ADHD Medication Management: How to Use and Adjust Stimulants Safely (with William Dodson, MD)
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- čas přidán 24. 07. 2024
- Most ADHD diagnoses are quickly followed by a prescription for stimulant medication, the widely recognized first-line treatment for ADHD symptoms. Yet many clinicians receive little training in how to use these medications effectively. If a patient has a less-than-ideal experience when starting medication (troubling side effects, for example), and the clinician doesn’t respond quickly, he or she is unlikely to continue taking it faithfully.
In this hour-long webinar, Dr. William Dodson presents critical information about stimulant medications to ADHD clinicians and patients.
Download the slides associated with this webinar here:
www.additudemag.com/webinar/m...
0:34 Medications are the treatment of choice, not the last resort when everything else has failed. Things to consider when prescribing these ADHD medications: Recent or unstable substance abuse Uncontrolled glaucoma Uncontrolled seizures Untreated cardiovascular disease
8:40 Convenience → More consistent and stable benefits. The treatment goal is stability of performance, med, impulse control, engagement
11:57 Nothing predicts which molecule or the dose of that molecule at which an individual will get the optimal level of benefits and no side effects
14:28 There is a tremendous variability of optimal dose.
22:02 Accept whatever duration of action is at that person's optimal stimulant dose.
Related Resources
1.10 Things Your Doctor May Not Have Told You About ADHD Medications
www.additudemag.com/slideshow...
2. How Does ADHD Medication Work? With Lots of Monitoring
www.additudemag.com/slideshow...
3. ADHD Medication Side Effects No One Should Tolerate
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4. eBook: ADHD Medication and Treatment
www.additudemag.com/product/a...
5. ADHD Medication Options: Stimulants, Nonstimulants & More
www.additudemag.com/adhd-medi...
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I wish that every psychiatrist has this view and knowledge about medications.
I agree. I'm having a heck of a time finding a competent and knowledgeable provider.
Aman ! so very frustrating
Very good analogy with the glasses not being about dosage but about the individual tiltration 🤩 💛
Concerning basic concept #1 - what if the medication completely resolves substance abuse?
Absolutely Brilliant 🤩 I’m learning heaps and losing shame simultaneously. Thank You Doc ✨🍀✨
🎯 Key Takeaways for quick navigation:
00:00 🧠 *Introduction and Importance of ADHD in Medical Education*
- ADHD often goes overlooked in medical education.
- ADHD is not adequately covered in most psychiatric and pediatric residencies.
- Recommendations to find physicians well-versed in ADHD are shared.
01:46 💊 *First-Line Stimulant Medications and Practice Parameters*
- Stimulant medications are primary treatments for ADHD.
- Practice parameters from the American Academy of Child and Adolescent Psychiatry emphasize the importance of medications.
- Lack of lasting benefits from non-medication interventions for core ADHD symptoms.
03:29 📊 *Effect Size, Response Rates, and Choice of Molecule*
- The concept of effect size helps understand the efficacy of stimulant medications.
- Both methylphenidate and amphetamine have comparable response rates.
- Individual preferences and trial and error are vital for choosing the right medication.
08:48 ⏳ *Importance of Extended-Release Formulations and Rebound Effects*
- Extended-release formulations provide consistent benefits and reduce rebound effects.
- Immediate-release formats can lead to abrupt mood changes like 'Ritalin rebound.'
- Extended-release formats offer privacy, especially for children and adults during school or work.
10:31 ⏰ *ADHD and Time Management*
- Many individuals with ADHD struggle with time perception and management.
- Medication can assist in improving punctuality and time management.
- ADHD symptoms like procrastination and distractibility can be alleviated with appropriate treatment.
15:08 💡 *Individual Variability in Optimal Dosage*
- Optimal dosage varies significantly among individuals.
- Fine-tuning medication is crucial based on individual symptoms and responses.
- Tolerance to side effects is faster than the tolerance to the benefits of ADHD medications.
19:33 📝 *Importance of Documentation and Feedback for Medication Management*
- Keeping records and documenting responses to medication is vital for effective management.
- Parents, teachers, and the patient provide essential feedback on medication effects.
- Regular monitoring ensures the best therapeutic outcomes and minimal side effects.
26:35 🕒 *ADHD Medication Beyond School and Daily Activities*
- ADHD medication is not limited to school activities; it's essential for social interactions, family relationships, driving, and safety during weekends and holidays.
- ADHD medication is advised wherever there's impairment due to ADHD.
- Different medications have varying response rates, and some individuals may require alternatives due to tolerance or other factors.
27:21 💊 *Alternative ADHD Medications*
- Some individuals don't respond well to standard ADHD medications.
- Second-line medications like clonidine and guanfacine can be effective for some but not all.
- Methamphetamine, though stigmatized, is highly effective for treating ADHD when used in appropriate dosages.
28:59 🚫 *Strattera and Other Off-Label Medications*
- Strattera shows varied efficacy across different age groups, with its effectiveness decreasing in older populations.
- There are alternative or off-label medications like bupropion, modafinil, and pernite, though they aren't FDA approved for ADHD treatment.
- These alternative medications might be considered when other treatments fail, but evidence supporting their use for ADHD is limited.
30:11 🗣️ *Patient Perspectives and Grief Over Missed Opportunities*
- Many patients express regret over not starting ADHD medication sooner, considering the significant improvements in their lives.
- ADHD medications help individuals achieve a return to normative functioning with minimal side effects.
- It's essential to address side effects by adjusting doses or employing specific techniques to alleviate them.
31:34 🧬 *Genetic Testing for Medication Selection*
- Genetic testing aimed at predicting the effectiveness of ADHD medications isn't scientifically validated.
- The premise behind genetic testing for ADHD medication metabolism lacks a solid scientific foundation.
- Patients are advised against spending money on genetic testing for medication selection due to its unproven efficacy.
33:26 ⏸️ *Medication 'Vacations' and their Implications*
- The concept of "medication vacations" is rooted in outdated beliefs about growth suppression due to ADHD medications.
- Stopping ADHD medication, even during breaks like summer vacations, poses risks that outweigh potential benefits.
- Continuous treatment with ADHD medications is essential for managing risks like substance use disorder, accidents, and other adverse outcomes.
54:21 💊 *[Understanding Generic ADHD Medications]*
- The speaker discusses the differences between brand name and generic ADHD medications, emphasizing the importance of knowing which generic products are equivalent to brand names.
- Generic medications can have a significant variability in dosage, ranging from 20% lower to 25% higher than the indicated dose.
- Activists or Watson generics are equivalent to the brand name, while others may not be consistent, leading to potential inconsistencies in treatment.
55:46 🧠 *[Debating the Concept of Executive Function in ADHD]*
- The discussion delves into the validity of the executive function theory concerning ADHD treatment and its effectiveness.
- The speaker challenges the notion that executive function is a defining feature or primary concern in ADHD treatment.
- There's skepticism about the extent to which medication can directly influence or improve executive function, suggesting a different perspective on its role in ADHD management.
56:31 🚗 *[ADHD as a Lifelong Neurological Wiring]*
- The video addresses a common misconception about ADHD, particularly the belief that individuals might "outgrow" ADHD symptoms with age.
- ADHD is characterized as a neurological wiring issue, suggesting that it's an inherent part of an individual's biology.
- The speaker dismisses the notion that turning 18 or reaching adulthood will magically change one's ADHD condition, emphasizing its lifelong nature.
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I've never been given education about the two different meds I've taken, from either the specialist clinic or my doctor. It's assumed I'll do my own research. Which I do but a baseline would've been helpful. Having information like this is invaluable, so thank you, Dr Dodson.
Very helpful, thank you!
This was incredibly informative, thank you!!
Thank you very much. This helps very much.
He has some of the best information.
Just diagnosed with ADT without the H in Quebec, Canada, Ah ha ha! I am native American from Innu First Nations of Quebec, Canada, G0H 1B0 / Thanks a lot Dr William Dodson for all those good insights! :D
44:21 -I understand that Dr Dodson has mentioned he’d supply lists to clinicians in regards to medications and dosing, but is there a place we (parents of ADHD kiddos) can access the list of foods and drinks (citric acid/absorbic acid) that interfere with the absorption of stimulation medications? As a parent I would find this so very helpful! Also Dr Dodson mentions not to take those food/drinks 1hr before and after taking medication… on an extended release med like Adderall XR, do we not need to restrict those absorbtion interfering foods and drinks about 4hrs later around the second release time too ?
I am wondering that too! I used to take orange juice every morning but I can't take it with my Adderall XR so I'm not sure when in the day is it safe to drink it again. If I have some at noon let's say, can it prevent the 2nd bead of Adderall from getting absorbed properly?
Great info. However describing methamphetamine abusers as “speed freaks” is very derogatory. Having worked with many patients who are being treated for their substance use disorder I can assure you they are real people - not freaks; who are struggling desperately, almost ubiquitously suffered from childhood trauma, and when given appropriate resources to receive treatment are immensely grateful. Thanks for your consideration.
Are these slides available in a printable format on the ADDitude website, with a transcript? It would REALLY help approaching my doctor.
Age 70 Female UK, Dx age 56 I managed to get Modifinial* Provgil. For adults is it not allowed possibly for off label use by ins or FDA?? It is cleaner and life changing, but little understood seems military use got it pushed through authorized for sleep apnea. My blessed Rain Man drug!!!
That's pity that the microphone is noisy and has distortion. Audio quality is awful. The content is awesome.
Can stimulants be helpful to treat impulsivity agressivité in patients with Aspergers and adhd combined who has not so much of deficit attention
How old is this lecture? The information about the actavis generic concerta might be considered old now.
Can you have Vyvanse twice a day? It doesn't last all day and when I crash I crash badly. Most doctors in Spain give up on once a day medications if you crash early but there's no instant or medium release amphetamines.
How long does it last? Usually the when doctors give a booster it’s instant release form
I think you technically could (health-wise), but the problem will be getting the prescription for it. Most places wont allow you to have double the monthly dose since it's a controlled substance. You would have to get a 2nd prescription for a different stimulant to close the gap. As azzy mentioned, it's typically an instant release form - in the US at least. Vyvanse doesn't have an instant release form, but Adderall does and it is also an amphetamine. Is it not available in Spain?
Vyvanse is the only amphetamine available here unfortunately. No Adderall
It can. Psychiatrists can fight with insurance to cover it. Or you can just use Dexedrine ER twice a day or a booster of IR Dexedrine Dexedrine and vyvanse are going to just have the D isomer of amphetamine. The only difference is vyvanse is a prodrug. Adderall is not the same because it’s a mixed amphetamine of 3:1 D-L amphetamine.
It would be great to be able to see a psychiatrist and a psychologist..but when you cannot get the help because of shortages...and/or NONE available in oregon and you're denied care...
yep it's so sad about the adderall shortage going on. Was fortunate enough to get my first script filled but hopefully don't have any future issues. The meds have returned me to normative functioning thus far.
Vyvanse does not containe dextroamphetamine, Adderall does. Adderall works best for me.
Vyvanse makes me feel nervous.
Adderall makes me feel calm.
I can sleep when I take Adderall
"no long-term educational benefit" sounds like some kind of weasel language, like they are saying something like 'well it doesn't increase IQ, or teach you algebra'. Which is true, but deceptive.