Chris Davis set a club record last year with 53 home runs. Yet, his presence in the media now has more to do with his ADHD and suspension for the use of Adderall. This has been a set of unfortunate circumstances since Mr. Davis has ADHD which was diagnosed years ago and treated with ADHD medication. The article in the Baltimore Sun newspaper February 27, 2015 reviews and clarifies the current status with Mr. Davis and his provision for a therapeutic use exemption (TUE).
I was interviewed for the article to provide background on ADHD, medications, treatment, and the increased attention by professional sports to formalize a process by which players can be appropriately identified with ADHD and permitted to take medication for this disorder. It is my hope that professional sport leagues, international sports leagues, and college sports consider adopting a clear protocol for diagnosis and treatment according to experts in the ADHD field. In doing so, we can identify athletes without ADHD who seek to take stimulants for performance enhancement and penalize them accordingly while allowing those with ADHD to seek and follow their treatment.
You might think you’re exercising good judgment by enhancing your health and wellbeing by taking herbs and supplements. While the scientific research with replicated studies is limited, the nutraceutical companies have spent billions promoting their use. Yet now, the real problem is uncovered. The New York Times recently published a story on a investigation into herbs and supplements and found several companies whose products sit on shelves at national pharmacy chains don’t contain the ingredient on the label. UGH. Feeling trick and swindled. You bet. Read the full story here.
While I don’t discourage my patients from pursuing complementary and alternative treatments, understand that regulatory oversight and scientific research is critical in determining the real utility of treatments. Without this, marketing under the guise of education becomes the detrimental order of the day.
For those of you who follow my blog and others who have stumbled upon it, I wanted to bring this opportunity to your attention. Shire Pharmaceutical annually provides these scholarships to help students with ADHD get ahead. If you are interested and eligible, please look into this.
The 2015 Scholarship program will award $2,000 and one year of ADHD coaching services* to each of 50 recipients in the United States. Adults with ADHD who are pursuing higher education are encouraged to apply.
The scholarship program is for legal residents of the United States who:
✔
have been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD)
✔
are accepted to or will be enrolled in a 2- or 4-year undergraduate program** at an accredited college, university, trade school, technical school, or vocational school located in the United States
✔
are under the care of a licensed health care professional for ADHD
Void where prohibited by law. Contest is subject to all federal, state, and local laws, and full rules and regulations.
*Coaching services provided through the Edge Foundation.
Almost everyday insurance companies request pre-authorization for stimulant medication for my patients. While many of these requests are approved, many others are not. One obstacle to approval is stimulant dosing. Insurance companies routinely deny coverage for any stimulant dose that exceeds FDA drug label maximum dose. You might believe this is a safety issue and insurance companies are serving you well. I’d like to believe this too. Unfortunately, their decisions are often a guise for cost savings.
In order for you to understand the process, you need to know how the FDA approves the dosing of medication that it approved for a disease/disorder. Let’s take Concerta for example. The registration trial submitted to the FDA was conducted in the U.S. (Adler L, et al) with another trial conducted in German. The U.S. trial for adults had a dosing started at 36 mg in the morning and could be adjusted up to 108 mg in the morning if the subject had not achieved a predetermined improvement level. The FDA approved Concerta 72 mg as the maximum daily dose in adults. Why? Didn’t you say the trial went to 108 mg a day?
Yes, I did. The FDA decided that the higher doses (90 and 108 mg daily) didn’t produce any greater improvement than 72 mg daily. However, the trial was not designed to answer the question “If you don’t response to 72 mg, would your ADHD symptoms decline with 90 or 108 mg?”. Well then, of the subjects in the trial, what was the distribution of doses amongst all the adult subjects? (Remember, the researcher could increase Concerta dose if the subject hadn’t improved to a defined threshold on an ADHD rating scale)
Dose(mg) % of subjects
36 34%
54 15%
72 18%
90 15%
108 21%
So, you’ll notice that 36% (15+21) of adult subjects needed a dose over the FDA max daily dose. That’s 1 out of 3 subjects. Imagine that you are that patient whose ADHD needs a higher dose. Imagine that your doctor, unfamiliar with this research, tells you he can’t prescribe at doses higher than FDA approved max daily doses. Imagine that your insurance company denies what would otherwise be an effective dose. Imagine that you believe that the FDA max dose is related to safety (it’s not in this case). Imagine that the insurance company uses language to intimate safety concern.
The outcome of this imagination? UNDERTREATMENT. Persistent symptoms and daily impairments.
I provide this information so that my patients are educated about the state of the art for ADHD treatment and how to understand the avalanche of information available. Make the distinction between being informed by information and being educated by information.Being informed means having access to the information. Being educated means you understand how to interpret the information. The internet provides the former, I hope your physician provides the later.
Over the years, it has been challenging for psychiatrists to manage the risks of psychiatric medications in patients who considered childbearing, become pregnant, and chose to breastfeed. And while there is some information on many psychiatric medications, there remains little in regards to stimulant medications. Unfortunately, there is no registry for stimulant exposed pregnancy by which we can gain insight into their relative risk. The information we do have is related to animal research or people who have been active substance abusers. Very little of this research helps me in discussing evidence-based medication decisions with my patients. In my capacity as a researcher, I have had conversations about creating a stimulant pregnancy exposure registry with the pharmaceutical companies involved in ADHD but to no avail as yet.
With the proposed FDA changes in drug label for pregnancy and lactation, I hope we’ll have a better method of reviewing and evaluating relative risks and patients/families will be better informed.
The following article was distributed today, December 8, 2014 by the American Psychiatric Association, Psychiatric News Alerts.
FDA to Change Pregnancy and Lactation Labeling Information for Prescription Drugs
On Wednesday, the Food and Drug Administration (FDA) published a final rule that will set new standards for presentation of information concerning pregnancy and breastfeeding on labels of prescription drugs and biological products. The rule goes into effect June 15, 2015. “The [current] letter category system [A, B, D, and X] was overly simplistic and was misinterpreted as a grading system, which gave an oversimplified view of the product risk,” said Sandra Kweder, M.D., deputy director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research, in a press statement. “The new labeling rule provides for explanations, based on available information, about the potential benefits and risks for the mother, the fetus, and the breastfeeding child.” The information provided under the new labeling requirements will be divided into the following categories:
Pregnancy: Containing information such as dosing and potential risks to the developing fetus and will require information about whether there is a registry that collects and maintains data on how pregnant women are affected when they use the drug.
Lactation: Containing information about using the drug while breastfeeding, such as the amount of drug in breast milk and potential effects on the breastfed child.
Females and Males of Reproductive Potential: Containing information about pregnancy testing, contraception, and infertility as it relates to the drug.
“The new system is potentially more informative and more useful than the old grading system, … [but] a great deal will depend on the content of the information that is provided under the new requirements, particularly for psychotropic medicines,” stated Nada Stotland, M.D., a professor of psychiatry at Rush University and an expert in OB-GYN psychiatry, in an interview with Psychiatric News. “If the information provided is reasonable and clear, it should help decrease the anxiety both psychiatrists and patients may feel regarding these medication decisions.” Stotland, a former APA president, emphasized that psychiatrists must continue to inform the public about multiple treatment options—including psychotherapies and social support therapies—that can safely aid in lessening symptoms of mental illnesses during pregnancy. “If left untreated—or unsuccessfully treated—mental illness can have adverse consequences for both mother and child,” she emphasized.
If you’re reading this blog, you are one of the millions of people who now use the Internet to gain information on medical issues. In a recent survey of consumers, this is where people are looking for medical information.
Most accessed online resources:
53% web M.D.
22% Wikipedia
19% health magazines and websites
16% advocacy group websites
12% YouTube
10% Facebook
10% blocks
9% Pharma company websites
(results from third annual national consumer survey by Makovsky Health and Kelton, 2014)
I would like to take this opportunity to direct your attention to the attitude magazine website that has a large number of webinars from noted academic and professional experts in ADHD. For many with ADHD it’s often easier to watch a video on a specific ADHD topic then to read a book. While many with ADHD can sit and read for extended periods of time, it always struck me as odd that clinicians referred patients to books knowing their ability to sustain attention would be limited, especially in the evening when it medication affect us dwindled.
Explore the webinars on this site as a can be extremely helpful. On this blog site, I will continue to direct my patients in readers to reliable sources of information and clinical insights from my practice not available elsewhere.
Since many of my patients are on this antidepressant, I am posting the FDA warning issued this morning. Below is a copy of the text. Please see the link at the bottom of this blog for additional information.
Effexor XR 150 Mg Extended-Release Capsules (Pfizer) and Venlafaxine HCl 150 Mg Extended-Release Capsules (Greenstone): Recall – Possible Presence of Tikosyn Capsules
AUDIENCE: Pharmacy, Psychiatry, Family Practice
ISSUE: Pfizer Inc. issued a voluntary recall of one lot of 30-count Effexor XR (venlafaxine HCl) 150 mg extended-release capsules, one lot of 90-count Effexor XR (venlafaxine HCl) 150 mg extended-release capsules, and one lot of 90-count Greenstone LLC-branded Venlafaxine HC1 150 mg extended-release capsules. This action is being taken because of a pharmacist report that one bottle of Pfizer’s Effexor XR contained one capsule of Tikosyn (dofetilide) 0.25mg in addition to the Effexor XR capsules.
The use of Tikosyn by an Effexor XR/Venlafaxine HCl patient, where the contraindications and drug-drug interactions with Tikosyn have not been considered by the prescribing physician, could cause serious adverse health consequences that could be fatal.
This recall is to the patient level and involves Pfizer lot numbers V130142 and V130140, which both expire in October 2015, and Greenstone lot number V130014, which expires in August 2015.
BACKGROUND: These products were distributed nationally to wholesalers, distributors, certain government agencies, patient assistance programs and retailers, such as pharmacies and hospitals. These direct customers are being notified by UPS next day mail, and Pfizer is arranging for the return of all recalled products.
RECOMMENDATION: Pharmacists should immediately quarantine, discontinue distribution of and return all recalled lots of these products, as well as notify any of their customers to whom they distributed the products. Patients with affected product should notify their physicians and/or return product to their pharmacies.
Patients with questions regarding the return of product should contact Stericycle at 1-888-345-0481 (Monday to Friday 8am to 5pm ET). Patients with questions regarding this recall can contact Pfizer Medical Information at 1-800-438-1985 (Monday to Thursday 9am to 8pm ET or Friday, 9am to 5pm ET).
Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:
Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
Read the MedWatch safety alert, including a link to the press release, at:
Anticipating over 300 attendees, the 13th Annual ADHD Conference for parents, teachers, professionals and adults with ADHD on Saturday, February 22, 2014 from 8:00am to 1:00pm will feature several expert speakers. West Chester University is just outside Philadelphia. Below is the program of speakers and topics.
Marie Paxon, program coordinator, invited me to present on the science of diagnosis and treatment of ADHD in adolescents and adults. If you reside in the area, please consider attending because it is a great way to learn a great deal about ADHD quickly and network with people with ADHD and those who offer guidance and treatment. See you there.
ADHD and the Brain: Knowledge Matters Speakers
Marilyn B. Benoit, M.D. is a child and adolescent psychiatrist. She is senior vice president of Clinical and Professional Affairs and chief clinical officer at Devereux. She is a past president of the American Academy of Child and Adolescent Psychiatry. Dr. Benoit has served on the faculties of Howard and George Washington Universities and is a clinical associate professor of psychiatry at Georgetown University Medical Center, from which she received the Vicennial Silver Medal of Honor for 20 years of distinguished service.
David W. Goodman, M.D. is assistant professor of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine. He is also director of the Adult Attention Deficit Disorder Center of Maryland in Lutherville and medical director of Suburban Psychiatric Associates, LLC. Dr. Goodman is the author of The Black Book of ADHD.
Marjorie Johnson, LCSW, PCC is a licensed clinical social worker and certified coach who provides leadership and career coaching, training, and counseling. She specializes in helping students and professionals with ADHD. Ms. Johnson serves on Chester County/Main Line CHADD’s Professional Advisory Board and is a professional member of ADDA (Attention Deficit Disorder Association.). She is past president of the International Coaching Federation-Philadelphia chapter and was named the 2011 Small Business Person of the Year by the Exton Chamber of Commerce (PA).
Jesse D. Matthews, Psy.D. is a licensed psychologist and has worked with individuals with ADHD for a number of years. He is in private practice at The Center for Psychological Services in Paoli and Ardmore and also works at Holcomb Behavioral Health Systems, a community mental health organization. He evaluates adolescents for substance abuse at the Chester County Youth Center in West Chester and does substance abuse evaluations and treatment in an outpatient program in Kennett Square. Dr. Matthews is an adjunct professor at Immaculata University. Previously, Dr. Matthews worked for six years as a counselor at Hill Top Preparatory School, and he facilitated the Chester County/Main Line CHADD teen ADHD support group for two years.
Joan M. Polka, Ph.D. is a psychologist in the Counseling Center at West Chester University assigned full time to the Act 101 portion of the Academic Development Program (a developmental education opportunity for underprepared first-time college students). She is also co-chair of Chester County/Main Line CHADD’s Adult Program and was the 2011 CHADD Educator of the Year.
Martin Patwell, Ed.D. is director of the Office of Special Services for Students with Disabilities at West Chester University. He has also been the director of evaluation clinic at Landmark School. He has presented “Trends and Issues in Disabilities in Higher Education” at Jiangxi University, Nanchung, China. He is also a consultant to The College Board, Inc.
Preeti Singh, M.S. is the associate director of the Twardowski Career Development Center at West Chester University.
Sharon Watson, M.S. is assistant director of West Chester University’s Office of Services for Students with Disabilities. She has over 20 years of experience working with students with learning differences, mental health, and physical disabilities.
8:30 a.m. Welcome
Chester County/Main Line CHADD and West Chester University
West Chester University
Earl F. Sykes Student Union
110 West Rosedale Avenue
West Chester, PA 19383
8:45 –9:15 a.m.
ADHD Across the Lifespan
Marilyn Benoit, M.D.
Research has proven that ADHD does not end with childhood. Over the course of a lifetime, the scenarios change, but the struggles might not. What does ADHD look like at each stage of life and what is the impact? This fast-paced-but-thorough presentation will help attendees learn more about this complex disorder and will provide a summary of current treatment and management options. Don’t miss this valuable session to gain a better understanding of childhood, teen, and adult ADHD.
9:15 –10:30 a.m.
ADHD and the Brain – What You Need to Know About Treatment and Management
David W. Goodman, M.D.
Those with ADHD express frustration with the disorder’s symptoms: trouble focusing, procrastination, forgetfulness, and difficulty filtering out distractions. Some people have a slower processing speed and others struggle with impulsivity. To make things even more complex, many people with ADHD will have a co-occurring condition like learning disabilities, anxiety, depression, or autism. The good news is that treatment is available, and there are strategies to counteract these challenges. Dr. Goodman will provide an overview of medications and pro-social treatments for ADHD and discuss common co-occurring conditions in this valuable presentation. Children and adults report that they receive unhelpful advice like “try harder,” “start applying yourself,” and “pull yourself up by your bootstraps.” Attend this session to learn about evidence-based treatments for ADHD and how they make a difference.
10:45 –11:30 a.m.
ADHD and Social Interactions
Jesse Matthews, Psy.D.
Social interactions can consist of anything from a casual conversation with an acquaintance to daily communication with loved ones. This can present challenges for both children and adults with ADHD. Those with ADHD may feel isolated and disconnected from others. They may find that executive function challenges can cause them to misinterpret social cues, which are usually unspoken or vague. The invisible challenges of impulsivity, forgetfulness, and an inability to regulate emotions can have a negative effect on forming and maintaining friendships. Fortunately, new information and strategies are available through the field of social learning and social cognition. Attend this session to learn more about this exciting topic and how to apply it to everyday life.
• Facilitated activity: Mindfulness Meditation and ADHD
Marjorie Johnson, LCSW
Mindfulness meditation is a way to calm the mind and relax the body while increasing the ability to sustain attention and manage distractibility. Hear about compelling research and daily applications of mindfulness meditation. Practice it to experience the deep relaxation it generates.
11:45 a.m. –1:00 p.m.
Becoming Successful in College and Early Career
ADHD and Career Success
Preeti Singh
Career development is a life-long process, involving decision making, self-awareness, exploration, preparation, and experience. What tools are available to help students successfully navigate this territory? This brief presentation will provide an overview of resources and strategies.
WCU Student Panel
Sharon Watson, facilitator
Current students at West Chester University who have “been there, done that” tell it like it is. Their transitions, challenges, and routes to where they are today provide a look at what real students face in college.
• Facilitated activity: ADD and Loving It?!
This video blends humor, hope, and science to dispel the myths about adult ADHD. Comedian Patrick McKenna seeks a diagnosis for adult ADHD and learns the facts from an impressive array of experts. Funny, moving, and transformative, this fascinating documentary will hold you spellbound!
On February 5, 2014 Wednesday at 3:00pm, I will be providing a webinar on “The Representation of ADHD in the Media”. The webinar is sponsored by the National Resource Center for ADHD, supported by a grant for the Centers of Disease Control. The topic was chosen after a number of recent articles on ADHD in national publications. Given my media experience, I was invited to provide an educational overview to how articles are developed, discerning the subtext, and advocating for input for those who deal with ADHD everyday.
I hope to provide the participants with a “behind the curtain” insight to the positive and negative representations in local and national press. My presentation with slides will be 25 minutes followed by 30 minutes of Q and A. Please join us.
I was recently honored with an invitation to be a member of the Board of Directors for the national CHADD (Children and Adults with ADHD Association). This organization has been the leading U.S. resource and advocate for those people and families with ADHD.
The annual conference held in November is applauded as a successful forum for professional presentations by leading national experts in the field. Its magazine Attention is an excellent source of information on a broad range of ADHD related topics. This magazine, published every month, is clearly worth the price of membership.
I strongly recommend learning about the organization, taking advantage of its resources, and networking with those who experience the impact of ADHD everyday. Join CHADD.
