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ADHD Medications and Treatments

ADHD affects an estimated 3% to 5% of children and adults in the U.S. Dr. Richard Sogn shares information and advice about attention deficit hyperactivity disorder, including its causes, diagnosis, and promising ADHD treatments

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WebMD Health News

Sunday, November 19, 2006

Natural Supplements and Vitamins and ADHD
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It's often difficult for parents to have the child they love diagnosed with ADHD. Our natural instinct is to protect them from problems. It's harder still to consider a trial of medication for ADHD, and many parents wonder whether natural supplements are an alternative to medications. Almost anything that is 'good for someone's brain' is good for ADHD, including adequate nutrition, sleep, exercise, and methods of reducing stress (relaxations techniques, yoga, meditation, prayer. Although natural products are helpful for many medical conditions, there is little scientific evidence supporting the use of any natural product for the treatment of ADHD.

I am not an expert in natural medicines. I know physicians who have also completed their degree in natural medicine who are far more knowledgeable than I am. However, I do read the scientific research from studies on the use of natural products for various psychiatric conditions, including ADHD, depression, bipolar disorder, and anxiety disorders.

I am frequently asked about the effectiveness of caffeine for ADHD. A small amount of research reports mild improvement in symptoms of ADHD in a minority of children. However, most children primarily experience side effects and achieve little benefit from doses high enough for an effect.

Antidepressants have been used as second-line medications for the treatment of ADHD (e.g. Wellbutrin, imipramine), as they increase neurotransmitters involved with ADHD. Likewise, 'natural' antidepressants have been tried. St. John's wort has not been found effective for ADHD. Although some studies have found SAMe effective for ADHD symptoms in some adults, there has been no evidence for its effectiveness in children, and additional research is needed before SAMe can be recommended for the treatment of ADHD.

Ginkgo is thought to increase blood flow to the brain and is used for dementia. There is little evidence for the effectiveness of ginkgo when used alone in the treatment of ADHD, although one study indicated that the combination of ginkgo and American ginseng might treat symptoms of ADHD in some children. However, additional research is needed.

Dimethylaminoethanol (DMAE) was a prescription drug for ADHD-like symptoms until the 1980s when it was withdrawn because of lack of proof of effectiveness and safety, and it is now available as a dietary supplement. As was true in the 1980s, there still isn't enough evidence about effectiveness or safety to recommend it.

Many children with ADHD have difficulties falling asleep, either because they are restless and can't settle into sleep, or secondary to their stimulant medication. Some studies of melatonin have found it to be effective for treatment of insomnia in children with ADHD. However, risks vs. benefits must be weighed as there is some worry that melatonin might have an effect on gonadal (sex organ) development in children.

Antioxidants are felt to prevent oxidative damage in the brain and nervous system. Antioxidants from pine bark extract (pycnogenol) and grape seed extract are often recommended for ADHD. Although a small number of parents and adults with ADHD report effectiveness, no current research studies have found them to be effective.

Essential fatty acids (EFAs) are called 'essential' because our body cannot make them, and they must be ingested in our diet. About 25% of children with ADHD seem to have lower serum levels of omega-3 and omega-6 fatty acids. It would seem logical that giving supplements of omega-3 or omega-6 fatty acids would be beneficial for ADHD. However, most studies have not found EFA supplements to be of benefit. A recent study did find that a combination of flaxseed oil and vitamin C improved restlessness, impulsivity, and behavior in a significant percentage of children studied, but additional research is needed.

There is no evidence that taking very large doses of vitamins or minerals is effective for treatment of ADHD. However, some children with ADHD have lower levels of zinc and magnesium. Low zinc levels might be related to a poor response to traditional treatment with stimulant medications, and one study suggested that the addition of zinc to traditional treatments might improve that response. There is little research on the supplemental use of magnesium. A recent study suggested that iron supplements might improve hyperactive symptoms in boys with ADHD, but more research is needed, and too much iron can be toxic. Vitamin B6 was reported to be of some benefit in older studies, but those studies need to be duplicated using current diagnostic criteria for ADHD.

Blue-green algae is often recommended for ADHD, although there is little research to support its effectiveness, and there is concern about its purity from product to product and the possibility of contamination with heavy metals or toxins.

I wish that I could recommend an effective, safe, side effect-free natural supplement for the treatment of ADHD. Not everyone responds to or tolerates treatment with traditional medications, and many parents and adults with ADHD would prefer a 'natural' alternative. Although additional scientific studies are needed, two ADHD experts have reviewed their recommendations for use of natural supplements. I would recommend reading, "Healing ADD" by Daniel Amen (or read information on his website: www.amenclinics.com), and/or "Delivered from Distraction" by Edward Hallowell, M.D. and John Ratey, M.D.


Related Links: Are Herbal Supplements OK for Kids?, Choosing the Right ADHD Medication for Your Child

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Posted by: Richard Sogn, MD at 7:36 PM

Tuesday, November 07, 2006

ADHD and Anxiety
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Children, adolescents, and adults with anxiety disorders often have an increase in anxiety or experience side effects to stimulants used to treat AD/HD. Anxiety is also a common reason for inattention and distractibility in the classroom, and can sometimes be mistaken for AD/HD. However, anxiety disorders (as well as depression, and learning problems) also tend to coexist with AD/HD.

Strattera is probably the medication of first choice for someone with anxiety, although it has its own side effect profile and doesn't work for everyone. Frequently, anxiety needs to be treated first, and when treatment is successful, a stimulant can often be successfully added.

If your child is fearful or seems to have anxiety problems, I'd suggest a comprehensive evaluation by a good child psychologist and perhaps a referral to a child psychiatrist for medications.

More information about anxiety in children can be found in, "Your Anxious Child," by Dacey and Fiore.

Related Topics: High Cost of Mental Illness in Children, Ritalin for Preschoolers?

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Posted by: Richard Sogn, MD at 12:04 PM

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