Heart Rate Changes Linked to ­Emotional Dysregulation

Topics: ADHD | Anxiety | attention | Conduct Disorder | Depression | Dysregulation | Emotional dysregulation | Heart rate

Review of: Deutz MH et al, J Am Acad Adolesc Psychiatry 2019;58(6):589–599 Can we use heart rate to assess and track psychopathology? Child psychiatrists associate lower resting heart rate (HR-rest) and heart rate reactivity (HR-reactivity) with externalizing behaviors such as disruptive behaviors and aggression (“under-arousal”) and elevations

Crocus Sativus vs Methylphenidate for ADHD

Topics: ADHD | Attention Deficit Hyperactivity Disorder | Crocus Sativus | methylphenidate | Saffron

Review of: Baziar S et al, J Child Adolesc Psychopharmacol 2019;29(3):205–212 The search for an equally effective, yet better tolerated alternative to stimulant medications continues. We often hear reports on the benefits of various non-pharmaceutical supplements. Now we have a new study looking at saffron (Crocus sativus). Saffron is reported to a

FDA Approves Adhansia XR

Topics: Adhansia XR | ADHD | adolescents | Attention Deficit Hyperactivity Disorder | Child Psychiatry | children | extended-release | methylphenidate | News of Note | pediatric | teens | treatment

We are always in need of a new formulation of stimulant medication that might capture a few more of our patients who just do not quite tolerate or respond well enough to the many existing formulations. So whenever a new one is released, we try to set aside our natural skepticism and take a look at the stated facts before judging its merit. Adhansia X

First Non-Drug Treatment Approved by FDA for Treating Children With ADHD

Topics: ADHD | adolescents | Attention Deficit Hyperactivity Disorder | Brain Devices | Child Psychiatry | children | efficacy | eTNS | News of Note | pediatric | safety | teens | treatment | Trigeminal Nerve Stimulation

NeuroSigma made a splash by announcing that the FDA has granted medical device approval for its external Monarch Trigeminal Nerve Stimulation (eTNS) System for treating kids with ADHD ages 7–12 who are not currently taking medications. What does medical device approval mean? The FDA reviewed the Monarch eTNS System through the de novo ­pre-market

Risk of Psychosis With Stimulants in ADHD Patients

Topics: ADHD | adolescents | amphetamine | Child Psychiatry | children | Free Articles | Medication | methylphenidate | pediatric | Psychosis | Research Update | stimulant | teens

Review of: Moran LV et al, N Engl J Med 2019;380(12):1128–1138 In 2007, the FDA required stimulant manufacturers to warn of possible psychosis with stimulants. But what is the real incidence? This study set out to find and discern if there is a difference between methylphenidate and amphetamine classes of medications. Drawing from two large comm

Psychostimulants: Bringing Order out of Chaos

Topics: ADHD

There are now no fewer than 14 FDA-approved psychostimulants… and counting. This does not include the many generics, the new non-stimulant Straterra or the off-label ADHD meds Wellbutrin (bupropion) and desipramine. Yes, capitalism is in full swing in the stimulant world. But who’s complaining? Now we have multiple options from which to pick and

Straterra: A Safer Desipramine?

Topics: ADHD

The Eli Lilly reps are almost delirious about their new ADHD “miracle drug”, Straterra (atomoxetine). This is not surprising. No pharmaceutical firm has survived the conversion of a blockbuster from brand to generic (as happened to Prozac in 2001) without sustaining a buyout or merger, and while it may be hard to drum up sympathy for a multi-billion

Adult ADHD: Is it Real?

Topics: ADHD

They have been flooding into your office: grown-ups who believe that they have ADHD. Some are referred to you by their exasperated spouses (“my wife gave me an ultimatum…”), some recognize themselves in their hyperactive children (“I tried his ritalin one day, and I’ve never been more focused in my life”), and some are swept into treatment b

Dr. Jefferson Prince on Treating ADHD

Topics: ADHD

TCR: Dr. Prince, you have done innumerable evaluations of children and adults with ADHD. These days, psychiatrists in the community are besieged by patients wanting treatment for ADHD, and the pressure is on to come up with a diagnosis and treatment during a single 45 minute session. Is this possible? Dr. Prince: That’s a great question, and with kid

Stimulant Abuse

Topics: ADHD | Substance Abuse

David Sorenson, M.D., is medical director of the Anna Jaques Hospital Child Psychiatry Inpatient Unit in Amesbury, Massachusetts. His experiences with patients misusing ADHD medications should give us pause. “Many psychiatrists are naive about stimulants. I’ve heard a lot of stories about what kids are actually doing with their medications by lis

How to Treat ADHD in Bipolar Disorder

Topics: ADHD | Alpha Agonists | Amphetamines | ArModafinil | Atomoxetine | Attention Deficit Hyperactivity Disorder | Bipolar Disorder | Bipolar II | Comorbidity | Guanfacine | methylphenidate | Modafinil | Nuvigil | Pharmacology | Provigil | Psychopharmacology | Psychopharmacology Tips | stimulant | Stimulants

Patients with bipolar disorder often present with cognitive complaints. Our October 2021 issue laid out a diagnostic plan for these symptoms, and in this article, I’ll cover some treatment approaches for patients with a DSM-based ADHD-bipolar comorbidity (ie, the ADHD symptoms began in childhood and persist after the mood episodes have stabilized).

Viloxazine for ADHD

Topics: ADHD | Atomoxetine | Attention Deficit Hyperactivity Disorder | Qelbree | Research Update | Viloxazine

Review of: Nasser A et al, Int J Clin Pract 2021;75(8):e14330 Study type: Meta-analysis of randomized controlled trials Viloxazine (Qelbree) just got FDA approval in 2021 for the treatment of ADHD in children and adolescents, and the FDA is reviewing data in adult ADHD. Viloxazine has a long history of use as an antidepressant in Europe. Like atomoxet

Light Therapy: Good for What Ails You?

Topics: ADHD | Alternative treatments | Antidepressant Augmentation | Bipolar Depression | Bulimia Nervosa | Complementary treatments | Complimentary Medicine | Depression | Depressive Disorder | Light and Dark Therapy | Light therapy | Lightbox | PTSD | Seasonal Affective Disorder | Sexual Dysfunction | Sleep | Sleep Disorders | Traumatic Brain Injury (TBI)

There are several lifestyle changes with broad health benefits that we often encourage in our patients. Exercise, a healthy diet, sleep hygiene, and supportive social connections are near the top of the list, and bright daytime light might be worth adding. Light therapy is a standard treatment for seasonal affective disorder, and in this article we’ll

How to Diagnose ADHD in Bipolar Disorder

Topics: ADHD | ADHD Rating Scale-5 | Attention Deficit Hyperactivity Disorder | Bipolar Disorder | Bipolar II | Comorbidity | Diagnosis | Diagnostic Testing | Hypomania | Psychiatric interviewing

Hailey is a 24-year-old woman with bipolar II disorder who has recently come out of a mixed episode. Although her mood symptoms have resolved, she is distracted easily, has difficulty organizing her work, and often forgets important tasks. She read about ADHD online and asks if she can have a stimulant to help her focus. ADHD and hypomania share many

Atomoxetine: Myths and Truths

Topics: ADHD | Atomoxetine | stimulant | Stimulants

Atomoxetine (Strattera) is approved for ADHD in children and adults but has also been explored in many other disorders. That has led to some myths and truths that we’ll explore here. First, a little about atomoxetine’s mechanism of action. Atomoxetine is a selective norepinephrine reuptake inhibitor, a mechanism shared by maprotiline, a long-forg

A Closer Look at Alpha-2 Agonists for ADHD

Topics: ADHD | Alpha Agonists

The alpha-2 agonists guanfacine ER (Intuniv) and clonidine ER (Kapvay) were approved for ADHD in 2010–2011, but three things have held back their use: They are less effective than stimulants (effect size of 0.5 vs. 0.8) They are only approved in children and adolescents Cost Recently, the ER versions went generic and the first major trial in a

Stimulants and Creativity

Topics: ADHD | Amphetamines | ArModafinil | Attention Deficit Hyperactivity Disorder | Creativity | methylphenidate | Modafinil | Provigil | Side Effects | stimulant | Stimulants

Your patient is a 25-year-old music teacher with ADHD. Though her organizational skills have improved with methylphenidate, she complains that it impairs her performance as a jazz musician: “I feel self-conscious, like a robot.” Popular lore holds that creative people have ADHD traits and that ADHD bestows advantages in creative thinking. Stock c

Guanfacine ER for Adults With ADHD?

Topics: ADHD | Alpha Agonists | attention | Attention Deficit Hyperactivity Disorder | Guanfacine | Pharmacology | Psychopharmacology | Research Update

Review of: Iwanami A et al, J Clin Psychiatry 2020;81(3):19m12979 Study type: Randomized, double-blind, placebo-controlled trial Stimulants are rapid, safe, and effective first-line treatments for many adults with ADHD. However, there are inevitably patients for whom stimulants are not indicated or tolerated—those with arrhythmias or stimulant use d

Highlights From This Issue

Topics: ADHD | Adult ADHD | Micronutrients | Narcolepsy | Schizophrenia

Micronutrients are vitamins and minerals that play an essential role in human physiology. They have promising studies in a host of psychiatric disorders, and Dr. Rucklidge explains why. Adult-onset ADHD has been proposed as a new diagnosis, but the data supporting it point in a different direction. Light therapy is one of few natural treatments with

Stimulants as Cognitive Enhancers

Topics: ADHD | Amphetamines | Attention Deficit Hyperactivity Disorder | Cognition | Cosmetic pharmacology | methylphenidate

Depending on your practice setting, you are likely to encounter adults who seek stimulants for various “non-medical” uses, from cognitive enhancement to recreational abuse to outright diversion. Abuse and diversion are easier to detect these days with the controlled substance databases available in most states. Abuse of stimulants is relative