, Celexa, Lexapro, Paxil, Effexor, or Cymbalta. For more information from Dr. Hege about panic attacks and the most effective medications for anxiety and panic attacks, go to the Panic Attacks Information page on his website.

Dr. Hege has 25 years of experience dealing with patients who need help for anxiety and panic attacks. Call him today at 770-458-0007 for an evaluation for relief of your panic, and for help deciding the most effective and safest treatment for your anxiety attacks. 

Thursday, November 27, 2008

Panic Attacks And Depression

Panic attacks can be devastating for those suffering from the condition. Attacks come at random and can occur frequently or can have long periods of time between episodes. The fact that attacks can't be anticipated causes more anxiety. Ultimately, two thirds of the people who have a panic attack will be diagnosed with a panic disorder within a year following their first attack, and half of those who go through a panic attack will develop clinical depression within a year. It seems that panic attacks and depression often go hand in hand.

The first thing to do after experiencing a panic attack is to go through a medical evaluation so physical conditions can be ruled out as the cause of the panic attack. Overactive thyroid, heart problems, too much nicotine or caffeine, certain medications, and abuse of alcohol or illegal drug use can cause symptoms similar to panic attacks. Scientists aren't sure what causes true panic attacks. They may be caused by chemical imbalances in the brain. Sometimes panic attacks are an inherited condition. Many times there is no physical reason for an attack, but it is best to get medical help to rule out physical causes.

Repeated anxiety attacks can cause depression and panic attacks can turn into a panic disorder. The anxiety of wondering if another panic attack is on the way causes severe stress and sometimes thoughts of suicide in people who suffer from them. Since panic attacks are frighteningly similar to symptoms of serious medical conditions such as heart attacks, people naturally become more anxious that their attacks may be life-threatening. The lack of control that sufferers go through is often depressing as is the fact that they can't anticipate an attack. If a person has lived with panic attacks for a while, the anxiety they feel can give them low self-esteem or may lower their self-image which also can result in depression. Panic attacks and depression combined can make people feel like they are in a downward spiral that can never be escaped.

When panic attacks and depression occur together, it is best to get help from a qualified psychiatrist. Early intervention can help the person before the condition affects their lives too much since often people will avoid the places or situations they feel bring on their panic attacks, leading to a decreased quality of life. Depression is a serious condition and needs to be treated separately from the the panic attacks. But, anti-depression medication, certain types of psychotherapy, or a mixture of the two can effectively treat the individual who suffers from panic attacks and depression. Dr. Darvin Hege, an Atlanta-based psychiatrist, says "addressing the core panic disorder or other condition with the vast selection of tools with which psychiatrists are familiar will likely result in relief and success."

Dr. Darvin Hege has 25 years of experience dealing with patients who have panic attacks and depression simultaneously. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770 458-0007 for an evaluation for relief of your panic attacks and depression and for help deciding the most effective and safest treatment.