Dr Hege - Affordable Medications for Psychiatric Diagnoses

You’ve gone through the sometimes difficult process of being diagnosed with Adult ADHD, bipolar disorder, anxiety or depression. Now you have to figure out how to pay for the medication. Whether or not you have insurance to help with costs—you may find some of these tips helpful.

Generics are Affordable Medication

Choosing a generic over a brand medication is a great way to save money. Generic Adderall immediate release costs 90% less than brand Adderall XR. All of the antidepressants except Lexapro and Cymbalta are generic now.

The only atypical antipsychotic, dopamine blocking, mood stabilizer that is generic is Risperdal. The other most frequently prescribed mood stabilizers also have generics. They are lithium, valproic acid (Depakote), oxcarbezine (Trileptal), Keppra (levetiracetam), and carbamazepine (Tegretol). At this time, Zonegran(zonisamide) has no generic available.

A lot of prescription sleeping pills have generics including Ambien. All of the benzodiazepines are now generic, including the extended release Xanax (alprazolam ER).

However, often the newer, brand-only medications offer superior effectiveness and/or fewer side effects than the older generics. Consult your doctor or pharmacist about generic versus brand medications.

Where to Buy Affordable Medications

Patients tell me that the cheapest places to buy their psychiatric medicines are at Costco or Sam's Club. The biggest savings are in generic medication. (The spread between different stores’ prices on brand medications is not nearly as great as for generic medications.)

Patients report paying $.75 to $1.25 per pill at retail pharmacies for generic, short-acting Adderall. At Costco, they pay about $. 40 per pill. The pharmacies in Kroger and Target match prices. When you get a lower price at Costco or Sam’s Club, keep the receipt and present it at the most convenient, price-matching participating pharmacy when you fill your prescriptions the next time and ask for a matching price. An option is to go online at the Costco website and check out their price for your medication. Print it out for evidence to take to your price matching pharmacy. However, that list is not comprehensive and you may have to go to the store to get a price. Some patients have been able to call Costco to get a price, while others have been told they have to come in to the store to get a quote on their medication price.

By the way, you don't need a membership card to go to the pharmacy at Costco or Sam's Club. It is illegal for membership stores to require membership fees to access their pharmacies.

Other Tips for Affordable Medication

Another great way to save money is pill splitting. Most tablets can be split. A pill splitter costs $3-$5 and can be purchased in most pharmacies. Pill splitters are even available for $1 at the dollar stores.

The most dramatic cost savings are for patients who are on Abilify. If prescribed 2 mg per day, it is possible to split a 20 mg tablet into eighths, which is approximately 2.5 mg per day. Since Abilify has such a long half-life, the blood levels swing only a small amount from high to low each day. Patients are unlikely to experience any side effects if they get 1 mg one day and 4 mg another day.

A 30 day supply of the 2 mg size may cost around $400. By cutting the 2 milligram tablets into eighths, it only requires 4 tablets per month. At $13 per tablet, this is only $52 per month.

Other pills I frequently have patients cut are Lamictal 200 mg, Seroquel 400 mg, Trileptal 600 mg, gabapentin 600 mg, Adderall and Ritalin (both in the immediate release form), Provigil 200 mg, and Suboxone 8 mg.

You should discuss pill splitting with your doctor before you do it to make sure it is safe and will still be effective for your particular medication.

Call 770-458-0007 today to schedule an appointment for an evaluation to see if you are getting the most affordable and effective medications for your psychiatric diagnoses, such as Adult ADHD, depression, anxiety or bipolar disorder.

Darvin Hege, M.D.
http://www.eveningpsychiatrist.com/

Mirapex – A New Medicine for Depression

Mirapex is a little used and powerful antidepressant option for bipolar depression and treatment resistant depression.

Typically prescribed for the treatment of Parkinson’s—a disease characterized by deficient dopamine production in the motor centers of the brain—Mirapex is a dopamine agonist. Mirapex helps Parkinson’s patients by raising their dopamine levels.

Likewise, depression involves a state of relative deficiency of serotonin, norepinephrine, and/or dopamine in the mood centers of the brain. Studies show Mirapex increases dopamine in the mood centers of the brain. Increased dopamine tends to reduce depression symptoms of low energy, low motivation, low pleasure, and slowed thinking and movement.

How can I get New Medicine for Depression?
Although I learned about Mirapex’s usefulness in treating depression in 2003, very few psychiatrists prescribe this new medicine for depression.

I have prescribed Mirapex for bipolar depression and treatment-resistant depression for over 200 patients in the last 2.5 years. Many of these patients have found this new medicine for depression to be very effective.

If you’d like to explore this option for treatment of bipolar disorder or depression, call my office today at 770-458-0007 to schedule an appointment.

Effective New Medicine for Depression
I've worked with several treatment-resistant patients who failed to respond adequately or had adverse reactions to as many as 30 previous medicines. Of course, Mirapex is not for everyone. A significant group of patients have not responded or had side effects that required us to stop the medicine. Careful monitoring is required whenever medications are prescribed.

Patients that have responded to this new medicine for depression have been quite grateful for the relief of their symptoms. They also report the lack of weight gain and sexual side effects that plague the typical antidepressants and mood stabilizers. After Lamictal, Mirapex is the medicine I most often prescribe for bipolar depression.

Learn More about New Medicine for Depression
There have been three controlled clinical trials and a review article that provide growing evidence for the safety and efficacy of Mirapex for treatment of bipolar depression and treatment-resistant depressions.

Mirapex has a large effect size of 0.6-1.1. This means it is a lot more helpful than placebo in bipolar depression and treatment- resistant depression. However, it has not been approved by the FDA for these conditions. It is approved for Parkinson's disease and restless legs syndrome.
Mirapex is well tolerated by most patients, although some patients report side effects such as nausea, tiredness, sedation, headache, or insomnia. Less frequent side effects are abnormal muscle movements, restlessness, sleep attacks, faintness when standing.

Rare, more serious adverse reactions include hallucinations, hypersexuality, excess spending, or compulsive eating. So far, mania, hypomania, and psychosis have occurred at lower frequencies for Mirapex than for traditional antidepressants.

You can read an abstract of the review article at: http://www.ncbi.nlm.nih.gov/sites/entrez

Type this article title into the search window:
Pramipexole in Psychiatry: a Systematic Review of the Literature.

You may also purchase the full text of the original article for $15.

Find out whether Mirapex would be helpful for you. Call 770-458-0007 today to make an appointment.

Darvin Hege, M.D.
www.eveningpsychiatrist.com

New Stop Smoking Methods Available Now

Pharmaceutical solutions as stop smoking methods have been popular for a long time and include the nicotine patch, nicotine gum, or Wellbutrin.

What new Stop Smoking Methods are Available?

A relatively new drug, Chantix is having a profound effect on the smoking population in this country. Most of my patients say using Chantix is the easiest and most effective way to come off cigarettes or wet tobacco.

In fact, Chantix is starting to dent the business of the stop-smoking clinics because results are so much more effective than other methods. I noticed a stop-smoking clinic in a strip shopping center near my office has closed. It reminds me of what happened to the impotence clinics when Viagra came out—most clinics closed.

Stay Informed About New Stop Smoking Methods

Chantix has been out over a year but many people don’t even know about it yet. As a professional psychiatrist, I strive to keep abreast of any new forms of treatment and pass that information along to my patients.

A month ago, I had a patient that I was treating for depression. She felt well informed about how to quit smoking and had tried numerous ways to come off cigarettes over the years. When I mentioned Chantix, she’d never heard of it. She is now celebrating over a month of abstinence on Chantix and is delighted with how easy it was.

Will New Stop Smoking Methods Work for You?

Of course, not everyone is successful with Chantix. Many patients just don’t know how to quit smoking. Others are so discouraged from so many previous failures that they are reluctant to even try another method.

There is usually some clinical reason for failure to quit smoking that can be uncovered if the patient is willing to explore it with me. Some of the most common hurdles are other psychiatric conditions. When these conditions are defined and treated, patients are often successful with Chantix.

The most common obstacles to successfully quitting smoke are depression, anxiety, and/or other co-occurring substance abuse or dependence, such as alcohol, Xanax, or cocaine addictions. (Cigarette smoking is substance dependence. If a person becomes dependent on one substance, they are at high risk of becoming addicted to another substance as well). Untreated ADHD and bipolar disorder are also common contributors. When these conditions are successfully relieved with proper medication, stop smoking success rates improve significantly.

Possible side effects include nausea, headache, and irritability. Rare reports of violence may be related to associated alcohol or drug abuse.

Call 770-458-0007 or make an appointment to discuss using Chantix as a method to stop smoking and/or explore with you what treatable problem may be the root cause of your failure to stop smoking.

New ADHD Medicine

http://www.eveningpsychiatrist.com/aadd.htm
Vyvanse is a new form of Adderall that may have advantages for some patients. The advantages may be a more consistent improvement in ADHD symptoms throughout the day and may last longer than the extended release Adderall. There may be less abuse potential as well.

Vyvanse is a prodrug. A prodrug is not an active medication until it is metabolized in the body. Vyvanse is a compound of a protein and amphetamine. In the body amphetamine is split off from the protein and becomes active and goes to the brain. This splitting off is a chemical reaction that is rate limited. Therefore the amphetamine is released at a consistent, controlled rate that prevents spikes and dips of brain amphetamine concentrations throughout the day. When there is a spike, side effects of jitteriness, tremor, or edginess occur. When there is a dip, focus and productivity decrease. The brain level of the medication falls only after all the Vyvanse has been metabolized. The duration of the benefits lasts for 12 hours or longer if the dose given is high enough for the patient.

The risk of abuse is reduced because the amphetamine is bound to the protein. It is very difficult for drug abusing individuals to free the amphetamine and get it into the bloodstream by snorting or injecting it.

The FDA approved Vyvanse this summer for the indication of ADHD based on studies done in children and adolescents. We expect it to be effective and safe for adults with ADHD as well.

Vyvanse comes in 30, 50, and 70 mg dosages. We expect patients to benefit most and tolerate it best if their dosage of Vyvanse approximates 2-2.5 times their current total daily dosage of extended release and/or immediate release Adderall, especially for patients who have been taking multiple doses per day to have at least 12 hours of therapeutic blood levels per day.

If you are not already one of our patients, please call for an appointment to be evaluated so we can discuss these potential benefits for you.

Darvin Hege, M.D.

For more information about Vyvanse:
http://eveningpsychiatrist.blogspot.com/2008/01/vyvanse-update-on-first-100-patients.html and
http://www.eveningpsychiatrist.com/aadd.htm

WOMEN, ADULT ADHD, SUMMERTIME, AND CO-CCURRING CONDITIONS

Summertime can be an especially hard time for mothers, especially if they have adult ADHD. The usual multitasking responsibilities of motherhood are further strained by the additional hours of the emotionally draining, child care. The children require sustained attention and patient reactivity for their structure, nurturance, teaching, and discipline. If the mother is working as well, she has to juggle another competitor for her time, attention, and emotional and physical energy.

Women with adult ADHD are also at significantly higher risk of having children with ADHD. ADHD is one of the most highly heritable psychiatric conditions. Children with ADHD are difficult enough to deal with if the mother doesn't have ADHD. The combination of mother and child with ADHD can only exhaust the mother further.

Summertime is a great time for mothers who suspect they have ADHD to come in and get relief with medication. And if a child is suspected of having ADHD, it is a good time to bring in the child for evaluation when they're not in school. If they have ADHD and are treated effectively, a mother's summer may improve dramatically.

Co-occurring conditions are common with adult ADHD. Two recent studies now have shown significant improvement in bulimia and fibromyalgia when ADHD is present as well and the ADHD is effectively treated. The abstracts of the two articles can be viewed below.

Women are getting help for adult ADHD at a faster pace than men now. The third abstract below describes this trend. Join the ranks of your colleagues and call for help today.

Darvin Hege M.D. June 10, 2007
http://www.eveningpsychiatrist.com/aaddforwomen.htm


J Womens Health (Larchmt). 2005 May;14(4):345-50
Bulimia nervosa and attention deficit hyperactivity disorder: a possible role for stimulant medication.
Dukarm CP.
Department of Pediatrics, Sisters of Charity Hospital, Buffalo, New York 14214-2692, USA. dukharm@buffnet.net
BACKGROUND: Bulimia nervosa and attention deficit hyperactivity disorder (ADHD) share several key features, including impulsivity and low self-esteem. Stimulant medications have been highly effective in the treatment of ADHD. However, medication management of bulimia with antidepressants has demonstrated only partial resolution of bulimic symptoms. To date, there are no published reports of controlled trials evaluating the efficacy of stimulants for bulimia. The purpose of this paper is to report 6 patients with comorbid bulimia and ADHD who were treated with the stimulant medication, dextroamphetamine. RESULTS: All 6 patients described reported complete abstinence from binge eating and purging after treatment with psychostimulants, and none of the patients discontinued taking the medication because of side effects. The side effect of decreased appetite proved beneficial in decreasing the desire to binge eat. However, all 6 patients remained within a healthy weight range. CONCLUSIONS: Data from these case reports suggest a possible benefit of screening for ADHD as part of the overall evaluation of bulimia. In addition, these cases suggest the potential role of psychostimulants in the management of bulimia because of the high rate of abstinence from bulimic symptoms and the low rate of adverse side effects. Clinical trials are needed to fully evaluate the efficacy and tolerability of psychostimulants in the treatment of bulimia nervosa.
PMID: 15916509 [PubMed - indexed for MEDLINE]


Fibromylagia, chronic fatigue, and adult attention deficit hyperactivity disorder in the adult: a case study.
Psychopharmacol Bull. 2007;40(1):118-26


Young JL, Redmond JC.
Rochester Center for Behavioral Medicine, Rochester Hills, MI. judithcredmond@aol.com
Adult attention deficit hyperactivity disorder (ADHD) may share common features with fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS). In an outpatient psychiatric clinic, a number of adult patients who presented primarily with symptoms of ADHD, predominately inattentive type, also reported unexplained fatigue, widespread musculoskeletal pain or a pre-existing diagnosis of CFS or FMS. As expected, ADHD pharmacotherapy usually attenuated the core ADHD symptoms of inattention, distractibility, hyperactivity, and impulsivity. Less expected was the observation that some patients also reported amelioration of pain and fatigue symptoms. The utility of ADHD medications in FMS and CFS states may be their innate arousal and enhanced filtering properties. This model supposes that FMS and CFS are central processing problems rather than peripheral disorders of muscles and joints.
PMID: 17285103 [PubMed - indexed for MEDLINE]

J Atten Disord. 2007 May;10(4):335-42
Trends in medication treatment for ADHD.
Castle L, Aubert RE, Verbrugge RR, Khalid M, Epstein RS.
Medco Health Solutions. lon_castle@medco.com.
Objective: This study examines demographic trends in the use of medications to treat ADHD in adult and pediatric populations. Method: Using pharmacy claims data for a large population of commercially insured Americans, the study measures ADHD treatment prevalence and drug use from 2000 to 2005. Results: In 2005, 4.4% of children (ages 0 to 19) and 0.8% of adults (ages 20 and older) used ADHD medications. Treatment rates were higher in boys (6.1%) than in girls (2.6%), but the rates for men and women were approximately equal (0.8%). During the period of the study, treatment prevalence increased rapidly (11.8% per year) for the population as a whole. Treatment rates grew more rapidly for adults than for children, more rapidly for women than for men, and more rapidly for girls than for boys. Conclusion: Improved identification of ADHD in adult and female patients has contributed to rapid growth in ADHD medication use. (J. of Att. Dis. 2007; 10(4) 335-342).
PMID: 17449832 [PubMed - in process]

Darvin Hege, M.D.
<http://www.eveningpsychiatrist.com/aaddforwomen.htm>

Women, adult ADHD, summertime, bulimia, fibromyalgia

WOMEN, ADULT ADHD, SUMMERTIME, AND CO-OCCURRING CONDITIONS

Summertime can be an especially hard time for mothers, especially if they have adult ADHD. The usual multitasking responsibilities of motherhood are further strained by the additional hours of the emotionally draining, child care. The children require sustained attention and patient reactivity for their structure, nurturance, teaching, and discipline. If the mother is working as well, she has to juggle another competitor for her time, attention, and emotional and physical energy.

Women with adult ADHD are also at significantly higher risk of having children with ADHD. ADHD is one of the most highly heritable psychiatric conditions. Children with ADHD are difficult enough to deal with if the mother doesn't have ADHD. The combination of mother and child with ADHD can only exhaust the mother further.

Summertime is a great time for mothers who suspect they have ADHD to come in and get relief with medication. And if a child is suspected of having ADHD, it is a good time to bring in the child for evaluation when they're not in school. If they have ADHD and are treated effectively, a mother's summer may improve dramatically.

Co-occurring conditions are common with adult ADHD. Two recent studies now have shown significant improvement in bulimia and fibromyalgia when ADHD is present as well and the ADHD is effectively treated. The abstracts of the two articles can be viewed below.

Women are getting help for adult ADHD at a faster pace than men now. The third abstract below describes this trend. Join the ranks of your colleagues and call for help today.


Darvin Hege M.D. ; June 10, 2007



J Womens Health (Larchmt). 2005 May;14(4):345-50
Bulimia nervosa and attention deficit hyperactivity disorder: a possible role for stimulant medication.
Dukarm CP.
Department of Pediatrics, Sisters of Charity Hospital, Buffalo, New York 14214-2692, USA. dukharm@buffnet.net
BACKGROUND: Bulimia nervosa and attention deficit hyperactivity disorder (ADHD) share several key features, including impulsivity and low self-esteem. Stimulant medications have been highly effective in the treatment of ADHD. However, medication management of bulimia with antidepressants has demonstrated only partial resolution of bulimic symptoms. To date, there are no published reports of controlled trials evaluating the efficacy of stimulants for bulimia. The purpose of this paper is to report 6 patients with comorbid bulimia and ADHD who were treated with the stimulant medication, dextroamphetamine. RESULTS: All 6 patients described reported complete abstinence from binge eating and purging after treatment with psychostimulants, and none of the patients discontinued taking the medication because of side effects. The side effect of decreased appetite proved beneficial in decreasing the desire to binge eat. However, all 6 patients remained within a healthy weight range. CONCLUSIONS: Data from these case reports suggest a possible benefit of screening for ADHD as part of the overall evaluation of bulimia. In addition, these cases suggest the potential role of psychostimulants in the management of bulimia because of the high rate of abstinence from bulimic symptoms and the low rate of adverse side effects. Clinical trials are needed to fully evaluate the efficacy and tolerability of psychostimulants in the treatment of bulimia nervosa.
PMID: 15916509 [PubMed - indexed for MEDLINE]


Fibromylagia, chronic fatigue, and adult attention deficit hyperactivity disorder in the adult: a case study.
Psychopharmacol Bull. 2007;40(1):118-26


Young JL, Redmond JC.
Rochester Center for Behavioral Medicine, Rochester Hills, MI. judithcredmond@aol.com
Adult attention deficit hyperactivity disorder (ADHD) may share common features with fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS). In an outpatient psychiatric clinic, a number of adult patients who presented primarily with symptoms of ADHD, predominately inattentive type, also reported unexplained fatigue, widespread musculoskeletal pain or a pre-existing diagnosis of CFS or FMS. As expected, ADHD pharmacotherapy usually attenuated the core ADHD symptoms of inattention, distractibility, hyperactivity, and impulsivity. Less expected was the observation that some patients also reported amelioration of pain and fatigue symptoms. The utility of ADHD medications in FMS and CFS states may be their innate arousal and enhanced filtering properties. This model supposes that FMS and CFS are central processing problems rather than peripheral disorders of muscles and joints.
PMID: 17285103 [PubMed - indexed for MEDLINE]

J Atten Disord. 2007 May;10(4):335-42
Trends in medication treatment for ADHD.
Castle L, Aubert RE, Verbrugge RR, Khalid M, Epstein RS.
Medco Health Solutions. lon_castle@medco.com.
Objective: This study examines demographic trends in the use of medications to treat ADHD in adult and pediatric populations. Method: Using pharmacy claims data for a large population of commercially insured Americans, the study measures ADHD treatment prevalence and drug use from 2000 to 2005. Results: In 2005, 4.4% of children (ages 0 to 19) and 0.8% of adults (ages 20 and older) used ADHD medications. Treatment rates were higher in boys (6.1%) than in girls (2.6%), but the rates for men and women were approximately equal (0.8%). During the period of the study, treatment prevalence increased rapidly (11.8% per year) for the population as a whole. Treatment rates grew more rapidly for adults than for children, more rapidly for women than for men, and more rapidly for girls than for boys. Conclusion: Improved identification of ADHD in adult and female patients has contributed to rapid growth in ADHD medication use. (J. of Att. Dis. 2007; 10(4) 335-342).
PMID: 17449832 [PubMed - in process]