Combining medications for ADHD

It had become common for both children and adults to take more than one medication in the treatment of ADHD. It is prudent to remember that the more medications one takes, the higher the risk for drug-drug interactions as well as potential negative side effects. At this point, there is a limited amount of published research data on combination treatment. Despite the limited data to back up the practice, the strategy of using more than one medication continues to become more popular.

The most common scenario where combining medications is considered is when one medication is partially effective and there is still a need for improvement and increasing the dose is not an option because negative side effects have already occurred at the higher dose. It is much more prudent to do a medication trial with another medication before adding a second medication. There are many times where changing the medication results in improved effectiveness. Sometimes, that might mean going back to a medication that has been tried in the past.

It is essential that there is a discussion with the prescribing physician about realistic expectations regarding the potential benefit of medication treatment. Unrealistic expectations can lead to mutliple medications and unnecessary high doses. The approach to combination treatment needs to be the same as making any other medical decision. There need to be a clear undertanding of the goal of treatment; evaluating the potential benefit versus the potential risk of the treament being considered, exploring alternative options; and finally recognizing the potential risks of not utilizing that treatment option. These 4 essential points must be considered and discussed with the prescribing physician before combination treatment is initiated.

See Making the Connection: A Parent's Guide to Medication in ADHD (www.adhdparents.com)

Bupropion/ Wellbutrin for ADHD

One of my patients yesterday asked me about Bupropion (Brand is Wellbutrin) for treating ADHD. Bupropion is primarily an antidepressant that is sometimes used in the treatment of ADHD. Its actual benefit in treating ADHD symptoms is mild especially for symptoms such as impulsivity and hyperactivity. The data in children and adolscents is minimal in comparison to other medications. There is a clear need for more research on this drug. For people who have a history of substance abuse or depression along with the ADHD, it can be a safe first alternative. (See Making the Connection- A Parent's Guide to Medication in ADHD- pages 81-82)

What is the best ADHD medication?

There are many different medications on the market that are used to treat ADHD. The two classes are the stimulants and the non-stimulants. The stimulants (such as methylphenidate, mixed amphetamine salts, etc...) are still considered the most potentially beneficial medications in the treatment of ADHD symptoms. However, the nonstimulant Atomexetine can be potentially beneficial. The potential benefit of the different stimulants is the same. One stimulant is not better than another. Each person has a unique response to a given medication, so for some people there is one medication that works better than another. This can only be evaluated for each person.

ADHD Medications: What is a Parent to do?

The number of articles and books devoted to the topic of Attention Deficit Hyperactivity Disorder (ADHD) and the use of medications is enormous. It seems that everyone has an opinion on the matter; some are well-informed, while others are merely well-intentioned. The predicament is that the overabundance of conflicting information is resulting in the fear and paralysis of many parents of ADHD children. It is clearly becoming much more difficult for parents to make medication decisions on behalf of their children. At some point, every parent of an ADHD youngster will have to make a decision regarding the use of medications for treatment. Parents need some basic rules to follow to help with this arduous task.
I receive many phone calls every day from parents who want to know if they should put their son or daughter on an ADHD medication. My answer tends to be the same for almost all of them: in order to be able to make that decision, we have to know what the diagnosis is. A thorough evaluation is the first and most essential step in the process. It is impossible to treat any condition without knowing what you are treating. It is not prudent to “try a medicine to see if it works.” That is an inappropriate way to proceed and can actually be harmful. Many children who appear to have some ADHD symptoms actually have a different condition, such as anxiety or depression. Furthermore there are some kids who have anxiety in addition to the ADHD. In either scenario, it is essential to determine the diagnosis prior to initiating any kind of medication trial.
Once the diagnosis has been established, the second step is to weigh the benefit of medication treatment against the risks of its negative effects. The potential benefit of medication treatment of ADHD has been documented in numerous studies that have been successfully replicated by many researchers. At the same time, every medication has potential side effects. It is important to understand the different potential negative effects. Some are merely nuisance side effects that go away after a few days while others are more problematic. In order to proceed with a medication trial, the potential benefit should outweigh the potential negative effects.
Once the diagnosis of ADHD has been established and it has been determined that the potential benefit outweighs the potential negatives, the parents need to understand the risks of not treating the ADHD. Many studies have been conducted to examine the consequences of untreated ADHD. It is clear that there are numerous potential consequences such as academic failure, peer rejection, depression, accidents, substance abuse, etc…These consequences are significant and are typically not transient; they tend to continue to manifest into adolescence and adulthood.
If you are a parent of an ADHD child or teenager you need to understand these three basic rules before you proceed with trying a medicine for your son or daughter. It is also critical to work with a clinician with whom you are comfortable and who is able to explain the diagnosis of ADHD and how the diagnosis was determined. The decision to use medication can be an arduous one, but if you follow some basis rules and you work with a knowledgeable clinician the process will be much easier. One of the things that I emphasize in the book "Making the Connection: A Parent’s Guide to medication in AD/HD" is that this decision needs to be thought through and that it is never an emergency to start an ADHD medication.