ADHD and the drugs to help
Dear Dr. Jeff: I've recently been diagnosed with ADHD,
and am wrestling with whether I want to take the Adderall my doctor prescribed.
There are lots of rumors around, and I'm trying to separate fact from
Dear S.H.: "Attention Deficit Hyperactivity Disorder"
is a neuropsychiatric disorder, characterized by inattention, impulsivity,
and hyperactivity. These behavioral deficits cause problems which are
performance-based, rather than skill-based. Although students with ADHD
are of at least average, if not above average intelligence, and certainly
possess their fair share of talents and abilities, 25 to 35 percent fail
to graduate high school. Young adults with ADHD also have a six-fold increased
risk of developing substance abuse problems.
ADHD is a chronic, life-long disorder, usually appearing
first in childhood. It may affect as many as 3 to 5 percent of Americans,
and 1 to 3 percent of college students. ADHD can be difficult to diagnose,
and many experts feel that it is both over-diagnosed (especially in highly
active, slow-learning boys) and under-diagnosed (in inattentive but quiet
girls). A high percentage of people with ADHD also have a learning disorder,
and complete neuropsychological or educational-psychological evaluation
should be undertaken for anyone diagnosed with ADHD.
Stimulant medications (e.g. Ritalin and Dexedrine) remain
the primary therapy for ADHD. They modulate levels of the neurotransmitter
dopamine, and in so doing, are thought to decrease neurologic "white
noise" from competing centers of the brain, facilitating focus and
concentration on central tasks. They are now available in a variety of
short- and long-acting preparations. The newer products are being marketed
directly to consumers, sometimes with confusing results.
Standard methylphenidate ("Ritalin") lasts only
3 - 5 hours, and is usually taken in multiple daytime doses. An older
sustained release formulation ("Ritalin-SR") lasts 6 - 8 hours,
but has a slow onset of action. "Metadate CD", the newest formulation,
has the same 8 hour duration, but contains both immediate- and extended-release
components, peaking first at 1.5 hours, and then again at 4.5 hours. "Concerta"
tablets contain both an immediate-release coating of medication, and an
osmotic pump which gradually releases the remainder of the drug over a
12 hour period. Concerta tablet shells are not digested, and leave the
GI tract as empty "ghost" shells.
Typical monthly costs of the four preparations range from
$32 to $70, respectively.
Standard dextroamphetamine ("Dexedrine") is as
effective as methylphenidate in treating ADHD, and has about a 5 hour
duration. Extended-release "Dexedrine Spansules" last about
8 hours. "Adderall" contains a mixture of amphetamines, lasts
only 4 -5 hours, and so is best taken in two daily doses. A sustained-release
formulation ("Adderall XR") is on its way, and will surely be
advertised in magazines and on TV. The amphetamine preparations all cost
about $25 per month.
All of these medications are controlled substances. The
shorter-acting stimulants are readily abused for recreational purposes,
and are all known to be frequently traded among friends as "study
aids". At the University of Wisconsin, one in five students reported
misusing this medication. At Bowdoin, this may be equally common.
Headache, abdominal pain, appetite suppression, insomnia
and nervous tics are all common side effects of stimulants. Taken orally,
in prescribed doses, stimulants are safe and effective medications. Rarely,
in people with predispositions to seizure disorders or cardiac problems,
they can be dangerous, even fatal. This is especially true when they are
Many "natural" products are also promoted for
ADHD, including essential fatty acids, phosphatidylserine, ginkgo, DMAE,
and Ephedra. None have been scientifically proven to be effective. And
remember: "natural" doesn't necessarily mean safe.
A balanced, healthful diet and regularly scheduled exercise,
on the other hand, can be very helpful for someone with ADHD. Compensatory
strategies for structuring studies and organizing activities are also
effective. Bowdoin students can find assistance in developing these strategies
at the Baldwin Center. Joann Canning, Director of Accomodations for Students
with Disabilities, can help coordinate these efforts. Providers at the
Counseling Center can help students deal with the feelings of inadequacy,
stress and frustration that often come with ADHD. And last, but by no
means least, the student support group FORWARD! welcomes all to attend
their Wednesday evening meetings in Moulton Union.
Jeff Benson, M.D.