Medication

At the Affinity Center we are committed to helping people using a combination of interventions within a holistic approach. Medications are often suggested as part of an individualized treatment plan. The information contained here is intended to provide an overview of the different medications used at The Affinity Center. Direct discussion with your physician and therapist will help you fully understand the role of medication in the treatment plan the Affinity Center team has recommended for you.

ADHD is a neurobiological disorder that affects the portion of the brain responsible for our “Executive Functions”. Executive Functions help us stay alert, sustain and shift our attention appropriately, plan, organize, store and recall information, modulate emotional responses and inhibit inappropriate behavior. When this part of the brain is affected, the person often appears “under-aroused”, inattentive and/or hyperactive or impulsive. Medications have been shown to very helpful for these problems.

There has always been controversy about the role of medication in the treatment of ADHD. Some of it justified, most of it not. It is true that many children and adults have not had good experiences with medication and there are contentions that it is being overprescribed and perhaps not always used for justifiable reasons. This is not for a lack of scientific support and clear guidelines for when and how medication should be used, however. The truth is that medications for the treatment of ADHD have been extensively studied for the past four decades. There are well over 220 well designed studies demonstrating their safety and effectiveness, more than any other class of psychoactive drugs, and more than most of the medications in your medicine cabinet, including aspirin. When prescribed appropriately and monitored systematically, medications can be the single most effective component of a comprehensive treatment plan. The most important questions that should be asked when considering medication options are: Do you want to and is it appropriate for you to try medication, and will you be followed carefully to insure you are on the right type, the right dose, and the right schedule of medication to insure maximum benefits and safety?

At The Affinity Center we regularly review the medical literature and meet with professionals around the country who have extensive experience with ADHD and these medications. Those resources allow us to offer safe, helpful and state-of-the art medication treatments when they are indicated.

The most important resource to determine the most helpful medication regimen for you, is you. We really want to listen to your experience and work closely with you to monitor and evaluate your response to medication.

STIMULANTS
Research and experience tell us that stimulant medication is still considered the first choice in the treatment of ADHD. Stimulant medications are either amphetamine or amphetamine-like medications that stimulate brain activity to increase attention and decrease impulsivity and/or hyperactivity. They are called “stimulants” because they produce a temporary increase (usually for about 4 to 12 hours) of the functional activity or efficiency of areas within the brain responsible for alertness, attention, memory, organization, the self-monitoring and control of behavior and the other “executive functions” that are core problems for people with the disorder. Unlike most of the rest of the medications described here, we list stimulants by their trade names rather than their generic names. That is because we more often than not prescribe the brand name version in the beginning whenever possible and use generic versions later once we have established an appropriate medication regimen. Many people taking these medications have noticed problems with generics, feeling they are generally not as consistent or as helpful for reducing the symptoms of ADHD and are often more likely to have side effects.

Brand name stimulant medications prescribed at the Affinity Center include (organized by their generic name category):

Mixed Dextroamphetamine/Amphetamine Salts: Adderall, Adderall XR

Dextroamphetamines: Dexedrine, Dextrostat, Dexedrine CR, Vyvnase

Methylphenidates: Ritalin, Ritalin LA, Focalin, Focalin XR, Metadate, Metadate CD and ER, Concerta, Daytrana (patch)

(XR, ER = Extended Release CR = Continuous Release LA = Long Acting CD = Continuous Dosing)

Non-Stimulant Medications to Treat ADHD

Other types of medication may also be used in your treatment here at The Affinity Center. These medications may have originally been developed and used for other diagnoses (not necessarily ADHD) but have been shown to be helpful in reducing ADHD symptoms and are approved for its use. These include: Intuniv, Kapvay and Strattera. Other medications have shown to be effective to treat other symptoms often present when people have ADHD like anxiety, depression, tics and mood related problems. The following categories of medication may be used in combination with stimulants or alone:

ANTIDEPRESSANTS
Although antidepressants get their name from their original use indications, over time they have been shown to be effective for many other problems as well. Medications in this category are used for depression, anxiety, sleeplessness, rage reactions, hyperactivity, impulsivity, and obsessive-compulsive disorders. Unlike the fast action of stimulants, antidepressants generally require a cumulative effect over several days or weeks, so patience while initiating therapy is needed. The antidepressants used at The Affinity Center include (with brand names in parentheses):

Tricyclics (called this because of their chemical structure): amitriptyline (Elavil); clomipramine (Anafranil); desyrel (Trazadone); imipramine (Tofranil); desipramine (Norpramin)

SSRIs (called this because they are Selective Serotonin Reuptake Inhibitors, meaning the chemical that they specifically target is serotonin): citalopram (Celexa); fluvoxetine (Prozac); escitalopram (Lexapro); fluvoxamine (Luvox); nefazodone (Serzone); paroxetine (Paxil); sertraline (Zoloft)

Other(less “selective”) antidepressants: atomoxetine (Strattera)**; venlafaxine (Effexor/Effexor XR); duloxetine (Cymbalta); vilazodone (Viibryd); buproprion (Wellbutrin/Wellbutrin XL/Wellbutrin SR/Zyban); mirtazapine (Remeron); desvenlafaxine (Pristiq)

*Straterra has a unique role in the treatment of ADHD. Originally developed as an antidepressant it was not particularly effective for depression. It has since been specifically approved by the FDA for treatment of ADHD and we find it a very helpful medication, often in combination with stimulants, particularly when anxiety is present along with ADHD symptoms.

ANTI-HYPERTENSIVES
Anti-hypertensive medications were originally designed to treat high blood pressure. We have used these medications for years, often in combination with stimulants. These medications can improve frustration tolerance, reduce impulsivity, decrease anxiety, improve task-oriented behavior, help with sleep and decrease tic behaviors for those with tic disorders. Over the past two years the FDA has approved Intuniv and Kapvay for treating ADHD. These medications often require sustained use to determine effectiveness.

atenolol (Tenormin); labetolol (Lopressor); clonidine (Catapres/Kapvay); guanfacine (Tenex/Intuniv)

MOOD STABILIZERS
The mood stabilizers listed below were found helpful for managing mood swings while they were being used for other reasons. Tegretol and Depakote, for example, were used to treat seizure disorders. These medications usually do require a cumulative effect over several days or weeks to determine their impact.. These drugs also require periodic blood tests to determine the medication’s presence in your body.

carbamazepine (Tegretol); lamotrigine (Lamictal); Lithium; valproic acid (Depakote)

ANXIOLYTICS (ANTI-ANXIETY MEDICATIONS)
Anti-anxiety medications help to lessen anxiety. Sometimes very useful and appropriate these medications are also potentially addictive so we use them with caution and monitor them closely.

alprazolam (Xanax); lorazepam (Ativan); buspirone (Buspar); Clonazepam (Klonopin)

SEDATIVES/HYPNOTICS
Hypnotics are used to help establish healthful sleep patterns. In general, they are used for a limited time as other strategies are implemented to help with sleep.

temazepam (Restoril); zolpidem (Ambien); eszopiclone (Lunesta)

ANTIPSYCHOTICS
These medications are given this name because they were originally developed to help people with psychosis (symptoms such as disorganized thoughts or hallucinations). At the Affinity Center we mainly use them for treatment of tics, aggressive behavior, anxiety and mood disorder. The medications listed below are called Atypical Antipsychotics, which are newer and have fewer side effects than their predecessors.

olanzapine (Zyprexa); quetiapine (Seroquel); risperidone (Risperdal);aripiprazole (Abilify); ziprasidone (Geodon)

 

The Affinity Center Approach to Medication:

The Affinity Center team will use the information gathered in the evaluation process to work with you in developing a treatment program. Many factors including temperament, family history, your own medical history and other issues will be considered in determining the most appropriate medication for you.

Research and our experience has shown that finding the right type of medication, taking the right dose and using it consistently and at optimal times of the day are the keys to positive outcomes.

It is extremely important during medication trials to stay in close contact with us at the Affinity Center. A medication diary can help you monitor progress at home or at work. In follow-up visits we will evaluate the effectiveness of medication based on target indicators that were determined during the evaluation. There is no “cookbook recipe” that works for everyone. The process of finding the right “therapeutic window”, or the optimal dose and type of medication to produce the most improvement with the least side effects, is individualized for every client. Sometimes you have to try several different doses and types, or a combination of medications, to get the best results. It may take time, but we will follow you closely and work hard to find a safe and effective medication that works for you.

 

Additional Information about Stimulant Medication:

And now the warnings…

1. Until you know how these medications affect you, be cautious when operating machinery, driving a car, riding a bicycle, etc.
2. Keep these and all medications out of the reach of children and use containers that small children cannot open.
3. If mistakenly swallowed, call the local poison Control Center (Cincinnati is 558-5111).
4. Do not use these medications if you are pregnant, trying to get pregnant (practicing unprotected sex or no birth control) or are breastfeeding.
5. It is a federal crime to transfer stimulant medication to any person other than the patient for whom the medication was prescribed. Do not share this medication with anyone else.
6. Remember, there are no medications that are completely “safe”. Do not attempt to change the pattern of taking medication without first talking with your Affinity therapist or physician. The same is also true for restarting a medication program after an interval of not taking it.