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The American Journal of Psychiatry published a research study which proposed that while ADHD (attention deficit hyperactivity disorder) is most typically thought of as a pediatric and adolescent disorder, approximately 4.4% of adults in the U.S. have symptoms of ADHD that were either never addressed as a child, or where the adult is unaware that they have the disorder. If you’ve been exhibiting any symptoms of ADHD, Atlanta psychiatrist Dr. Hege can provide an evaluation and prescribe medications to help.

Diagnosis of Adult ADHD is Difficult & Often Missed

There are over 230 million adults 18 years of age and older in the U.S., accounting for 76% of the country’s total population. The numbers show that over 10 million adults not only show symptoms of ADHD, they also exhibit co-morbid disorders; such as bipolar disorder or obsessive compulsive disorder, which significantly complicate a diagnosis and have an impact on the treatment options.

Many physicians and mental health professionals often miss the appropriate diagnosis of ADHD in adults as the symptoms manifest differently in adults then they do with the children they commonly diagnose with ADHD. The Mayo Clinic takes note that adult ADHD symptoms are intermixed with numerous issues such as having a poor employment history, difficulty with academic work, unstable long term relationships, being accident prone, and struggling with substance abuse to name a few.

Symptoms of Adult ADHD

Adults with symptoms of ADHD also exhibit anxiety and mood disorders, depression, impulse control disorders and demonstrate impairments in executive functioning; these higher levels of cognitive functioning directly impact on the ability to perform as an employee, a parent, a spouse, and as a productive member of society.

Executive function refers to the brain’s ability to focus, integrate and manage multiple tasks, organize thoughts and ideas, as well as appropriately handle emotional control. An adult with ADHD would also exhibit problems with memory and recall, ability to complete routine tasks, distractibility, and difficulty with timeliness. Impairment in any of the areas of executive function is tightly interlaced with the symptoms of adult ADHD.

Atlanta Adult ADHD Specialist

Working with a specialist in adult ADHD is critical for a comprehensive evaluation and diagnosis followed by the development of a specific medication regime.  Dr. Darvin Hege is a highly respected Atlanta adult ADHD specialist, who not only treats the symptoms, he also successfully focuses on the foundational causative factor of ADHD bringing his patients satisfaction and enjoyment in their lives.

If you or a loved one is exhibiting any of the symptoms for adult ADHD, please call Dr. Hege, for an initial appointment and evaluation.

Reprinted from boston.com

Ritalin and other drugs used to treat attention deficit disorder are safe for adults’ hearts, even though they can increase blood pressure and heart rate, according to the largest study of these medicines in adults.

The results echo findings in a study of children with ADHD, by the same researchers, published last month.

The review of health records for more than 440,000 adults aged 25 to 64 showed those taking ADHD drugs had about the same number of heart attacks, strokes and sudden heart-related deaths as adults who didn’t use those drugs.

Although attention deficit disorder is usually thought of as a condition in childhood, many continue to have symptoms as adults, including impulsive, fidgety behavior and difficulty focusing or paying attention. ADHD affects about 4 percent of U.S. adults, roughly 9 million. About 8 percent of U.S. children aged 3 to 17, or 5 million kids, have ever been diagnosed with the disorder, government statistics show.

More than 1.5 million U.S. adults were taking stimulants used for ADHD in 2005, and use of ADHD drugs increased more rapidly in adults than in kids over the past decade, the study said.

The research will be published in the Journal of the American Medical Association’s Dec. 28 print edition, but was released online Monday because of its public health importance, journal editors said.

More than 150,000 ADHD medication users were involved in several states. Their health records over up to 20 years were compared with similar adults who did not use those drugs.

Overall, there were 1,357 heart attacks, 575 strokes and 296 sudden cardiac deaths. Roughly equal numbers occurred in ADHD drug users and nonusers.

Study participants used the drugs for an average of less than a year, which is short, but the upper range of use was almost 14 years, and there was no sign of increasing risk with longer use, the authors said, led by Laurel Habel of the research division at Kaiser Permanente Northern California in Oakland.

A journal editorial says the study provides encouraging news, given lingering concerns about isolated reports of heart problems and sudden deaths in users of some ADHD drugs.

The findings support the Food and Drug Administration’s decision in 2006 against putting a black box warning about serious heart events on ADHD drug labels. But despite the results, medical histories and exams should still be performed for all patients before starting ADHD drugs, and periodic evaluations should be done during drug treatment, said editorial author Dr. Philip Shaw of the National Human Genome Research Institute.

The federal Agency for Healthcare Research and Quality and the FDA helped pay for the study

See original article at http://articles.boston.com/2011-12-12/lifestyle/30507967_1_adhd-drugs-attention-deficit-disorder-heart-attacks

Adult ADHD (Attention Deficit Hyperactivity Disorder) affects 4.4 % of adults. Hallmark adult ADHD symptoms are inattention, distractibility, and impulsivity. If you have adult ADHD, the symptoms were present in childhood but may not have become a prominent problem until adulthood. As adults, we accumulate an increasing burden of responsibilities. These responsibilities include marriage, family, job, and finances. Our brain's ability to filter and prioritize the multitude of demands placed upon it may be overwhelmed. Expectations of us as mature, responsible adults include modulating our anger and fears, listening to and hearing our spouses and bosses explicit and implied instructions, and to be able to focus and concentrate to read required reports and instructions. If we have the drag of ADHD present, we may become "stressed out", depressed, overly anxious, or turn to alcohol, drug, or medication abuse. If the patient presents for help at this point, the overlying problem of depression, anxiety, or substance abuse may be diagnosed and treated. However, the foundational problem of ADHD may be missed. Unless the ADHD is successfully treated, the person may improve temporarily but still struggle unnecessarily and be more prone to relapsing to another bout of depression, anxiety, or substance abuse.

The "ADD" in Adult ADHD symptoms refers to the predominantly inattentive subtype cluster of symptoms. The "ADHD" refers to the condition that includes the hyperactivity-impulsive symptoms in addition to the inattentive symptoms. The particular symptoms of the predominantly inattentive subtype and the symptoms of the hyperactivity-impulsive subtype are described in the next section under "What are the signs and symptoms of ADHD". Females have predominantly inattentive symptoms without the hyperactivity symptoms more often than males. When the hyperactivity symptoms are present, the person with the symptoms is more often identified earlier in life as having a problem. Hence, boys are more often diagnosed and treated than girls.

What Causes ADHD

What is ADHD

HOW TO GET CHEAP / AFFORDABLE PSYCHIATRIC MEDICATIONS http://ltcc.usadrugplan.com/

Here is an improved way to get cheap medicine. Click on this link,USA Drug Plan , to take you to a website to print out your discount card. There is also a link on this page to find out the price of the medication of your choosing in the ZIP code you choose. Most of the time in my ZIP code, 30338, the Kroger pharmacies have the cheapest prices. These prices usually compete with Costco pharmacy, which are usually the lowest price medications here in the Atlanta area.

Most of my patients prefer to go to Kroger rather than Costco because Kroger pharmacies are open longer hours and seven days per week, Kroger is usually closer geographically, it usually isn't as far from your parking space into the store and inside the store to the pharmacy, and usually you don't have to wait as long to get your prescription filled.

A couple examples of the prices at Kroger pharmacy with this discount card are generic Adderall short acting for $.35 per pill and generic Lamictal, lamotrigine, for $.40 per pill. The discounts for generic medications are usually much more dramatic than the small discounts that may be obtained on brand medications.

Call 770-458-0007 today for an appointment with Dr. Hege. Dr. Hege has a lot of experience in selecting psychiatric medications cost-consciously because 50% of his patients have no insurance. He specializes in the evaluation and medication treatment of ADHD, Suboxone and Subutex opioid replacement therapy, panic disorder and other anxiety disorders, bipolar II disorder, depression, and alcohol and other substance abuse problems.

Affordable fees for psychiatric services by Dr. Hege 
is a webpage on Dr. Hege's website.

Is ADHD a real medical condition that justifies treatment with medication? The popular media quite also describe it as a questionable diagnosis, or overdiagnosed, or treated with unnecessary medication. Critics suggest the symptoms of hyperactivity, inattention, and impulsivity are merely extreme variations of normal human traits. Their criticism further attributes the cause to over demanding parents, poor teachers skills, and an over competitive society.
In scientific literature the majority view ADHD as a valid and common psychiatric disorder of childhood. A set of criteria for establishing in a psychiatric condition as a valid psychiatric disorder was established by Robins and Guze in 1970. This became the framework for how all diagnoses get included in the American Psychiatric Association’s diagnostic manual. These criteria all require that scientific studies have had been done and support every one of the six criteria.
Following are the six criteria required to make a classification of a cluster of signs and symptoms as a valid psychiatric condition:

1. CLINICAL CORRELATES
“A valid diagnosis needs to be reliably identified through a consistent pattern of signs and symptoms demarcating it from other disorders and from psychiatric wellness.”
This means that if a group of doctors independently evaluated the same group of patients and use the same test to diagnose the patients, there is high agreement as to which patients did have the disorder and which did not have ADHD. Numerous scientific studies have established the high reliability of different rating scales for the diagnosis of ADHD.

Also, a diagnosis of a condition cannot be made if the symptoms of that condition do not cause significant impairments. Studies have documented inferior academic performance, reduced social skills, inattention in the duration of focus on a single task, impulsivity disrupting schoolwork, and hyperactivity causing fidgeting and talking excessively. Impairments continue into adolescence with high rates of delinquency, more arrests, and higher risk of substance abuse disorders. Other studies document higher rates of injury, cycling injuries, and pedestrian injuries. Driving performance impairment leads to higher accident rates and traffic citations.

2. DELIMITATION FROM OTHER DISORDERS
This means that ADHD is a condition that is separate from other diagnoses. It isn’t a cluster of signs and symptoms and impairments that is actually part of another diagnosis. Symptoms of major depression, generalized anxiety, and bipolar disorder often include symptoms that overlap with ADHD. For example, hyperactivity and reduced concentration are common in major depression. However, when patients that are diagnosed with major depression and ADHD have the symptoms that are part of major depression subtracted from their ADHD diagnosis, the majority of these dual diagnosed patients still meet the criteria for ADHD. Also, when the symptoms of ADHD were removed from patients with a dual diagnosis that included major depression, most of them still met the criteria for major depression.

This overlapping or comorbid occurrence of two or more psychiatric diagnoses in an individual is common. Interestingly, when family studies are done, some conditions such as ADHD and depression tend to run together in families. Other conditions as anxiety disorders and ADHD run independent of each other.

Impairments and other negative consequences in ADHD patients cannot be all explained away by coexisting conditions of conduct disorder, major depression, and learning disabilities. For example, rates of arrest, drug abuse, and executive dysfunction are elevated in ADHD. These problems are further elevated it conduct disorder is also present.

3. COURSE AND OUTCOME
A valid psychiatric disorder needs to have a characteristic course and outcome. Long-term studies showed childhood ADHD is a chronic disorder that survived into adulthood in a significant number of patients. While many fail to meet the full strict criteria for the condition in adulthood, 90% retained significant symptoms to have persistent significant clinical impairments. Numerous studies report that ADHD has a natural course that provides another method ofdelimiting it from other disorders. For example, if symptoms of ADHD occur intermittently along with episodes of another disorder, this would not be viewed as evidence of ADHD because of lack of chronic persistence of symptoms.

4. EVIDENCE FOR HERITABILITY FROM FAMILY AND GENETIC STUDIES
ADHD meets the criteria for being a scientifically based disorder on neurologic grounds of being heritable. Numerous family studies and genetic studies provide evidence.

Family studies found parents and siblings of ADHD children have a 2-8 fold increased risk of being ADHD. All 15 twin studies showed increased risk in the twin of an ADHD child. The risk was 75% for familial status of having ADHD. Consequently, only 25% of this is due to environmental factors. The studies came from families from around the world (US, UK, Australia and Sweden). Studies from all of these countries are in agreement that there is an inherited risk for ADHD.

Adoption studies provide further evidence of the genetic influence on risks for ADHD. Biologic relatives of ADHD children have higher rates of ADHD than adopted relatives.

Molecular genetics studies found strong association between several neurotransmitter genes and ADHD. These neurotransmitters are dopamine, norepinephrine, and serotonin. They are implicated in causing ADHD and are involved in the therapeutic effects of ADHD medications.

5. LABORATORY STUDIES
Another method of developing evidence to support a neurobiological connection of ADHD diagnoses is laboratory studies. PET scan studies found evidence of defective dopamine transporter function in the striatal region of the brain of ADHD patients. These were performed on live patients with real-time images of metabolic activity. Scientifically controlled studies of the physical structure of brain of ADHD patients compared to normal found evidence of abnormal structures in parts of the brain. Ten controlled studies of brain function found abnormalities in multiple areas of the brain of ADHD patients. While the particular parts of the brain were not consistently involved in the different ADHD patients, the findings were consistent with their knowledge of brain pathways and systems involved in the regulation of complex behaviors that may be involved in the motor control, in attention, and executive function deficits seen in ADHD.

6. TREATMENT RESPONSE
The validity of a diagnosis is bolstered if patients with a defined condition respond to a particular medication treatment. Many controlled studies provide evidence of the high rate of treatment response of methylphenidate in reducing overactivity, impulsiveness, and inattentiveness. In addition to improving ADHD symptoms, many studies provide strong evidence of the medication effectiveness in reducing ADHD-related impairments in children and adults. Other medications besides stimulants have been proven to be effective in ADHD patients. These include tricyclics and atomoxetine(Strattera). All of these medications have been shown to block norepinephrine and/or dopamine reuptake at receptor site. While this data provides additional evidence of the validity of the ADHD diagnosis, they do not mean that this treatment response should be used as a method to make the diagnosis. Stimulant medications can improve cognition and attention in non-ADHD individuals just as high blood pressure medicine may reduce blood pressure in people with normal blood pressure .

DISCUSSION
Numerous studies provide enough evidence that ADHD meets the six criteria of Robinson and Guze standard criteria:
“………
1) ADHD patients show a characteristic pattern of hyperactivity, inattention, and impulsivity that lead to adverse outcomes.
2) ADHD can be distinguished from other psychiatric disorders including those with which it is frequently comorbid.
3) Longitudinal studies show ADHD is not an episodic disorder. It is always chronic and sometimes remits in adolescence or adulthood.
4) Twin studies show ADHD is a highly heritable disorder, as heritable as schizophrenia or bipolar disorder. And molecular genetic studies have discovered genes that explain some of the disorder’s genetic transmission.
5) Neuroimaging studies show that ADHD patients have abnormalities in the motor control frontal-cortical-cerebellar pathways involved in the control of attention, inhibition, and motor behavior.
6) Most ADHD patients show a therapeutic response to medications that block the dopamine or norepinephrine transporter.
…….”

One concern is that most studies have been done with the most severe examples of ADHD who are referred to doctors and clinics.Thus, the studied populations may not represent the whole spectrum of severity of symptoms and impairments. Therefore, it would not be valid to generalize the facts about these patients to nonreferred ADHD patients in the community. However, two of the criteria for the diagnosis of ADHD are based on wide population studies. (1) Several epidemiologic studies have been supportive because they found the clinical features of ADHD in these community population samples. (2) and several studies were done with population samples demonstrating the high heritability of ADHD in cases that are not necessarily the most severe cases.

Another group of critics argue that ADHD signs and symptoms are better viewed as a normal continuous varying spectrum of traits rather than a disorder. The problem with this argument is that even normal variation can be a disorder if the more extreme cases suffer distress or disability. An example is how the normal variations of blood pressure and serum cholesterol level become medically urgent disorders in the more extreme levels.

Other critics argue that because there is not 100% agreement of results among different studies, a diagnosis is not valid. However, the preponderance of the evidence is overwhelmingly supports that ADHD is a valid diagnosis, especially when careful reviews of the different studies and meta-analysis studies were done.

Some critics hold the opinion that ADHD impairments are due to a highly competitive society, failure of parenting and teaching, or societal intolerance of extreme but normal symptoms. However, the genetic and neurobiological evidence is too strong to totally discount. There obviously are environmental factors that contribute to whether or not a person develops ADHD. There Is much evidence that ADHD’s causes are multifactorial, caused by the addition and interplay of genes and environmental risk factors.

Parents and patients with ADHD often have misgivings about accepting help and medication for ADHD. When they encounter misunderstanding about the diagnostic validity of ADHD, their resistance grows. Corrective education from medical and mental-health professionals may be the first step in helping distressed ADHD patients to get help that will bring them relief and success in their lives.

Written by Dr. Darvin Hege, M.D. on January 8, 2010 with content drawn heavily from the following article:

The scientific foundation for understanding attention-deficit/hyperactivity disorder as a valid psychiatric disorder. Faraone SV. Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY 13210, USA. faraones@upstate.edu

Dr. Darvin Hege has 25 years of experience dealing with patients who may fit the criteria for ADHD and may need a medication like Adderall for ADHD. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770-458-0007 to discuss getting an ADHD evaluation and for help deciding the most effective and safest treatment.

Can chronic use of therapeutic doses of Adderall, Vyvanse, or Dexedrine (amphetamines) cause brain damage?

The bottom line is we don't know. However there is a body of research that raises some concerns but gives no strong conclusive evidence either way. A comprehensive review article was published in February of 2009 "Literature Review: Update on Amphetamine Neurotoxicity and Its Relevance to the Treatment of ADHD" and is available free (1).

A worrisome study in monkeys in 2005 by Ricaurte found some evidence suggesting dopamine nerve damage in areas of the brain involved in ADHD dysregulation and amphetamine therapeutic effects (2). Some of the monkeys were given doses that are normally given to humans. However, multiple similar studies in rodents did not find evidence of this damage in usual dosage ranges that are given to humans. In contrast to amphetamines, high dose methylphenidate (Ritalin, Concerta, Focalin, Daytrana) studies appeared to have lower risk for brain toxic effects (3, 4).

Stimulant treatment of ADHD during childhood appears to reduce the risk of substance abuse that is otherwise associated with ADHD.(5, 6) Also children with ADHD who had not been treated with stimulants have smaller brain white matter volume than children with ADHD who had been medicated or children without ADHD. Stimulant treatment in children may actually increase brain growth and development.(7) However, older rodents, when given methamphetamine in doses that are known to be toxic to younger rodents and humans, had more toxic brain reactions than younger rodents. They also had brain levels of amphetamine that was twice as high as the levels in younger rodents when given the same dose. Natural aging processes reduce dopamine production greatly. Older humans may be at greater risk of toxic effects of amphetamine 

No controlled studies have examined the adverse behavioral, cognitive, neurophysiological effects of years, much less decades, of chronic amphetamine treatment. Neuroimaging with PET and MRI techniques are becoming increasingly useful in measuring brain anatomy and function in living human beings to explore for brain damage in humans treated with amphetamine. We look forward to the coming evidence to make more informed treatment recommendations to our patients with ADHD.

1.(Free) Literature Review: Update on Amphetamine Neurotoxicity and Its Relevance to the Treatment of ADH