HOW TO GET CHEAP/AFFORDABLE PSYCHIATRIC MEDICATIONShttp://ltcc.usadrugplan.com/
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.
Saturday, April 23, 2011
Monday, February 8, 2010
IS ADHD A REAL MEDICAL CONDITION OR NOT?
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:
1. CLINICAL CORRELATES
“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.
2. DELIMITATION FROM OTHER DISORDERS
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.
3. COURSE AND OUTCOME
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.
4. EVIDENCE FOR HERITABILITY FROM FAMILY AND GENETIC STUDIES
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.
5. LABORATORY STUDIES
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.
6. TREATMENT RESPONSE
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 .
DISCUSSION
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. faraones@upstate.edu
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.
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:
1. CLINICAL CORRELATES
“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.
2. DELIMITATION FROM OTHER DISORDERS
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.
3. COURSE AND OUTCOME
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.
4. EVIDENCE FOR HERITABILITY FROM FAMILY AND GENETIC STUDIES
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.
5. LABORATORY STUDIES
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.
6. TREATMENT RESPONSE
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 .
DISCUSSION
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. faraones@upstate.edu
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
ADDERALL NEUROTOXICITY
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
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
Thursday, November 5, 2009
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.
Wednesday, November 26, 2008
Panic Attacks At Night
Panic attacks are common for many people. It doesn't matter where you are or what you are doing - a panic attack can come on randomly and disrupt your day (or night). Over 6 million Americans suffer from panic attacks and between 44 percent and 71 percent of those people have also experienced panic attacks at night.
While it would seem that people should have more anxiety during the day, due to stresses of work and home, panic attacks at night are more common than you would think. Panic attacks at night are characterized by waking abruptly from sleep in a state of anxiety, and for no obvious reason. Episodes of panic attacks at night are generally over within ten minutes or so, but those few minutes can set the tone for sleeplessness the rest of the night. 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. It can be hard to go back to sleep after the body is revved up from the attack. Also, 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.
Part of the distress of panic attacks at night is the sense of loss of control. Patients suffering from an attack may also feel the night brings with it a sense of being defenseless while unconscious (sleeping) and the thought that something might happen while they are most vulnerable. Panic attacks at night can be precipitated by events that happened during the day. Things that happened during the day may be revisited at bedtime, causing anxiety before sleeping. Events at home may leave an emotional imprint on the mind, causing the patient to be more anxious than usual. Even eating late at night just before going to bed can keep the sufferer awake and make them more prone to panic attacks at night.
There are some things people can do to help them deal with panic attacks at night:
- Learn and practice calming techniques like yoga, tai chi, and meditation.
- Learn and practice slow, deep breathing exercises.
- Reduce stress at night by taking time to relax and forget the worries of the day before retiring to bed at night.
- Develop healthy eating habits and exercise programs to help reduce stress.
If these techniques are not enough to help you deal with panic attacks at night, counseling and medication are an important next step. Find a therapist who has experience in dealing with panic attacks at night. Treatment such as cognitive behavior therapy and anti-anxiety medications can alleviate or eliminate panic attacks for most people. 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 panic attacks at night. For more information from Dr. Hege about panic attacks and the most effective medications for stopping panic attacks at night, go to the Panic Attacks Information page on his website.
Although having panic attacks at night can be a frightening experience, they aren't something you just have to live with. Medications, therapy, and stress reduction can help sufferers face the night without fear.
Dr. Hege has 25 years of experience dealing with patients who have panic attacks at night. Call him today at 770-458-0007 for an evaluation for relief of your panic during the night, and for help deciding the most effective and safest treatment.
Saturday, November 22, 2008
ADULT ADHD: HOW DO WE DIAGNOSE IT?
There are several clues that a new patient has adult ADHD before I ever see them for an ADHD evaluation. Staff may comment to me about a new patient who is having difficulty following directions to get to our office. New patients who arrive too late for their first appointment and have to be rescheduled often have ADHD.
Dr. Darvin Hege has 25 years of experience dealing with patients who may fit the criteria for ADHD and need an ADHD evaluation. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770 458-0007 for an ADHD evaluation and for help deciding the most effective and safest treatment.
My initial observations and interactions with the patient often give me clues and can help with the ADHD evaluation. Anxiety about meeting a psychiatrist may make it hard to pay attention to direct them into the correct door to enter my office. I help with directions including telling them and pointing to the doorway where we are going and suggesting where they may want to sit in the consulting room. They also may need some more time to scan the room and if they get distracted by my diplomas or pictures, I will try to give him some structure to focus on the interview at hand by asking them how I may help. Quite occasionally people with ADHD say they don't know how I may help. Often if I ask them what symptoms are bothering them that caused them to come see me, then they can get specific about their concerns.
Chief complaint:
The patient's chief complaint usually include a previous diagnosis of ADHD or their belief that they may have ADHD. Those who believe themselves to have ADHD have often been to my website and review the criteria for ADHD and have completed ADHD evaluation questionnaires. Usually they have fulfilled or much surpassed the threshold for the diagnosis. Frequently patients come to me under pressure from a partner or an employer for forgetfulness, not completing tasks, not listening or paying attention to detail, tardiness. Other patients come for anxiety, depression, bipolar, substance abuse issues, relationship problems and I discover they have ADHD when I do my usual comprehensive exam on all new patients that includes ADHD symptoms questions.
History of present illness:
Most patients give a history of having had problems for many years that usually goes back into childhood before there was an evaluation for ADHD. Distractibility and inattention usually usually first caused problems during the school years. However, it may have been in high school or college that the patient first realized it took them longer than their classmates to read a chapter because of having to reread so much and that they were not making grades as good as peers that they knew were not as smart as they . Others became aware of their inefficient use of time when they started working in a job that required a lot of paperwork. Others only became aware of the nature of their problem when they became involved in a serious relationship or marriage and their partner confronted them about their not paying attention when they were talking to them or kept interrupting them. Others started their own business and found they were procrastinating at doing what they had to do to make their business go. Examples are not doing paperwork for taxes, not returning calls punctually to business clients, not writing proposals, or not invoicing regularly.
Specific symptoms:
I have developed my own practical questions over the years to elicit the various ADHD symptoms that make up the criteria for the formal diagnosis of ADHD in adults. Most patients who have the condition can resonate and confirm if they have symptoms or not. Also, I do some preparation with the patient before I ask the questions. I ask them to simply answer yes or no to each question, choosing a yes or no based on which is closest to the truth. I asked them not to start elaborating by changing the criteria I have set, and not to start expounding with examples to confirm a yes. If I don't set the structure, they may talk for several minutes and neither of us know if the answer is a yes or a no. I alert them that if they start expounding that I will try to gently interrupt them and I hope I don't insult them with this structure.
Here are the questions I use to help with an evaluation of ADHD:
(This first set of questions are criteria for the inattentive type of ADHD. Yes to six of these questions are necessary for the diagnosis.)
- In classes over the years have you had trouble keeping your mind on the teacher and found yourself daydreaming a lot?
- Do you have pattern of making a fair amount of careless mistakes on tests, even when you knew the correct answers?
- Have you had a good many complaints over the years about your not listening?
- Have you been plagued by procrastination fairly regularly throughout your life?
- Can you write up a project plan, i.e. can you write an outline for an essay or project that includes points or steps in a logical sequence?
- Do you have a pattern of avoiding most things that require sustained mental effort?
- Do you have pattern of frequently misplacing or losing things?
- Have you tended to be easily distracted throughout your life?
- Do you have pattern throughout your life up being somewhat absent-minded or forgetful?
(Four of these hyperactivity-impulsivity symptoms are necessary to meet the criteria for the subtype of hyperactivity.)
Hyperactivity:
- Are you chronically a rather fidgety person, i.e., regularly squirm in your seat, drum with your fingers, shuffle papers, or do things that annoy people around you?
- Do you have pattern throughout life of having difficulty staying in your seat for one hour for classes or meetings?
- If you go into a room where a group of people you know are sitting around having a sedate conversation, do you try to liven it up by making it fun or exciting?
- Are you the type of person who is usually on the go and/or driven by a motor and/or would rather be doing something physical more than something mental?
- Do you talk excessively or quite occasionally get feedback that you talk too much?
Impulsivity:
- Do you tend to blurt out the answer before the person has finished their question?
- Does it seem harder for you to wait on your turn than for the average person?
- Do you tend to interrupt others conversations?
Through this ADHD evaluation, if the patient meets the criteria for one or both subtypes of adult ADHD, I'll proceed with a conversation with them about the medication choices, benefits, and potential adverse reactions, and begin treatment if the patient is ready to start it at this time.
Dr. Darvin Hege has 25 years of experience dealing with patients who may fit the criteria for ADHD and need an ADHD evaluation. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770 458-0007 for an ADHD evaluation and for help deciding the most effective and safest treatment.
Tuesday, November 18, 2008
Panic Attacks And Menopause
First of all, let's agree that menopause is no walk in the park for many women. Their hormones are constantly fluctuating back and forth, they have hot flashes and mood swings, and they either can't sleep or they wake up with night sweats. Add in anxiety and panic attacks and many women will feel like they are going right over the edge. Panic attacks and menopause just don't mix well.
Simple anxiety is something everyone experiences on occasion. We all stress over projects at work or issues at home. But, panic attacks are anxiety attacks on steroids. A panic attack can make the sufferer feel like they are having a heart attack! The most common symptoms people have with panic attacks are racing heart beats or heart palpitations, chest pain or discomfort, a feeling of shortness of breath or choking, sweating, dizziness or feeling lightheaded or faint, and unnatural fear and anxiety. To get an idea of what a panic attack is like, think about how you feel when you are cut off by another car and narrowly miss hitting someone or something. Now, multiply that feeling tenfold!
Women who are experiencing a panic attack are likely to breathe shallowly and rapidly. Their racing heartbeat makes them more upset, and the terror and fear that something horrible is happening to them only increases their panic. Panic attacks are not triggered by something in the environment around the sufferer or by something they did; rather the attacks begin for no apparent reason and are as likely to affect someone who is sitting calmly while reading a book as they are to affect a woman in a stressful situation.
While people can be prone to panic attacks at any stage of life, women are more likely than men to suffer from them, and panic attacks and menopause seem to go hand in hand. Many women today are stressed out and overworked, and put themselves at the back of the line behind family and work needs. When women enter perimenopause and menopause, their bodies begin to have hormone imbalances. It is believed that these hormone imbalances, coupled with stress, are at least partially to blame for an increased susceptibility to panic attacks.
Many women will go through perimenopause and menopause, and panic attacks will only happen once or twice during the entire process. For other women, menopause and panic attacks will become a way of life until menopause is completed. For these women, medication may hold the answer to getting them through this troubling time of life.
Dr. Darvin Hege, an Atlanta, GA psychiatrist says "there are two classes of anti-panic medicines that are highly effective. They are Benzodiazepines (Group 1) which consist of Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), Tranxene, Serax Valium, Librium, and others, and Antidepressant/Anti-panic medicines (Group 2) consisting of SSRI's (Zoloft, Prozac, Paxil, Celexa, Lexapro, and Luvox) and tricyclics (Tofranil, nortriptyline, protriptyline, Elavil, Sinequan, Surmontil, and others)." Dr. Hege further notes that "the most important difference between Group 1 and Group 2 is that medicines in Group 1 work much quicker, i.e. stop panic attacks in twenty minutes to a couple of weeks in worse cases. Group 2 requires 1-8 weeks to be effective. However, Group 1 can be physically addictive. Group 2 medicines are just as likely to stop all panic attacks as Group 1 after a lag period. The lag period is 1-3 weeks to the onset of reducing the severity and frequency of attacks. It takes Group 2, 3-10 weeks to totally stop all panic attacks in 70% of patients. Most people need to be on medicine for at least 1 year to significantly reduce the risk of relapse back into panic attacks soon after stopping the medicines."
Menopause and panic attacks are not something that women just have to "put up with". For those women who suffer relatively few attacks, natural therapies or stress reduction can help. Yoga, meditation, and exercise can help calm otherwise frantic lifestyles. Just the simple fact of knowing what a panic attack feels like can help women respond less negatively if they have one. For those women who can not deal with the anxiety and fear that a combination of menopause and panic attacks can bring on, there is relief in the form of counseling and medication.
Dr. Darvin Hege has 25 years of experience dealing with patients who have panic attacks and menopause 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 for help deciding the most effective and safest treatment.
Wednesday, November 12, 2008
Panic Attacks And Pregnancy
Panic attacks and pregnancy simultaneously create risks for the fetus. Stress and anxiety in the mother increase adrenaline and cortisol that can reduce oxygen to the fetus and contribute to risks during labor and delivery. The peak age of onset is in the 20s and more women than men get panic attacks. Therefore, the incidence of panic attacks and pregnancy together is elevated. The prevalence of panic attacks and pregnancy is about 1 to 2%.
In a retrospective study of first onset of panic attacks in childbearing age women, 10 times as many women reported their first panic attack occurred in the first trimester of a pregnancy. Other retrospective studies suggested that breast-feeding reduced the risk of panic disorder during the postnatal period and weaning increased the risk. If a woman has had panic attacks before pregnancy, studies have suggested that they may have worsening of the panic attacks during pregnancy and/or the postnatal period if the panic disorder was severe.
Medical causes of panic attacks need to be ruled out. These include thyroid disorders, anemia, preeclampsia, and pheochromocytoma. Comorbid psychiatric conditions frequently underlie panic disorder. These include mild bipolar disorder, depression, ADHD, other anxiety disorders such as PTSD, generalized anxiety disorder, or alcohol or drug abuse or withdrawal.
Panic attacks and pregnancy present challenges for treatment. Self-care strategies include elimination of caffeine, reduction of sleep deprivation, and relaxation techniques. Non-medication therapy with cognitive behavioral therapy with a professional therapist may be effective.
Medication treatment for panic attacks and pregnancy are often very helpful, but risk and benefit analysis include the following: as mentioned in the beginning there are medical, physical development, labor and delivery, postpartum, and later physical and mental developmental risks for the baby when the mother is having uncontrolled panic attacks during pregnancy, postpartum, and early childhood stages.
Now I will address some of the concerns of taking medication during panic attacks and pregnancy. Medications that help panic attacks the quickest are benzodiazepines. Benzodiazepines include Xanax, Klonopin, Ativan, Valium, Librium, Tranxene, and Serax. There was at least one study suggesting an increased risk of cleft palate if Valium is used during pregnancy. That suggestion was about a 1% risk. SSRIs retrospective studies have not suggested any congenital malformations except possibly in Paxil. Hence, the other SSRIs are first choice. These include Prozac, Zoloft, Celexa, and Lexapro. The drawback of the SSRIs are that they require one to two weeks of administration before getting any benefit and one to two months before getting full benefit against panic attacks. Withdrawal or discontinuation symptoms of any of these medicines in the baby after delivery are additional concerns.
Dr. Hege has 25 years of experience dealing with patients who have panic attacks and pregnancy simultaneously. Call today at 770 458-0007 for an evaluation for relief of your panic during the planning or managing of a pregnancy or postpartum, and for help deciding the most effective and safest treatment.
Monday, September 29, 2008
AFFORDABLE/CHEAP SUBSTITUTES FOR VYVANSE, ADDERALL XR, CONCERTA, FOCALIN XR, AND DEXEDRINE SPANSULES FOR ADULT ADHD.
Dramatic savings can be achieved with this strategy if you're willing to accept some inconvenience and a period of adjustment. Vyvanse, Adderall XR, Concerta, Focalin XR, and Dexedrine Spansules cost at least $125 per month if you are on one pill a day because they cost about four dollars per pill. If you need 2 or 3 pills per day, that costs $250 or $375 per month. Generic Adderall costs $.35 per pill at Costco. If you take 2 or 3 Adderalls per day, that's $.70 to $1 per day or about $20 to $30 per month. Here's how I implement this strategy for the most consistent focusing all day.
I have my patients set a daily alert in their cell phone to go off at a time in the morning soon after they arise each day. They promptly take their first dose of generic Adderall, Ritalin, Dexedrine, or Focalin for the day. Then they note how long it is until the benefit of the first dose starts to decline. The next day they set their second daily alert for each day at a time that is 30 minutes before their focus begins to decline. This way they take the next dose to be replacing the falling brain concentrations of the previous dose. This prevents a dip in focus between doses. Alerts are then set for the third and fourth doses of the day, as necessary, with the same interval between alerts as between the first and second alerts. My patients are reporting significant improvement in their work and school performance, more consistent and improved mood, and avoiding daytime crashes between doses. Crashes are the periods of tiredness, sleepiness, irritability, or easy crying from a rapid drop-off in ADHD medication brain concentrations.
When switching my patients from a more expensive, longer acting ADHD medication to the cheap, shorter acting, generic substitute, we start out on very low doses and then move up the doses gradually. This way we avoid side effects, find the most effective dose, adjust the period between doses, and adjust the size and time of the last dose of the day to prevent difficulty falling asleep.
For more information on how to save money on psychiatric medications, see my blog about affordable psychiatric medications http://www.eveningpsychiatrist.blogspot.com To make an appointment with Dr. Hege for evaluation and treatment for adult ADHD,
Call 770-458-0007.
Dramatic savings can be achieved with this strategy if you're willing to accept some inconvenience and a period of adjustment. Vyvanse, Adderall XR, Concerta, Focalin XR, and Dexedrine Spansules cost at least $125 per month if you are on one pill a day because they cost about four dollars per pill. If you need 2 or 3 pills per day, that costs $250 or $375 per month. Generic Adderall costs $.35 per pill at Costco. If you take 2 or 3 Adderalls per day, that's $.70 to $1 per day or about $20 to $30 per month. Here's how I implement this strategy for the most consistent focusing all day.
I have my patients set a daily alert in their cell phone to go off at a time in the morning soon after they arise each day. They promptly take their first dose of generic Adderall, Ritalin, Dexedrine, or Focalin for the day. Then they note how long it is until the benefit of the first dose starts to decline. The next day they set their second daily alert for each day at a time that is 30 minutes before their focus begins to decline. This way they take the next dose to be replacing the falling brain concentrations of the previous dose. This prevents a dip in focus between doses. Alerts are then set for the third and fourth doses of the day, as necessary, with the same interval between alerts as between the first and second alerts. My patients are reporting significant improvement in their work and school performance, more consistent and improved mood, and avoiding daytime crashes between doses. Crashes are the periods of tiredness, sleepiness, irritability, or easy crying from a rapid drop-off in ADHD medication brain concentrations.
When switching my patients from a more expensive, longer acting ADHD medication to the cheap, shorter acting, generic substitute, we start out on very low doses and then move up the doses gradually. This way we avoid side effects, find the most effective dose, adjust the period between doses, and adjust the size and time of the last dose of the day to prevent difficulty falling asleep.
For more information on how to save money on psychiatric medications, see my blog about affordable psychiatric medications http://www.eveningpsychiatrist.blogspot.com To make an appointment with Dr. Hege for evaluation and treatment for adult ADHD,
Call 770-458-0007.
Thursday, August 21, 2008
Thursday, April 24, 2008
Vyvanse Approved For Adults
Shire PLC announced today that Vyvanse has won US approval to treat adults. I have prescribed it for 275 patient since the FDA approved it for children and adolescents in August of 2007. 95% of these patients are adults. Only a few of my patients were afraid to take it because it was not FDA approved for adults.
This information was reported in the Wall Street Journal today, April 24, 2008, in an article on page D4, titled "ADHD Drug Is Approved for Adult Use".
Included in the article was this statement that Adderall XR will not lose patent protection until April 2009. I had been informed and was telling my patients that Adderall XR went off patent this year.
Additional information about Vyvanse may be found in three prior blogs on this blog site.
Additional information about Adult ADHD and women with adult ADHD may be found on my web pages, http://www.eveningpsychiatrist.com/aadd.htm , http://www.eveningpsychiatrist.com/aaddforwomen.htm .
http://www.eveningpsychiatrist.com/index.html
Monday, February 4, 2008
Vyvanse: How it works_Adult ADHD medication treatment specialist psychiatrist Dr. in Atlanta on the new Adderall named Vyvanse.
VYVANSE_HOW IT WORKS
Adult ADHD medication treatment specialist psychiatrist doctor in Atlanta on the new Adderall named Vyvanse.
Vyvanse has several advantages over Adderall XR, Adderall, dexedrine and other amphetamine preparations. It provides more consistent concentration assistance throughout the day, lasts longer, i.e., from morning till bedtime, all in a convenient, single morning dose, and less likely to reach abusive or overdose brain levels because of an enzyme regulatory action.
Here’s how it works. In the lab they took the dextroamphetamine molecule and stuck it onto a protein molecule. You swallow the capsule with the compound inside and it is absorbed from your intestine into your bloodstream and goes to your brain. However, the amphetamine molecule can’t get into your brain cells to help your concentration because the protein molecule is too big to get through the door into your brain cells. Enzymes in the body cleave the amphetamine from the protein. I use the following analogy to help my patients understand. The situation is like a waiting line outside a nightclub. The Vyvanse compounds of dextroamphetamine and attached protein molecules are like people with large backpacks that are too big for the small doors into the club. The people need the assistance of the bouncers at the door to help remove their backpacks and grant permission to enter the club. The bouncers activity is similar to the enzyme’s action. They allow the patrons to enter at a regulated rate. The longer the line of patrons, or Vyvanse, the later in the day the last amphetamine enters the brain cells. There is a limited number of these enzymes in your body so they put a ceiling on the rate of entry and the concentration level of amphetamine in your brain cells. Hence, you are less likely to overdose or abuse the amphetamine to get high concentrations of amphetamine into your brain. This also prevents spikes of high concentrations that cause jitteriness, edginess, nervousness,or anxiety that are often experienced in the early minutes or hours after taking the immediate release form or the extended release Adderall. Now this steady action of these enzymes on the Vyvanse compound also provides protection from the dips in concentration that are experienced with the other amphetamine preparations.
The longer duration action of Vyvanse is also related to this rate limited enzyme action. If we raise the dose of Vyvanse, we lengthen the waiting line of Vyvanse-protein molecules waiting to be cleaved to enter the brain. We can adjust up the dose so that you can have consistent focus from morning to bedtime. We adjust the one time morning dose of Vyvanse in this fashion. Pull the capsule apart and dump the ingredients into a measuring cup of water. Stir the solution and the Vyvanse compound dissolves in the water. Remember that the protein is only cleaved from the amphetamine by enzymes inside the body. After you have calculated the duration of hours that a particular dose of Vyvanse lasts, you drink the amount of solution proportionate to the number of hours you want the Vyvanse concentration to last. If you want it to last longer than your capsule dose, you swallow your capsule plus the measured solution. If you are going to have a short day or forget to take your Vyvanse until later in the day, you just take the proportionate fraction of your dose in solution form. If you find out later in the day one day that you’re going to need to concentrate longer that day than what you had dosed for that morning, you can take an additional partial fraction of a capsule dose at that time. You may then save the remaining aliquot of solution in the refrigerator for ingestion the next day.
Pharmacist s often are not aware yet that you may take partial doses, but you can tell them that “It’s in the package insert”. Now they may tell you that you can’t save the balance of the solution for the next day. That is what the package insert says because it was not researched in the clinical trials. However, my colleagues and my patients rarely report any loss of benefit or other effects.
For more blogs by Dr. Hege about Vyvanse
http://eveningpsychiatrist.blogspot.com/2008/01/vyvanse-update-on-first-100-patients.html
http://eveningpsychiatrist.blogspot.com/2007/11/new-adhd-medicine.html
Darvin Hege, M.D.
February 4, 2008
Adult ADHD medication treatment specialist psychiatrist doctor in Atlanta on the new Adderall named Vyvanse.
Vyvanse has several advantages over Adderall XR, Adderall, dexedrine and other amphetamine preparations. It provides more consistent concentration assistance throughout the day, lasts longer, i.e., from morning till bedtime, all in a convenient, single morning dose, and less likely to reach abusive or overdose brain levels because of an enzyme regulatory action.
Here’s how it works. In the lab they took the dextroamphetamine molecule and stuck it onto a protein molecule. You swallow the capsule with the compound inside and it is absorbed from your intestine into your bloodstream and goes to your brain. However, the amphetamine molecule can’t get into your brain cells to help your concentration because the protein molecule is too big to get through the door into your brain cells. Enzymes in the body cleave the amphetamine from the protein. I use the following analogy to help my patients understand. The situation is like a waiting line outside a nightclub. The Vyvanse compounds of dextroamphetamine and attached protein molecules are like people with large backpacks that are too big for the small doors into the club. The people need the assistance of the bouncers at the door to help remove their backpacks and grant permission to enter the club. The bouncers activity is similar to the enzyme’s action. They allow the patrons to enter at a regulated rate. The longer the line of patrons, or Vyvanse, the later in the day the last amphetamine enters the brain cells. There is a limited number of these enzymes in your body so they put a ceiling on the rate of entry and the concentration level of amphetamine in your brain cells. Hence, you are less likely to overdose or abuse the amphetamine to get high concentrations of amphetamine into your brain. This also prevents spikes of high concentrations that cause jitteriness, edginess, nervousness,or anxiety that are often experienced in the early minutes or hours after taking the immediate release form or the extended release Adderall. Now this steady action of these enzymes on the Vyvanse compound also provides protection from the dips in concentration that are experienced with the other amphetamine preparations.
The longer duration action of Vyvanse is also related to this rate limited enzyme action. If we raise the dose of Vyvanse, we lengthen the waiting line of Vyvanse-protein molecules waiting to be cleaved to enter the brain. We can adjust up the dose so that you can have consistent focus from morning to bedtime. We adjust the one time morning dose of Vyvanse in this fashion. Pull the capsule apart and dump the ingredients into a measuring cup of water. Stir the solution and the Vyvanse compound dissolves in the water. Remember that the protein is only cleaved from the amphetamine by enzymes inside the body. After you have calculated the duration of hours that a particular dose of Vyvanse lasts, you drink the amount of solution proportionate to the number of hours you want the Vyvanse concentration to last. If you want it to last longer than your capsule dose, you swallow your capsule plus the measured solution. If you are going to have a short day or forget to take your Vyvanse until later in the day, you just take the proportionate fraction of your dose in solution form. If you find out later in the day one day that you’re going to need to concentrate longer that day than what you had dosed for that morning, you can take an additional partial fraction of a capsule dose at that time. You may then save the remaining aliquot of solution in the refrigerator for ingestion the next day.
Pharmacist s often are not aware yet that you may take partial doses, but you can tell them that “It’s in the package insert”. Now they may tell you that you can’t save the balance of the solution for the next day. That is what the package insert says because it was not researched in the clinical trials. However, my colleagues and my patients rarely report any loss of benefit or other effects.
For more blogs by Dr. Hege about Vyvanse
http://eveningpsychiatrist.blogspot.com/2008/01/vyvanse-update-on-first-100-patients.html
http://eveningpsychiatrist.blogspot.com/2007/11/new-adhd-medicine.html
Darvin Hege, M.D.
February 4, 2008
Saturday, January 5, 2008
Vyvanse Update On First 100 Patients Treated
I have now prescribed Vyvanse for 105 patients. My patient's responses have been better than I expected. The majority of the patients prefer or much prefer Vyvanse over Adderall XR. The chief advantage is the consistently improved concentration. The second most frequent benefit is that it lasts longer. Some patients report it lasts all day and they experience no "fade" before bedtime. Patients frequently say they just feel normal all the time. Many patients report no more of the "crash" that they experienced when their Adderall XR levels dropped later in the day.
The most frequent reason that patients want to change back to Adderall or Adderall XR is that their insurance doesn't cover it. Other patients feel it doesn't work as effectively as Adderall. As I get more experience, I am using higher doses and having fewer of these complaints. When I started prescribing Vyvanse I started at a dose similar to the total daily dose of Adderall the patient had been taking. Now I am aiming for approximately double that dose and I am getting better results.
Few patients complain of jitteriness even when I raise the dose significantly. Usually, each raise only prolongs the duration of benefit to a later point in the day. A few patients have had to stop Vyvanse because of abdominal distress, headache, or insomnia.
Call us today at 770-458-0007 for an appointment if you would like to be evaluated for Vyvanse.
Dr. Hege
January 05, 2007
For more information :
http://eveningpsychiatrist.blogspot.com/search/label/Vyvanse
and http://www.eveningpsychiatrist.com/aadd.htm
Tuesday, December 11, 2007
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.
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.
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/
Friday, November 30, 2007
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
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