The drug therapy of ADD
Synonyms in a broader sense
- Attention deficit disorder
- Psycho-organic syndrome (POS)
- Attention Deficit Disorder, ADD
- Attention - Deficit - Disorder (ADD)
- Conduct disorder with impaired attention and concentration
- Dreamer / "Hans-peep-in-the-air",
definition
The abbreviation ADS stands for a syndrome, the attention deficit syndrome. A syndrome expresses the fact that there are a multitude of symptoms - both main and accompanying symptoms, which are more or less obvious to the outside world.
The synonym ADD (Attention - Deficit - Disorder), which basically addresses the same syndrome, is also known from English. There, as there, the disease can be supplemented by an H for hyperactivity or hyperactivity.
ADD children who behave inattentively but not impulsively and hyperactive are often very introverted and “dream” to themselves, may not be noticed at all or tend to be less negative than ADHD children, for example.
Both “types” can only partially - usually not enough - build attention to the successful processing of information. Of course, this has consequences. In school, the fluctuating attention span, which is sometimes below average, can have negative effects on school grades, and symptoms of ADD are often accompanied by a weakness in reading and spelling and / or a weakness in arithmetic. In general, there is of course the possibility that an ADD child is intelligent above average. Since the symptoms accompanying ADD often do not “allow” this suspicion due to the child's behavior, the child's intelligence is usually also measured as part of the diagnostic survey. In this way, specific statements can be made in the direction of gifted or normal giftedness.
The statements regarding possible causes of ADD suggest that “real” ADD children, i.e. children with a clearly diagnosed attention deficit syndrome, suffer from an imbalance of the messenger substances serotonin, dopamine and noradrenaline in the brain, which means that information is passed on does not work adequately between the nerve cells of individual brain areas. And this is exactly where drug therapy for ADD comes in. It aims to alleviate symptoms and enable the child to live and learn adequately.
Note on the subject
By dividing the ADD symptoms into main and accompanying symptoms, it becomes clear that therapy should always be multimodal and therefore aimed in different directions. Since, according to the current state of research, the imbalance of the messenger substances, the transmission of information between the nerve cells of individual parts of the brain does not function adequately, one tries to start there with drug therapy. You can read below what this means in individual cases.
In addition, drug therapy of ADD alone is not sufficient to treat all symptoms in an appropriate manner. Many behaviors have crept in and also imprinted that turning away from them seems very difficult. Drug therapy can thus be additionally supported by:
- targeted support in the domestic and family area
- psychotherapeutic forms of therapy
- curative educational forms of therapy
- Nutritional therapies
Often the family burden is so high due to the many problems that arise that the family or individual persons (must) be accompanied therapeutically.
Be honest with yourself: ask for help and be ready to receive help whenever necessary.
Drug therapy for ADD
The fact that drug therapy is so controversial is due, among other things, to the fact that the diagnosis of ADD is often not made unequivocally. Children who suffer from an attention deficit have an imbalance in the messenger substances and therefore usually, unfortunately not 100%, also respond to drug therapy. Each drug has its own individual side effects (e.g.Loss of appetite, headache, abdominal pain, insomnia, depression, increased willingness to fight) and also interactions that usually disappear again after stopping the medication. Often the medication as such does not have to be ended, but only changed and readjusted.
In this respect, other forms of therapy should first be considered and implemented. Every ADD must be assessed in terms of the severity of the symptoms. A child needs to be helped, especially when the school performance decreases and the problem spreads. If the other forms of therapy do not do this adequately, the attending physician can advise you and decide when and for how long drug therapy may be advisable.
The following is important to know: A drug therapy does not “cure” ADD, it only alleviates the symptoms and that for exactly as long as the medication is taken.
We are of the opinion that ADD should never be treated exclusively with medication, but that other - individually suitable - forms of therapy must also be used.
A very strong importance and necessity is assigned to domestic support.
In general, drug therapy should only be carried out from the age of 6. This can also be found in the descriptions of the drugs. See the list below.
ADD - children have to find their individual dose and test the right time to take it. Depending on the drug, the effect sets in immediately and then decreases suddenly, while others release the active ingredient gradually and the effect only slowly wears off.
In many minds there is a warning against a dependency on the respective stimulants. More recent research results and studies show that medication in the individually required dosage generally does not lead to dependency, but there are no long-term studies that clearly prove this or revoke it.
A warning is given, however, if there is an increased risk of addiction in families. Should the attending doctor ask in this direction, please do not feel personally offended and please answer honestly. It's about keeping harm away from your child and helping your child in the best possible way.
It can be stated at this point that the risk of dependency differs in individual cases, so it must be checked individually. General statements cannot be made here.
As mentioned above, drug therapy only has a positive effect on the child's behavior as long as the drug is taken. However, this does not mean that an ADD child has to take medication for the rest of his life. Multi-modal therapy in combination with drug therapy often ensures for a certain period of time that the accompanying symptoms can be treated so well that negative behaviors no longer appear or only appear to a very minor extent. By strengthening the child in this way, it may be possible to gradually dispense with drug therapy. This varies from child to child.
Why medication at all?
According to current scientific research, the changed functioning of the brain, which is responsible for the development of ADD, implies a complex disturbance in the catecholamine balance of the brain.
What does that mean?
- The messenger substances are normally in equilibrium, but this equilibrium is disturbed in ADD children.
- The catecholamines (= messenger substances) are assigned a specific function:
Norepinephrine drive
Serotonin - impulsivity
Dopamine drive.
The interaction of these messenger substances in turn creates further effects:
Norepinephrine and serotonin - the development of anxiety
Serotonin and dopamine - appetite, aggressions, lust
Norepinephrine and Dopamine - Motivation
Serotonin, norepinephrine, dopamine - mood, emotionality, cognitive skills. - Behaviors allow conclusions to be drawn about the underlying imbalance.
- This imbalance disrupts the transmission of information between the individual nerve cells in the area of individual brain areas. If this balance is disturbed, stimuli cannot be passed on in the usual way.
Accordingly, it can be stated that in the case of a clearly proven attention deficit syndrome (see also: Diagnosis of ADD) the imbalance of the messenger substances can be held responsible for the behavior deviating from the norm. While some messenger substances are sufficient, others are inadequate, this ultimately results in the different symptoms of ADD. Due to the versatile possible combination (see above), criteria catalogs for symptomatic analysis or the like can never really be regarded as a complete list.
What are the advantages of medication and what are against it?
The effectiveness of these substances clearly speaks in favor of taking medication. The ability to concentrate is improved within a very short time and participation in everyday school and work is made easier.
Drug therapy is therefore the simplest and often most effective form of treatment for attention disorders.
In addition, a large number of studies with large numbers of volunteers allow the benefits and risks of these drugs to be assessed.
However, the common drugs often have side effects that could possibly be more serious than the current study situation suggests.
In children in particular, there is therefore a concern of disturbing their development and being able to damage them in the long term. In addition, more and more new therapies promise similar success with fewer side effects.
The common drugs are therefore becoming less and less important.
However, they remain the best-researched form of therapy with undisputed effectiveness and other substances and measures can also cause side effects that are just not yet known. The most important thing in treatment is therefore to weigh the benefits and risks of each form of therapy and to create the best individual plan for the patient.
Which drugs are used?
In principle, the same active ingredients can be used in ADD as in typical ADHD. These substances increase the ability to concentrate through improved signal transmission in the brain and can therefore help with almost all attention disorders. The most commonly used for this is the so-called methylphenidate, which is contained in drugs such as Ritalin® or Medikinet®. If there is no sufficient improvement, other drugs can be used, for example amphetamines with the same mechanism of action. Although these stimulants are very effective in treatment, they are classed as psychotropic drugs and often have side effects. Other substances such as atomoxetine (in the drug Strattera®) attack at a different point in the signal transmission in the brain. Their effect is usually a bit weaker, but they are not addictive and there are fewer side effects. Other drugs that were actually developed for other diseases, but also help with ADD in individual cases, can also be prescribed at the doctor's discretion.
Different groups of drugs used to treat ADD
The different imbalances of the messenger substances claim different groups of drugs that target the imbalance and alleviate or alleviate symptoms. All of the following drug groups are classed as psychotropic drugs. This group of drugs generally includes all drugs that have a psychoactive effect and thus affect the activity of the CNS (= central nervous system). They work at the synapse / synaptic cleft, i.e. exactly where messenger substances are used to transmit stimuli from nerve cell to nerve cell. For more information, see Causes of the ADS on the ADS main page.
The following drug groups are used in the event of a messenger imbalance:
- Stimulants, including drugs with the active ingredient methylphenidate (e.g. Ritalin®)
- antidepressant
With regard to antidepressants, a distinction is made between:
- MAO inhibitors
- NARI (Selective Norepinephrine Reuptake Inhibitor)
- RIMA (reversible monoamine oxidase inhibitor)
- SNRI (serotonin - norepinephrine - reuptake inhibitor)
- SSRI (selective serotonin reuptake inhibitor)
Depending on the necessity and type of imbalance, the attending physician will prescribe medication from the appropriate group.
In the case of ADD, stimulants are primarily used and are considered the drugs of first choice. In addition, the use of tricyclic antidepressants may be advisable as part of therapy in ADD adults.
Herbal medications
Herbal medicines are used for a wide range of poor concentration in order to increase mental performance and psychological well-being. One example of this is the Chinese Gingko ingredient, which improves blood flow to the brain. Caffeine-containing supplements and Omega3 fatty acid capsules can also improve alertness in some patients. As a supplement, Bach flowers improve mental health and thus also mental performance. THC, the active ingredient of the cannabis plant, can also be prescribed by the doctor, but is used very rarely and mostly only in the hyperactive form of ADHD. Because unlike in typical ADHD, ADD does not require any reassurance from the active ingredients. Popular substances like valerian and the like are therefore usually not effective. The effect of herbal medicines is also controversial, insufficiently documented and side effects cannot be ruled out. In mild forms of ADD or severe intolerance to psychostimulants, they can be an alternative, but should be taken with caution.
What over-the-counter medications are there?
The herbal medicines mentioned are available without a prescription and in pharmacies.
Experienced pharmacists can also recommend other substances.
However, especially with over-the-counter drugs, attention should be paid to the quality of the substances, since more and more of these food supplements are now on the market, are also sold by supermarkets and the like and are not subject to as stringent tests as prescription drugs. When buying in a pharmacy, however, good quality can be assumed.
homeopathy
As with the herbal medicines, homeopathic approaches can be very effective, but they also have side effects.
Since homeopathy, as a holistic therapy concept, promotes overall psychological well-being, great therapeutic success can be achieved with ADD with its accompanying psychological problems. Depending on the appearance, different substances come into consideration, for example Sulfur with high intelligence and curiosity or Agaricus with typical dreaminess.
Side effects of the drugs
Side effects are a major problem in the therapy of attention deficit disorders.
Herbal and homeopathic active ingredients have a very complex effect, have often been insufficiently investigated and therefore have a very broad spectrum of side effects.
Most of the time these are mild and temporary, but should not be underestimated. They can manifest themselves, for example, as abdominal pain or headache and trigger interactions with other drugs or food components.
The common psychostimulants (in e.g. Ritalin®), on the other hand, have been well researched and the side effects are known, but unfortunately these are very common and occur in about half of all treated patients.
Typical are:
- Loss of appetite,
- Fatigue,
- depressive moods,
- nervousness
- and other mental limitations.
Changes in laboratory values, e.g. of blood cells has been reported.
In rare cases, psychoses or the like can also occur. Most of these side effects subside after a few weeks, but undesirable effects after long-term use of the substances are currently being investigated. Patients should therefore be well informed before taking the medication.
Drug treatment of ADD in children
Whether and how drug therapy may be advisable in individual cases cannot be assessed across the board. Two basic attitudes have developed:
- Negative attitude
- Favorable attitude
As is so often the case, the truth can probably be found in the middle of both opinions. In principle, an appropriate and thorough diagnosis of ADD is an important part. It provides information on therapies and their successes. There should be no doubt about the diagnosis exist: Not every child who dreams and does not pay attention is at the same time an ADD child.
Proponents of drug therapy often assume that drugs are used to restore the balance of messenger substances that are needed to transmit information in the brain.
With regard to the drug treatment of ADD, the following can be stated:
- Drug therapy only in clear cases.
- Drug therapy not under six years!
- Side effects can occur individually and are particularly dependent on the medication prescribed.
- The dose and when to take it vary from person to person. Both have to be “tested” in a certain way. The attending physician can approximate the correct dosage based on the underlying body weight and make dosage recommendations.
Medicines for "dreamers"
Since "dreamy ADD" is only a subtype of typical ADHD, there are, by definition, no drugs exclusively for this manifestation.
However, other combinations from the broad spectrum of ADHD therapy are used in ADD.
For example, those affected more often get by with pure behavioral and psychotherapy and without medication, or non-stimulating substances such as atomoxetine (Strattera®) can be used. In homeopathic treatment, remedies such as Agaricus are more likely to be used, as Sulfur or Stramonium are mainly used in dominant and hyperactive forms.
Drug treatment of ADD in adults
Since it is the diagnosis of attention deficit disorder in adults (ADD diagnosis in adults), they can also be treated with medication. Choosing the right medication is more difficult in adults. This is due, among other things, to the fact that metabolism in adults is faster and the hormonal balance is composed differently. As with children, stimulants are the drugs of choice here too. Often used is also tricyclic antidepressants, or a mixed combination. Selective serotonin reuptake inhibitors are rarely used at the moment. The fact that, to our knowledge, no drug based on methylphenidate is currently approved for adults is problematic. It can be prescribed by a doctor as part of what is known as an off-label prescription. The costs are rarely covered by health insurances and therefore usually not.
Some testimonials from adults who have opted for drug therapy report that the medication does not work immediately, but that it can take up to six months before the expected effect is achieved. Since drug therapy is subject to certain conditions in Germany (see above), experience reports are quite rare. Studies also mostly relate to children and adolescents. Adult studies on the topic often show different and inconsistent results.
As with children and adolescents, drug therapy should only be considered if a clear diagnosis can be made. This also includes the differential diagnosis of other personality disorders (Borderline, depressions, Tourette syndrome, ...).
- General information on dealing with the ADD child, especially information for parents on the treatment of ADD in the home and in the family: ADD and family.
- The psychotherapeutic and curative education therapy with their different forms.
- Nutritional therapy.
As already mentioned, therapy should always be linked to several factors at the same time. An exclusively drug therapy can work, but it does not necessarily affect all areas.
Many of the package inserts for the aboveMedicines therefore also refer to an overall therapeutic strategy that should be carried out alongside drug therapy.
