psychiatrists at the University Hospital, Auckland, New Zealand for the purpose of exchanging perspectives on diagnosis and treatment of ADHD across the life span. Many of the physicians had been to U.S. conferences that covered this topic so they were familiar with U.S. perspective.
Although we all agree on the validity of ADHD as a psychiatric disorder, there were some clear differences in approach. First, it is important to know that the only stimulant medications available in New Zealand are methylphenidate compounds (Ritalin, Ritalin LA, Concerta). They do not have any amphetamine preparations (Dexedrine, Adderall, Adderall XR, Vyvanse). Without clinical experience with amphetamines, there were a bias against them believing that they represented a “stronger and potentially more addictive”.
Although 50-60% of ADHD patients will respond to either stimulant compound (methylphenidate or amphetamine), about 25% of patients will respond better to one vs the other. Without amphetamine, there are a group of patients that won’t be optimally treated.
When physicians lack experience in using some medications, there is a bias that develops against the medication. This phenomenon develops beyond just ADHD into the rest of medical treatments.
Another issue in New Zealand is the rare physician who will treat ADHD in adults. Not only are adults unlikely to get newly diagnosed as adults, but children diagnosed with ADHD who grow to adulthood will find it difficult to obtain ongoing medication treatment. Apparently there is a special license needed to prescribe stimulant medications and very few adult physicians have such a license. Physician pursuit of such a license is not high. The perception is that adults with ADHD are quite rare. This belief is in contrast to numerous studies showing world-wide prevalence rates between 2-6% in adults.
What will usually drive an increase in treatment of medical disorders is the increasing number of effective treatments. One can see this in the history of depression treatment. As more antidepressants came on the market after Prozac, the rate of depression treatment increased over time. Now most depression is treated, not by psychiatrists, but by primary care providers. In fact, 80% of all psychotropic medications in the U.S. are prescribed by primary care providers
So, for my patients treated with amphetamine preparations that may be traveling in New Zealand for periods of time (eg student study abroad), we advise that a family member in the U.S. obtain an adequate supply of medication (usually 90 days though insurance plans) and ship the medication to the individual. If treatment is needed by a psychiatrist in New Zealand, there are several excellent and experienced doctors in Auckland and Christchurch.
When looking for expert physicians for adult ADHD, see my blog that offers instructions on locating such doctors around the world.
As always, thank you for your interest.
David W. Goodman, M.D. Read more…
