In my last Health Tip, we discussed Claire, a woman in her thirties with attention deficit disorder (ADD), reviewing lifestyle and non-medication approaches. This week, I’ll go over the conventional medications used for this very common condition (estimated at 5% of the population).
Let me start by saying that untreated ADD, in both children and adults, can prevent very (very!!) bright people from living up to their potential. Also, it’s important to know that with most ADD meds, there’s no “lifetime commitment”. Some kids really outgrow their ADD issues and stop their meds. Many ADD medication users find they don’t need a pill every day. Students (and adults) often skip their meds over summer vacation or on weekends when there’s no homework. Many adults with mild ADD use the meds on an as-needed basis.
By far the largest group of medications for ADD are the stimulants (accounting for 99% of ADD meds). These literally “wake up” the inefficient ADD brain by boosting levels of neurotransmitters dopamine, norepinephrine and serotonin. Because of this effect, psychiatrists often prescribe small doses of ADD meds for clinical depression, even when actual ADD may not be present.
The two stimulants are the amphetamines (Adderall, Vyvanse and Mydayis) and methylphenidates (Ritalin, Focalin, Concerta), and they’re all available in both immediate release and extended-release form, the latter developed to last a little longer than a school day. When the ADD meds first came out as "Immediate Release" only, classroom teachers had to send their ADD kids to the school nurse for a noontime dose.
If you open a capsule of any of the time release amphetamines, you’ll see it’s filled with tiny beads of different colors. Actually, the beads are all the same medication. It’s the coating that makes the difference. Adderall XR lasts to about 3 or 4 PM. Vyvanse was developed for adults and lasts until about 5 PM.
Mydayis is even longer lasting, 7 PM or so. Since Mydayis is new (and expensive around $330 a month) insurance companies balk at coverage. ADD patients can get pretty much the same effect as Mydayis by taking an Adderall XR in the morning (generic, inexpensive) and an Adderall immediate release tablet (ditto) at about 3 PM.
One of the genuinely annoying aspects about the stimulant medications is they’ve been classed as ‘controlled medications’, meaning you can only get a 30 day supply and a new prescription is needed each month. Some states and some insurers allow 90 day supplies, but Illinois and Blue Cross are not among these.
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