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May/ June 1999 - Volume 2 - Issue 5


What About Medication?
By D. Steven Ledingham

It is not unusual for people to be concerned about the misuse and abuse of medications, especially those used for ADD. The medication Ritalin is a popular target in the media and many false, exaggerated or inaccurate exist about this medication. Our purpose is not to defend any medication but to provide accurate information so you can make your own decision about what is responsible or irresponsible use of medication for you. Medications have some risks just as many types of foods we eat or substances we drink have some risk. Being responsible about life choices means weighing risks against advantages and making decisions we believe are right and responsible ones for us.

In considering the use of medication we should look at various sources of information, not just the warning labels that are inside the box or listed in the Physicians Drug Reference. Since the late 1930's medication has been an active component of treating ADD-type behaviors. Statistical information indicates in around 70% of the diagnosed cases of ADD and ADHD, medication is a helpful component of the treatment program. On a personal note, I was diagnosed in 1989, and have used medication as part of my treatment program ever since. In the last eight years I have talked with hundreds of adults who have successfully used medication to help them compensate for ADD.

There are reasons to not use medications in treating ADD-type behaviors. It is important to consider that these types of behaviors can appear for reasons other than ADD. A person may be diabetic or have a thyroid problem or an additional medical condition.

They may be suffering from post traumatic stress syndrome, or going through some major life stressors. The cause of some ADD-like behaviors could be drug abuse, dehydration or sleep deprivation. In the 90's our society is pushing us into a more hyper ADD type life-style by the constant barrage of "sound bites," advertisements, movie and the television programming we watch. The breakdown of our extended family, more hectic households and the need for both parents to work, all play a part in fragmenting our time, focus and attention.

Coexisting medical conditions and other medications can have interactions with drugs used to treat ADD. The lack of availability of appropriate medications or a financial hardship are also very real considerations. Some people are opposed to using any form of medication but may recommend an approach they consider to be more "natural" which could include the use of exercise or herbs, vitamins and other types of intervention.

The negatives of a learning disability often include; difficulty reading, writing or listening. All learning processes are affected including those more common ones necessary to function appropriately in families, schools and public places. Our social skills may be very poor and our friendships limited or nearly nonexistent. We are considered a very high risk population for drug abuse and are at high risk for accidents and are often referred to as "high stimulus seekers." A very high percentage of the criminal population appear to have ADD-type behaviors which frequently get them into trouble. It is very common for us to have problems in our marriages, our relationships with others, in school and college and in the workplace.

All cases involving the use of medication need to be evaluated individually to determine the pros and cons of medication use. As we now understand it, ADD is a biological condition in which 70 to 80% less dopamine and norepinephrine may be available in the ADD brain. These neurotransmitters play vital roles in staying on task and focus, as well as maintaining adequate memory function. As a result, medication can play a pivotal role in improving the ability of the ADDer in learning to function and communicate effectively in major life areas.

 

Medications for ADD commonly fall into three major categories

Central Nervous System Stimulants (neurostimulants)

  • Ritalin (methylphenadate hydrochloride)
  • Dexedrine (dextroamphetamine)
  • Adderall (dextroamphetamine saccharate)
  • Cylert (premoline)

These Medications act to increase the production of availability of dopamine and norepinephrine in the synaptic clefs of the brain. This is often achieved by inhibiting the emsimic action which dissolves and recycles the neurotransmitter in the system. They are believed to be specific in the neurotransmitter production which they effect. Along with there los risk, these are usually fast acting medications. This can make it easier to monitor their effectiveness, and to use them to help with ADD behavior.

Many of the alleged risks related to use of Ritalin such as becoming addicted to this medication, are based on the risk to those who do not have ADD and abuse this drug. At present I know of no body of evidence which indicates that people with ADD abuse the medication. To the contrary, ADDers often forget to take the medication at prescribed times or even misplace it. Children often resist taking the medication, hardly the behavior you would expect if someone was addicted to the medication.

Ritalin along with many other medications may create potential problems for the liver and kidneys, who's function it is to dispose of toxins in the system. For this reason it may be important to eat a healthy diet and consider using vitamins like B-6, antioxidants or herbal supplements like Milk Thistle, which help to protect the liver. Many frequent used substances, such as alcohol can also cause liver dysfunction by depleting the B-6 in the system, and focusing on eliminating alcohol at the cost of allowing other toxins to remain in the system. I seems that concerns about liver and kidney malfunction, depletion of necessary vitamins in the system, or interactions with other types of foods or medications may be possibly valid, but are fairly easy to manage if you are educated about the medication and use it properly.

Of the medications used to treat ADD, the neurostimulants are arguably the lowest risk. It is ironic that other higher risk medications may be prescribed for ADD because of the erroneous belief that Ritalin may be addictive or harmful.

Tricyclic Antidepressants

  • Tofranil (imipramine)
  • Elavil (amitriptyline)
  • Pamelor (nortriptyline)
  • Norpramin (disipramine)

These medications often effect the availability of Dopamine, Norepinephrine, or Serotonin. While designed primarily to assist with depression, they also may have a positive effect on ADD behaviors. The drawback to these medications is that the primary design is the treatment of depression, not ADD, and they take a longer (sometimes 3 to 4 weeks) period of time to become effective. Some Tricyclic antidepressants may interact with other foods or medication in a negative fashion. Also these medications can create problems in stopping suddenly. Always taper off the use of these medications to avoid problems.

Selective Serotonin Reuptake Inhibitors (SSRI's)

  • Prozac (fluoxetine HCL)
  • Paxil (paroxetine)
  • Zoloft (sertraline)
  • Wellbutrin (bupropion HCL)

These medications appear to lower the body's blood pressure, and some how appear to reduce stress in the process. Poorly coping with stress can have a very negative impact on the ability of the ADD person's thinking and problem solving. As a result these medications can sometimes improve the ADD symptoms.

The effects of medication may of medication may often be different for many people. What works well for one person may or may not work well for others. Seeing and listening to a knowledgeable M.D., on with experience in treating ADD is the best and safest way to go. Also I encourage caution with the use of so called "natural" solutions to ADD. Even herbs and vitamins can be dangerous if not taken in the correct amounts.

An important thing for the non-ADD person to remember is the terrible price the ADD youth or adult is paying in terms of what they are learning, how they communicate and what they achieve. If you believe medication can help that process now, then use it. Work to improve the behavior using all the medical and behavioral tools we have. Once you have seen improvement you may try other approaches, less medication, more "natural" approaches or whatever. Just remember, the goal is to help the ADD person to gain control of their choices and their life.

~ D. Steven Ledingham, 1/98. Excerpts reprinted with permission. To view this article in it's entirety, please visit his web site at: http://www.azstarnet.com/

 

 

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