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

Vyvanse_How It Works November 5, 2009

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. 

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. 

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. 

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:

1. Learn and practice calming techniques like yoga, tai chi, and meditation.


2. Learn and practice slow, deep breathing exercises.


3. Reduce stress at night by taking time to relax and forget the worries of the day before retiring to bed at night.


4. 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. 

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. 

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.) 

1. In classes over the years have you had trouble keeping your mind on the teacher and found yourself daydreaming a lot?
   
   


2. Do you have pattern of making a fair amount of careless mistakes on tests, even when you knew the correct answers? 
   
   


3. Have you had a good many complaints over the years about your not listening? 
   
   


4. Have you been plagued by procrastination fairly regularly throughout your life? 
   
   


5. 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? 
   
   


6. Do you have a pattern of avoiding most things that require sustained mental effort? 
   
   


7. Do you have pattern of frequently misplacing or losing things? 
   
   


8. Have you tended to be easily distracted throughout your life? 
   
   


9. 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: 

1. 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? 
   
   


2. Do you have pattern throughout life of having difficulty staying in your seat for one hour for classes or meetings? 
   
   


3. 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? 
   
   


4. 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? 
   
   


5. Do you talk excessively or quite occasionally get feedback that you talk too much? 
   
   

Impulsivity: 

1. Do you tend to blurt out the answer before the person has finished their question? 
   
   


2. Does it seem harder for you to wait on your turn than for the average person? 
   
   


3. 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.