Saturday, April 7, 2007

Treatment Can Be Slow

It can take months before everything is in place for treatment of ADD, and that is after an initial screening. Here are some typical steps involved:

  1. Get diagnosed by a psychologist who specializes in ADD or ADHD. (Getting an appointment can take 2-4 months)
  2. If the psychologist decides you have ADD or ADHD and recommends pharmaceutical treatment, you then need to find a physician with experience in ADD to prescribe medication. (If you don't already have a doctor or a doctor who is willing to treat ADD, this can take about a month.)
  3. Finding the optimal medication(s) & dosage(s) with your doctor can take weeks to months; there is some trial and error involved.
  4. It might also be good to get treated by a clinical psychologist. ADD does not happen to you in a vacuum, and your emotional health might also be affected and require attention. Your physician can help you figure out if a clinical psychologist is appropriate for you. (However, getting an appointment with a psychologist can take months.)
  5. A support group might also be available, and is likely listed in your local free weekly newspaper.
For each health professional you see, the first visit is typically a history-taking visit with some initial action taken. However, it might not be until your 3rd or 4th appointment that you start making satisfying progress-- where you and your health care professional understand each other and feel that your current plan of action is effective.

It seems that it would be much better to make appointments with all the health care professionals at the very start, and then cancel appointments as appropriate. Also, it might be good to see psychiatrist who can diagnose ADD, prescribe medications as necessary, and even attend to you emotional health, but the shortage of psychiatrists can make this difficult as well.

The point I'm trying to make is that getting treated can take a long time, but it appears that scheduling all elements early can greatly reduce lag time you might otherwise endure.

Friday, March 30, 2007

Wellbutrin XL: Some Benefits So Far

I have been taking Wellbutrin XL for a little over two weeks now, and I've been feeling much better. While taking the Strattera, I was quite angry and nervous a lot of the time, and my blood pressure was high. Lately I've been feeling really good-- relaxed and more confident, and my blood pressure is at a more normal level. However, I am aware that it is difficult to say how much this has to do with the medication exactly.

Interestingly, I've read anecdotal accounts online of people who felt the way I did taking Strattera when they were taking Wellbutrin. Both drugs act on the dopamine pathway, so I'm guessing there might be a connection. I think that the Wellbutrin XL, since it is extended-release, might not have this "angering" effect-- that is, since the drug is released from the capsule very gradually, your system is dealing with just a little at any one time. It could also help that I'm taking a somewhat low dose. Another, perhaps even more likely, possibility is just that different medications affect different people differently, and some trial-and-error is unavoidable. I think there is a lot of research going on about Wellbutrin and ADD, and it would be good to have more scientific information. (Please, again, see my disclaimer about how you should see a doctor for any health problem. Don't rely on the Internet, including this site!)

As far as the treatment of my ADD goes, it is a little hard to say at this early point if the Wellbutrin XL has helped. I've noticed that I've spaced out more, but I can't yet say if I've been noticing it more or it has been happening more. I think that I am becoming better aware when I lose track, and it is going to take some mental exercise to utilize that improved awareness. My doctor and I are still early on with figuring out what medications would work best for me, but I continue to do the best I can.

Monday, March 26, 2007

Internet: The Lame Seductress

I maybe shouldn't presume, but I imagine that a lot of people with ADD spend too much time on the web. There is a Facebook.com group (don't look for it now) titled "Wikipedia is Choose-Your-Own-Adventure for Grown-ups," and I think it is true. Even more so, the whole web is like a giant cluttered Choose-Your-Own-Adventure, where the "adventure" has endless and rather stupid subplots, many of which are never resolved. What I'm trying to say is that the Internet allows to look up tidbit after tidbit bap-bap-bap, stimulus-stimulus-stimulus. It's the ultimate Devil's playground for those with ADD.

I have tried to establish rules for myself, like no late night web surfing, when I lose track of time the most. However, the most effective strategy I've found is to leave my laptop computer somewhere other than my home, so I'm not tempted to look up "one more little thing." That "one more little thing" invariably becomes a mini-web of its own. So what can you do: stash the computer as soon as you've used it for the day, or get rid of it (or them!) if you don't really need one, especially at home. Limit the number of distractions in your life, especially those that have a low [usefulness]:[time involved] ratio. Even if you get a lot of email, for example, I think it's fairly safe to say that checking once a day would keep you up-to-date enough, and without all the nearly pointless repeat checking (email, news sites, Facebook), you might actually get things done.

Saturday, March 24, 2007

The Importance of Living Deliberately

Attention Deficit Disorder often goes hand-in-hand with disorders of anxiety or depression. It seems reasonable how this could be so: people suffering from ADD often feel like they can't do right. Even when they are successful, they are often frustrated by not being able to get it together. This frustration, I believe, can help make someone more prone to anxiety or depression, much like having wet hair on a cold day can make someone more prone to catching a cold.

An important prevention, like diet and exercise, is a good attitude. I believe it is important to make it a priority to live a life that matters to you. Others may suggest channeling creative energies into a field where it is appreciated if it looks like you could benefit from making a career change. However, I'm talking about the larger goal of living deliberately-- in other words, taking ownership of your life.

I realize that everyone has constraints (work, family, and the like), but it is very important, in my opinion, to not feel owned by your constraints. You need to seize the moment, let yourself feel some confidence, and just be autonomous, despite your obligations.

And how to do this? It involves the same three steps that work wonders for any change you are trying to make for yourself:

1) Imagine it
2) Pretend it
3) Become it


Brainstorm about it; jot it down if it feels right, and then just pretend that you are the way you want to be. In time, you really will be that way.

From Strattera to Wellbutrin XR

There are two main classes of ADD medications: stimulants and antidepressants. I haven't taken neurology yet, but it appears that both drugs have the same net effect in the end: they act on neurotransmitters and/or their receptors. "Stimulants" may sound like an odd choice, but the way I understand it, they stimulate (activate) your brain's "braking" mechanisms. Stimulants have shown to be more effective than antidepressants for treating ADD, although this is a trend and there is variation person-to-person.

As a medical student, there is a perceived career risk to taking stimulants, which are subject to special legal restrictions beyond those for other prescription drugs. To be honest, I don't understand how it can be that taking legally prescribed stimulants for legitimate conditions could be risky when applying for residency, etc., but health care workers with ADD often prefer non-stimulants to be avoid such issues.

The only non-stimulant FDA-approved for ADD is Strattera. Dr. Hallowell in his new edition of Driven to Distraction (or maybe Delivered from Distraction, another book of his) went from being very hopeful that Strattera would replace stimulants, to being hopeful that Strattera would show its promise once the dosing was fine-tuned, to recommending Wellbutrin (an antidepressant) instead.

There is a lot of information online about individuals' disappointments and success stories with various drugs. With medications for mental health, it is sometimes difficult to gauge if a medication is causing a problem or if it is the complexity of life.

While taking Strattera, my emotions were all over the place, but yet some things in my personal life were also. I experienced the common side effect of queasiness, but I was generally more productive. I was still very distractable, but a decreased appetite and a reduction in feelings of anxiety helped with efficiency. However, I did not take the Strattera on a consistent schedule: I was to take it twice a day, 12 hours apart, and I frequently disturbed the schedule. Like for any drug, consistency is very important (and is a notoriously big problem for people with ADD).

There has been promising research that once-a-day Wellbutrin XR is an effective treatment for adults with ADD, and this fits with Dr. Hallowell's experience. However, Wellbutrin is not FDA-approved for treating ADD and is so prescribed "off label."

Like other antidepressants, it can take weeks before Wellbutrin (or Strattera, for that matter) makes its full effect. My physician decided with me to switch to Wellbutrin XR from Strattera instead of adjusting the Strattera dosing schedule to take it once a day. I've been very consistent taking Wellbutrin, and I feel much better emotionally. Interestingly, Wellbutrin acts an inhibitor for the enzyme that metabolizes Strattera, so the two drugs should not be taken together (or the Strattera should at least be decreased).

It is too soon to tell if the Wellbutrin XR will help me with my ADD, but I am keeping my fingers crossed. I already feel more like myself again, which makes me think that the Strattera was not working for me, at least not as I was taking it.

My No-Cost Personal Assistant: Google Calendar

One problem, which is particularly bad for those with ADD, is losing track of the things you need to do. Perhaps this situation is familiar to you: you need to do thing X, optimally at time Y, but at time Y you can't quite concentrate on or remember thing X.

People with ADD tend to do best in structured environments, where there's an outside mechanism for making sure they do the right thing at the right time. Adults often have to provide this structure for themselves, and adults with ADD do have some effective strategies available.

One thing that has worked very well for me is to use Google Calendar to keep track of appointments, classes, etc. Google Calendar has an amazing (and free!) function where it will send you a text message on your cell phone as a reminder before the event. Every time I mark something in my calendar, I can specify how soon before I'd like to be reminded. When the text message is received on my phone, it beeps discreetly and I get reminded of what to do. For example, I'm reminded 5 minutes before it's time to take my medicine, and maybe 3 hours before a dinner meeting. I turned off email notifications, because I get too many emails as it is.

One note: your cell phone company might charge you for receiving text messages. If you start using this daily like I do, you might want to buy a text messaging package. Cingular (now AT&T), for instance, has 200 messages/month for $5 (+ $0.10 ea. add. message) or $0.15 per message.

Friday, March 23, 2007

How Can a Medical Student Have ADD?

Attention Deficit Disorder is unfortunately beset with a lot of undeserved connotations: under-achievement, misbehavior, dishonesty, and insensitivity. The syndrome has a stigma, because some of its symptoms are experienced to a degree by everyone; indeed, everyone zones out from time to time. People failing to accomplish or finish tasks is also quite common. It seems almost logical for people to insist that all ADD people need to do is hunker down.

However, the syndrome ADD has a real physiological cause: there is a problem with the amounts of neurotransmitters in the brain. Typically, the problem for people suffering from ADD is not that they won't turn on their brain and get to work; rather, it is that they can't shut off their brains to focus on their work.

About 3% of medical students have a form of ADD sometimes called Gifted ADD. I believe that ADD is itself a gift in some important ways: people with ADD tend to be very likable and creative. It is difficult, though, for many with ADD to satisfy various expectations such as sitting still. (Really, by fidgeting, we can burn off the excess brain energy and actually think better!) Most medical students with ADD are first diagnosed with the syndrome while in medical school. These students have found effective ways to channel their nervous and creative energies and otherwise cope with academic expectations. However, the pace of medical school is so very fast, that their coping mechanisms prove insufficient. Even for medical students, there can be regret for the things they have missed out on due to the limitations of ADD.

So what about me? I had a thorough neurophychologic screening to test intelligence and attention. And the results? Although I was in the 99th percentile for verbal ability and in the 85th percentile for spatial ability, I was only in the 30th percentile for attention span and in the 5th percentile for being able to inhibit irrelevant information.

Successful treatment can help those with ADD achieve their dreams, and I believe the experiences I hope to share on this blog will be meaningful for anyone with ADD.