Adult ADHD (Attention Deficit Hyperactivity Disorder)

Background

Studies have shown that 5% upwards of the population has ADHD, and this risk is much higher (10-46%) in people with SUD. SUD patients with a comorbid diagnosis of adult ADHD have poorer treatment outcome and higher risk of relapse than SUD patients without ADHD.

Medication is not always required - education and coping strategies are often sufficient.

Some interesting points about ADHD in Australia:

• ADHD is common, with an Australian prevalence rate of around 5%
• Girls are diagnosed less often than boys and may be missed as they have fewer hyperactivity symptoms
• Adolescent girls with inattentive ADHD can be misdiagnosed with depression or anxiety, which is secondary to the ADHD
• The ADHD symptoms of hyperactivity decrease in adolescence, but the inattention persists, leading to premature withdrawal of treatment
• ADHD persisting into adulthood needs ongoing treatment
• ADHD can severely disadvantage adults who development psychiatric comorbidity/substance abuse, family problems, job loss and trouble with the law
• ADHD is estimated to cost the Australian economy $20 billion annually

First steps

The first steps may be to sort out other underlying issues, including sleep and mood. It is important to avoid escalation of addictive medications such as benzodiazepines. There are several options, including melatonin, clonidine, quetiapine, gabapentin, suvorexant or zopiclone. Stabilising mood is important. Lamotrigine may be considered, although antidepressants such as venlafaxine and duloxetine can have multiple benefits. Some of the new class of antidepressants are particulary effective for patients with ADHD, although they are not on the PBS.

Psychostimulant medications / Cognitive enhancers

Stimulant or cognitive enhancer medications are commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD) in children and adults. They work by increasing the levels of certain chemicals in the brain, such as dopamine and norepinephrine, which help regulate attention and behavior.

There are two main types of stimulant medications for ADHD: Methylphenidate and Amphetamines.

• Methylphenidate: This is the most commonly prescribed stimulant medication for ADHD. It is available under several brand names, including Ritalin and Concerta (long-acting). Methylphenidate is taken orally and its effects can last for several hours.
• Amphetamines: This type of stimulant medication is available under the brand names dexamfetamine (short-acting) and Vyvanse (lisdexamfetamine - long-acting). Amphetamines work by increasing the levels of dopamine and norepinephrine in the brain and can last for up to 12 hours.
• Both Methylphenidate and Amphetamines have been found to be effective in reducing the symptoms of ADHD, such as inattention, hyperactivity, and impulsivity. However, as with any medication, there can be side effects, including decreased appetite, stomach aches, trouble sleeping, and increased heart rate.
• It is important to note that stimulant medications for ADHD should only be taken under the guidance of a doctor and after a careful evaluation of the patient's symptoms. Additionally, the use of these medications should be combined with other treatments, such as behavioral therapy, to achieve the best results.

Stimulant medications for ADHD can be an effective treatment for reducing the symptoms of the disorder. However, it is important to carefully consider the potential benefits and risks of these medications. They need to be prescribed in cooperation with a psychiatrist as they are strictly controlled due to being "legal speed".

In addition to stimulant medications, there are also non-stimulant medications that are commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD). These include:

• Guanfacine: This medication is marketed under the brand name Intuniv and works by decreasing hyperactivity and impulsiveness and improving attention. Guanfacine is usually taken once a day and is typically used in combination with a stimulant medication or as an alternative for individuals who cannot tolerate stimulants. Guanfacine can have side effects, which may include dizziness, drowsiness, dry mouth, and constipation. It is typically started as 1mg daily and titrated upwards to gauge its effect.
• Clonidine: This medication is marketed under the brand name Catapress and works by decreasing hyperactivity and impulsiveness and improving attention. Clonidine is usually taken twice a day and is typically used in combination with a stimulant medication or as an alternative for individuals who cannot tolerate stimulants. It can drop blood pressure and thus cause dizziness.
• Modafinil is a medication that is primarily used to treat excessive sleepiness caused by narcolepsy, sleep apnea, and shift work sleep disorder. However, it is sometimes used off-label for the treatment of attention deficit hyperactivity disorder (ADHD).
  Modafinil works by increasing levels of certain neurotransmitters in the brain, such as dopamine, which can improve focus and alertness. However, it is important to note that modafinil is not a stimulant and does not work in the same way as medications like Vyvanse or Ritalin. Common side effects of modafinil include headache, nausea, and anxiety. It may also interact with other medications. It is also quite expensive so rarely used in ADHD.
• While non-stimulant medications can be effective in reducing the symptoms of ADHD, they may not work as well as stimulant medications. Additionally, as with any medication, there can be side effects, such as drowsiness, dry mouth, and headache.

ADHD is a chronic condition. If these medications seem appropriate, due to Government requirements, you will need to see a psychiatrist early in the initial assessment, and, for ongoing treatment, every 2 years. You will also need a set of blood tests to rule out other medical conditions. If you are over 40, an ECG will be required.