The FDA has approved Vyvanse (lisdexamfetamine dimesylate) as maintenance therapy for adults with attention deficit hyperactivity disorder (ADHD).
The approval is based on results from a randomized study designed to evaluate the efficacy of the drug in 123 adults aged 18 to 55 years who were receiving treatment with Vyvanse for a minimum of 6 months before enrolling in the study and who were responsive to the drug. 8.9% of patients in the active treatment group experienced a relapse of symptoms compared with 75% of those in the placebo group during the 6-week double-blind withdrawal phase of the study Shire, the drug’s manufacturer, stated in a press release that “Vyvanse is the first medicine both proven to work and approved to maintain efficacy in adults with ADHD.” The FDA approval included the proviso that Vyvanse should be used as part of a total treatment program that may include counseling or other therapies. The FDA also noted that physician who elects to use Vyvanse for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient.The bottom line is that Vyvanse, while previously approved for Adult ADHD, now has been definitely shown to be effective for the long term treatment of this condition. For more information on the Atlanta Center for Adult ADHD, please visit www.Atlanta-ADHD.com
At the Atlanta Center for Adult ADHD, one of the most common medications patients try is Vyvanse (lisdexamphetamine). Vyvanse has an FDA indication (approval) for childhood, adolescent and adult adhd/add. Vyvanse has the advantage of an exceptionally long duration of action, up to 13 hours. This is due to the novel way Vyvanse is metabolized. Lisdexamphetamine is a prodrug which is inactive until metabolized in the body to dextroamphetamine, which in turn is responsible for increasing the release of dopamine and norepinephrine between neurons in the brain. This increase in neurotransmitters produces the improvement in ADHD symptoms that patients usually experience with Vyvanse.
Vyvanse may be taken with or without food (which is always more convenient). The medication is started at 30mg and may be increased up to 70mg as needed. However, many patients do well at the starting dose and no upward titration is needed. One drawback to Vyvanse is the cost and this medication is sometimes not covered under health insurance plans. Because of its long duration of action, Vyvanse is usually one ofthe first medications tried by adults in our practice. All patients who are started on amphetamine medications are carefully evaluated for any health issues such as underlying cardiovascular disease to ensure the medication can be taken safely.
For more information on the Atlanta Center for Adult ADHD, please visit Atlanta-ADHD.com or call 770-753-9898
The short answer is yes. Although medication management is the current treatment of choice, there are some individuals who do not want to take medications or who cannot take medications for certain health reasons. In addition, even optimally treated with medications, most adults will continue to have clinically significant symptoms.
A randomized clinical trial conducted by investigators at Massachusetts General Hospital in Boston showed individuals who received CBT (cognitive behavioral therapy) in addition to their regular ADHD medication had a superior response compared with their counterparts who received relaxation therapy with educational support in addition to their usual medication regimen.
The CBT intervention focused on psycho-education about ADHD, training in organizing and planning, learning skills to reduce distractibility, cognitive restructuring, and relapse prevention (Mastering Your Adult ADHD: A Cognitive Behavioral Treatment Program Therapist Guide and Mastering Your Adult ADHD: A Cognitive Behavioral Treatment Program Client Workbook, Oxford University Press).
At study completion, investigators found that compared with the relaxation group, those in the CBT group achieved superior symptom reduction. Furthermore, he said, CBT appeared to have a durable effect, with responders and partial responders maintaining their gains at 6- and 12-month follow-up.
The study was published in the August 25 issue of the Journal of the American Medical Association.
At the Atlanta Center for Adult ADHD, we have also observed good results with patients referred for this treatment and have excellent local resources for patients interested in pursuing cognitive behavioral therapy.
Our patients (and their parents) often ask what treatments besides medications can help ADD/ADHD.
Most of the scientific studies exploring this subject have examined effects on children rather than adults, but I would expect the effects on teenagers and adults would be similar.
There is one large randomized controlled study in 2009 finding a significant benefit of neurofeedback for children with ADHD. (The goal of neurofeedback is to teach individuals to be able to control certain brain wave patterns and increase brain activity associated with good attention states. Specifically, patients learn to reduce activity in the theta band of the electroencephalogram (EEG) (4–8 Hz) and to increase activity in the beta band (13–20 Hz).)
In the 2009 study, the effect was found to be “moderate”. There were some methodological issues with this study as well as with other past studies of neurofeedback to treat ADHD and government sponsored research into this area is ongoing. Still, neurofeedback appears to be one of the most promising complementary treatments available.
The following treatments have not been scientifically shown to be helpful for Adult ADHD: acupuncture, zinc/magnesium/iron supplements, polyunsaturated fatty acids (including fish oil), Ginko Bilobum, and St. Johns Wort. Elimination diets are generally not helpful. However, I strongly believe that eliminating monosodium glutamate and other glutamates from foods (ie, natural flavor, natural flavoring, malted barley, hydrolyzed protein, yeast extract, etc.) in individuals sensitive to these chemicals helps can help ADHD symptoms tremendously.
For healthy patients with no specific medical contraindication (ie, heart rhythm problem, seizure disorder), the use of stimulants in treating ADHD has been felt by clinicians to be extremely safe. Two new studies have carefully examined this issue and the results should be reassuring to patients currently on stimulants and to individuals considering stimulant treatment for ADHD.
The first study, published November 1 in the New England Journal of Medicine showed no increased risk for serious cardiovascular events, including sudden cardiac death, stroke, and myocardial infarction, among children and young adults.
The second study, published a few days ago in the Journal of the American Medical Association, reported similar findings in young and middle-aged adults.
In accordance with FDA recommendations, patients treated at the Atlanta Center for Adult ADHD are periodically monitored for changes in pulse and blood pressure. Patients will continue to be screened carefully to ensure they may take stimulants without any undue health risk. Please visit www.Atlanta-ADHD.com or www.ADHD-ADD-ATLANTA.com for more information or call 770-753-9898.
We are happy to announce the opening of the Atlanta Center for Adult ADHD at our Roswell office, offering state of the art medical and behavioral treatment for this condition. Dr. Banov is especially interested in ADHD and has participated in FDA regulated ADHD trials as a Clinical Investigator. Attention Deficit Disorder is a common condition among children and adolescents and has been diagnosed with increasing frequency among adults as well. Research shows that up to 60% of children with ADHD continue to have symptoms through adolescence and into adulthood. In addition, studies have shown that individuals with untreated ADHD have a much higher rate of substance abuse problems. Here at Atlanta-adhd, we have seen a high rate of untreated ADHD in our patients being seen for substance or addiction problems. Symptoms of Adult ADHD can include difficulty paying close attention to details, making careless mistakes, finding it hard to organize activities or finish a task, having difficulty following instructions or conversations and being forgetful in daily activities as well as frequently losing things. Some adults with ADHD are quite restless and fidgety. ADHD diagnosis involves clinical evaluation, behavioral testing and the Quotient ADHD System, a computerized device that accurately measures motion and shifts in attention. The test takes 20 minutes for adolescents and adults. Treatment of ADHD usually involves medication, either stimulant (such as Dexedrine or methyphenidate) or non-stimulant (such as amoxetine). We also offer ADHD coaching and cognitive therapy. We look forward to helping many adults in the Atlanta area dramatically improve their quality of life with effective ADHD treatment at our new center.
At our new Atlanta Center for Adult ADHD, we utilize proven, effective medication for ADHD. In 2011, there are five medications which are FDA approved for Adult ADHD: Extended-release mixed amphetamine salts (Adderal XR), lisdexamfetamine (Vyvanse), OROS methyphenidate (Concerta), extended release methylphenidate (Focalin XR), and atomoxetine (Straterra). These are all long acting medications.
The first four medications are stimulants, which are generally felt to be more “robust” (more effective) than Straterra. However, Straterra would be preferable in cases of past stimulant abuse, when stimulants cannot be used for certain health reasons, and when the patient just does not want to take a stimulant class medication. Although Straterra takes 4-5 weeks to achieve a high enough blood level, it eventually provides 24 hour ADHD coverage.
Bupoprion (Wellbutrin) is a non-FDA approved medication that can be used in many cases of ADHD when stimulants or Straterra cannot be taken.
Stimulants can be divided into two groups, amphetamines and methylphenidate.
Adderal XR and Vyvanse are considered amphetamines and Concerta and Focalin belong to the methylphenidate class. Some patients do better with amphetamines and some with methylphenidate. Other patients do equally well with either medication. In my experience, amphetamines are better tolerated as far as side effects than methylphenidate so I usually start patients with an amphetamine class medication. Since there are many health conditions that would prevent safe use of stimulants, such as certain types of heart disease, abnormal heart beat, history of mania or psychosis, seizure disorder, untreated hyperthyroidism, untreated drug abuse, or glaucoma, it is important for you and your doctor to discuss all current and past medical problems before starting a stimulant.
Duration of action of the long acting stimulants varies in each patient. In general, Adderal XR lasts about 12 hours, Vyvanse lasts about 12+ hours, Focalin XR lasts about 10-12 hours and Concerta lasts about 10-12 hours. If longer action is needed, a short-acting stimulant can be added although insomnia can result from taking a stimulant to late in the day.
Since it is difficult to predict which stimulant will best improve the ADHD symptoms and have the least side effects, trying more than one medication is often helpful.