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
Tuesday, November 6, 2007
Wednesday, June 13, 2007
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 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>
Sunday, June 10, 2007
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]
Subscribe to:
Posts (Atom)
