Saturday, August 13, 2011

Q: How to Deal with "Meds Roulette"?

A few years ago, I participated in an Ask the Expert Chat on "ADHD and Relationships", sponsored by the National Resource Center on ADHD. In this free forum, the public is invited to ask questions of a top ADHD expert in a live online chat. 

This text-based Q&A is later stored in the CHADD Ask the Expert archive (you can view the topics at that link but access is limited to CHADD members). Among CHADD membership's many benefits, I consider this one of the best!


Question from Nina:  How do you deal with a significant other who just got diagnosed with Adult ADHD and is trying out new medications with all different types of side effects?

Hi Nina,


Okay, so you’re at the stage that we sometimes call “Meds Roulette.” By the time some adults with ADHD are diagnosed, there can be intense pressure to "get better FAST."  Unfortunately, tweaking medications is not a fast process. So, it's important that you both show some patience and use a thoughtful approach. Most of all, it's important that both of you be educated.
 
We are extremely lucky to have many medication options today. Just a few years ago, choices were few and side effects much more problematic. Today’s wide range of options increases the odds that each person can find one that works with their unique biochemistry. We hope that some day, genetic research will help indicate which medication will be most effective for an individual. But we’re not there yet. In the meantime, that means lots of trial and error.

That said, a careful prescribing physician and a pro-active patient can take steps to avoid/minimize potential side effects or cut them short when they do occur. Noting side effects can be an important part of the process; side effects can provide clues as to the underlying neurophysiology and the next direction to consider. Unfortunately, many physicians aren’t so careful in their monitoring or don’t know how to read such clues.
 
The fact is, 75 percent of late-diagnosis adults have a co-existing condition, such as depression or anxiety. A stimulant alone can intensify the depression or anxiety in some people, who might need an antidepressant or anti-anxiety medication in addition to a stimulant. There are many possible concerns and options.

Overall, though, the problems I hear most often involve physicians following no logical plan or method. Instead, they use a more haphazard “pin the meds on the ADHD” approach. For example, some prescribe a medication at too high a dosage, when they should be “starting low and titrating slow.” (This means beginning with a low dosage and increasing it by small increments over time, noticing the effect at each stage.) A most regrettable result is the person deciding that "the cure is worse than the disease" and gives up. That’s a sad waste of opportunity.

Dr. Margaret Weiss is a top ADHD researcher and clinician. She was kind enough to share with me,  so I could share with my book’s readers, the recommended protocol for achieving optimal results with ADHD medication treatment. I am hoping that readers will share it with their doctors, so we can all work together to raise treatment standards.
 
Based on the best experts' advice, I also recommend that the partners of adults with ADHD get involved with the process, taking a team approach, unless it is clear that your ADHD partner can handle it well on his or her own. Throughout treatment, the physician should be asking for your feedback. This is recommended for several reasons:
  • Some ADHD adults don’t always notice the changes (positive or negative) or remember to share the details with the physician.
  • Some might half-hear or half-forget instructions from the physician. (It’s amazing to me how many ADHD-treating physicians, knowing ADHD challenges, don’t write down instructions for their patients.)
  • Some might not notice that the physician is not acting in a methodical or thoughtful manner.
Some people bristle at the idea of a "team approach" when pursuing ADHD treatment. They might say, "My partner is an adult; why should I be involved?" I wrote about the reasons for it in this post, Partners in Life, Partners in ADHD Treatment.

Of course medication is only part of the physical treatment process.  It’s also important to pay attention to diet, sleep, food sensitivities, and exercise.  No medication can offset poor health and lifestyle habits.

When the medication is right, however, it can make life so much easier for everyone. I’m constantly astounded by the positive reports from the adults in our Silicon Valley Adult ADHD discussion group  and the online “partners of adult with ADHD” group as well. It’s an awe-inspiring transformation to witness.  So, if you want best results from medication, know that it takes an educated, pro-active approach!  Here are more resources to help you do just that:
I welcome your comments and advice on finding effective medical treatment for Adult ADHD!—Gina Pera

Tuesday, May 31, 2011

Love Means Saying You're Sorry

This month's insights on Adult ADHD and relationships come from psychologist Ari Tuckman, with two excerpts from his book More Attention, Less Deficit: Success Strategies for Adults with ADHD. Enjoy, and please join in with your comments on these topics!  -- Gina Pera

By Ari  Tuckman, Ph.D.
It's been said that if one person in a relationship has ADHD, then the other person kind of has it, too. The one person’s ADHD affects not only how he interacts with his romantic partner, but also his ability to meet his practical obligations in the relationship, like getting to dinner on time and picking up after himself. This can lead to some predictable and interesting dynamics between the two people as they work to find a better way. Every couple faces their own challenges, but a relationship where one person has ADHD will tend to face certain kinds of challenges—and benefit from certain kinds of strategies.
          It’s important to remember that when it comes to improving your relationships and friendships or reducing the effect that your ADHD has on them, you don’t need to strive for perfection. Often, some partial improvements are enough to make things much better and create a situation where your positive qualities outweigh the negative feelings the other person has about your ADHD-based behaviors. Of course, you may also decide that you’re tired of trying to be something you aren’t and make some choices about who you interact with. Some other people may be much more appreciative of your good qualities and much more tolerant of your negative ones.
          I use the word relationship broadly to refer to interactions of all kinds: family member, friend, coworker, boss, for example, so it doesn’t apply just to romantic relationships. Besides, a lot of the same rules apply to all of these. Usually romantic relationships intensify feelings and thoughts that we can keep simpler in other relationships.
         Below are two excerpts from my book
More Attention, Less Deficit: Success Strategies for Adults with ADHD:, drawn from Chapter 15: Relationships and Friendships: Strive for Balance

Thursday, April 7, 2011

Q & A on Adult ADHD: What Is Personality, What Are Symptoms?

Continuing with last month's theme of sharing questions and my answers from CHADD's Ask the Expert chat, here is a two-part question from a reader named Matt. 


I welcome your responses to both Matt's questions and my answers.
—Gina Pera


1. How do you separate ADHD from the person? Because it is neurological, it just doesn't seem possible. It would be like separating sexual orientation from a person.

Hi Matt,
Boy, that’s a question for the philosophers! But I’ll give it a try. It’s true that, especially with late-diagnosis adult ADHD, you often hear comments such as “I don’t know if I have ADHD or if I am ADHD.
A 30-something man with ADHD recently told me that his personality is the Life of the Party. But, I asked him, is that really his personality? Or, could it be a behavior developed many years ago because he was unable to follow the many conversational threads at a party? 

Tuesday, March 1, 2011

Adult ADHD Question-and-Answer: on ADHD and "Denial"

A few years ago, I participated in an Ask the Expert Chat on "ADHD and Relationships", sponsored by the National Resource Center on ADHD. In this free forum, the public is invited to ask questions of a top ADHD expert in a live online chat. This text-based Q&A is later stored in the CHADD Ask the Expert archive (you can view the topics at that link but access is limited to CHADD members). Among CHADD membership's many benefits, I consider this one of the best!
The Internet is chockablock with information on ADHD, but some of it is unreliable. You can count on these Ask the Expert chats to be solid. (The latest one was with Dr. Russell Barkley.) Moreover,  back issues of CHADD's excellent Attention magazine are stored in the archives for members' access. So, if you're not a CHADD member, I encourage you to sign up now (it's tax-deductible, too!).

During my Ask the Expert chat, the questions came in massive quantities!  So many that I didn't have time to answer them in the chat itself. Fortunately, I saved the file. In the coming months, I will be sharing the most topical questions and answers with you.  This month: What do you do when an adult in your life is "in denial" about what seem obvious ADHD-related challenges?