Like medications for any other mental or physical condition, medications for ADHD can also have some side effects.

Unfortunately many doctors are not properly trained on ADHD in medical school. For example, here in Vancouver BC Canada, UBC medical students only get one hour on ADHD. So unless they went out to learn more about ADHD on their own time & dime, many aren’t that familiar with the condition of ADHD, let alone the medications which are one of many ways to manage ADHD, let alone how to manage some of their side effects.

Ideally, your doctor will tell you about the possible side effects of ADHD medications, how to manage them, and realistic expectation (pills won’t teach skills), but if they don’t, here are some tips from WebMD. Of course, before doing any changes to ADHD medications, ALWAYS discuss them with your doctor. If your doctor doesn’t know about ADHD, point them to CADDRA’s Canadian ADHD Practice Guidelines so they can learn.

Keep in mind one size never fits all, and one ADHD med never fits all. It can take time to get the right medication(s) and the right dose for you, they’re called medication trials not medication psychics. You might also want to do an ADHD medication log too. The more information you can give your doctor on how/when the meds are working, the better they can adjust your dosage for maximum effectiveness

WebMD has some good tips on how you can reduce the side effects that sometimes come with ADHD medications. While they’re focused on children with ADHD, some of their medication tips are applicable to adults with ADHD. Here’s one of their sections of tips on managing side effects of ADHD medications.

Managing difficulties with sleep

• Give the morning dose of ADHD medication earlier in the day. Discuss medication changes with the doctor. It may be necessary to try shorter-acting medications.

• Don’t allow your child to drink caffeinated beverages. Cocoa and many sodas, coffees, and teas all contain caffeine. A child who drinks these in the afternoon or evening may be tossing and turning at bedtime.

• Establish a sleep-only zone. Your child’s bedroom should be dedicated to sleep — not for homework, not for entertainment. Move the computer, radio, television, toys, and games to another room. A few stuffed animals are fine, but there should be no other distractions.

• Teach your child to relax at bedtime. A special blanket or a stuffed animal can help a child fall asleep. But it’s best to avoid bedtime activities that depend on a parent’s presence — like rocking or holding the child until sleep comes.

• Establish consistency. Bedtimes and waking times should be the same seven days a week. Waking times are more important than bedtimes in establishing sleep rhythms. It is easier to enforce a waking time than a bedtime. “Sleeping in” can be a sign that the child is not getting enough sleep.

• Establish daytime routines. Regular meal and activity times help, too. Routines make it easier for children to “wind down” to sleep.

• Discourage midnight visits. Waking up at night can become a habit for children. It can also be a way to get attention. While you don’t want to let a child cry themselves to sleep, it’s best to discourage middle-of-the-night visits with mom and dad or midnight snacks. Also, don’t allow interesting toys near the child’s bed (a stuffed animal or two is fine).

• Avoid sleep medications. Medications stop working over time, and may affect daytime alertness. They may also wear off during the night, and cause night waking. Some medications may cause nightmares or other types of sleep problems. If medications are absolutely necessary, talk to your child’s doctor about safe and effective treatments.

• Consider medical problems. Allergies, asthma, or conditions that cause pain can disrupt sleep. If your child snores loudly and/or pauses in breathing, medical evaluation is necessary. Consult your physician for help with the possible medical causes of sleep problems.

I find that it’s also useful to turn off all stimulating electronic devices like computers, tv, cell phones, video games an hour before you go to sleep so you give your racing ADHD brain time to slow down so you get to sleep earlier AND have better sleep. Sometimes this is easier said than done, I know by personal experience:)

For some people, having a snack with protein before bed helps them get to sleep, for others it keeps them awake, so experiment to see what types/quantity/timing of food(s) works best for you.

Another tip I and some of my adult ADHD coaching clients have found useful is to have a pad of paper and pen by your bed. So just as you’re getting ready to bed, if you think of something you have to/want to do the next day/ worry/concern, to write it down on the pad and remember to look at it the next day near your daytimer. That way you don’t have that thought/worry rattling around in your brain all night taking up psychic rent when you’re half asleep and too tired to do anything about it.

Check out the other tips on managing the side effects of Attention Deficit Hyperactivity Disorder medications on Web MD’s site.

What tips have you found useful in managing the side effects of ADHD medications?

So now you know how the US Government feels about Adults with ADHD. 2nd class citizens? An after thought? We’ll eventually get around to you, but you’re not really that important.

8 Years. Count em. Almost a decade. It has been used off label for quite some time, but now it’s “officially approved” by the FDA as medication for adults with ADHD. Maybe it’s not just the FDA’s fault, maybe its the manufacturer’s Mcneil Pediatrics/ Janssen-Ortho. Maybe both.

For the clinically inclined types, here’s the Medscape CME (free login required) on it. Here’s the detailed Concerta Prescribing Information PDF.

If this Health Canada page is accurate, it looks like Concerta was approved for use in adults in Canada on April 15, 2008, nearly 3 months ago. Quite surprising. In Canada, we’re often several years behind the US when it comes to Adult ADHD. Or even ADHD in children.

Brand Name: Concerta
Source: Janssen-Ortho Inc.
Active Ingredient: Methylphenidate hydrochloride
Comments: New indication: Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults (>18 years of age); TER(18mg, 27mg, 36mg, 54mg)ORL
Date: 2008-04-15
DIN: N/A
Therapeutic Class:CNS Stimulant

Why do you think it took so long for this to happen? What does it say about how Adults with ADHD are viewed or ignored by the government/medical system?

Do you think Adults with ADHD are ever going to start demanding that their government(s) and medical systems treat Adult ADHD as least as seriously as they treat ADHD in children?

I’m not saying that Children with ADHD are treated seriously enough or that they have enough resources, they aren’t and they don’t.

But Adults with ADHD are treated much worse.

And since ADHD is the 2nd most genetically inherited condition after height, if you don’t treat them well, what do you think will be the outcomes for their kids with ADHD?

There are many ways how to manage or deal with Adult Attention Surplus Condition, aka Adult Attention Deficit Hyperactivity Disorder. Here are a few.

Top Ten Ways to Manage Adult ADHD

1. ADHD Coaching. More for adults than children. Pills can be useful but pills don’t teach skills, they’re not designed to. They can, however, put you in a better place to learn them through ADHD coaching or therapy.

Once you stop using ADHD meds, their effectiveness is gone. Learned skills from ADHD coaching last longer.

See the 26 benefits of adult ADHD coaching. Adult ADHD Coaching focuses on practical day to day ways to manage adult ADHD more effectively at work and at home. Generally speaking therapy is more focused on the past, and coaching is more focused on the present and the future. Adult ADHD Coaches work on helping you learn to more effectively manage the challenges of ADHD and identifying and developing the strengths of having ADHD. They work over the phone for 3-4 sessions per month. Most of us adult ADD coaches offer a free sample sessions of ADD coaching so you can try before you buy.

2. ADHD Medication. Not the tool of the devil, not the magic cure all. Just a useful tool that has been studied more than probably 98% of any medications that you’ve taken, and stimulants have been used for 70 years. Talk to people who’ve actually taken medications for ADHD and a doctor that’s experienced in dealing with adult with ADHD before you make up your mind. Here’s some articles on ADHD medications, lists of companies making ADD medications and detailed clinical pdf’s on ADHD meds and ways to deal with side effects (scroll down to chp 10). If you do try ADD meds, at least give them an honest try, it takes a while to find the right med(s) and the right dose. Keep in mind meds are a partial solution, even ADHD drug companies don’t say they’re a complete solution

3. Cognitive Behavioural Therapy by someone that knows about Adult ADD. The knowing ADD part is crucial whether its a therapist or coach. Just like coaching it’s also crucial to have a good fit with the therapist. Therapy is useful in uncovering, understanding & dealing with things from your past that aren’t resolved and interfere with your present functioning. Some people, especially men, view going to a therapist as a sign of weakness. I view it as a sign of strength and courage. That you have the guts to look inside yourself instead being too weak and afraid to do so. So if you need to go to one, go, don’t be a wuss.

4. ADHD Support Groups. There’s a lot of info on the net about Adult Attention Deficit Hyperactivity Disorder. I have a 130+ page website on Adult ADHD and believe learning about Adult Attention Deficit Disorder is important, but it can be really useful to meet other ADDers in person. They’ll all “get” Attention Deficit Disorder, you don’t have to explain what it is to them, it’s helpful to meet others with the same problems & gifts, plus we’re not boring people:) I have a list of Canadian ADHD support groups by province and a list of US ADHD support groups and International ADHD support groups. If you’re in Vancouver come visit the group I lead, the Vancouver Adult ADD Support Group. If there’s no group in your area, create your own like I did, check out the section on how to start, run and promote a support group.

5. Adequate Diet. Keeping the race car brain running smoothly. Feeding your ADHD brain with a good diet, especially adequate dopamine building protein in the morning, and Essential Fatty Acids are important. Adders often forget meals and water. Starving your brain doesn’t make you smarter.

6. Exercise boosts the 3 main neurotransmitters associated with Adult ADHD. Dopamine, serotonin, norepinephrine and the feel good beta-endorphins and relieves stress. Exercise is the number one non medical way to deal with ADHD, depression, anxiety and stress. Make sure you chose exercise that’s interesting to you vs. what you think you “should” do. Not everyone likes the gym.

7. Learning to Slow down and Stop. So you don’t crash. Take regular, short, non electronic breaks or your brain will slow down/shut down/or distract/procrastinate out, all very common problems with ADHD Adults. This is the #1 way to be more efficient at work. Especially when you’re “too busy” to take a break.

8. Meditation. Think deep mental refreshment. Why do those Buddhist monks always look so chilled out? Race car ADHD brains need pit stops and tune ups or they burn out. If you’re a beginner, start with active forms of meditation first, NOT passive ones (i.e., don’t start staring at the wall and thinking of nothing). Active forms of meditation involve your senses, i.e., body, breath, voice, ears, or fingers, so it’s easier for ADHD Adults to focus and avoid getting distracted and helps to calm the monkey mind. Check out UCLA’s research on mindfulness and ADHD

• So try out Yoga, Tai Chi, Qigong, breathing meditations, walking meditations, guided meditations on CD, mantras, chanting, using mala‘s / prayer beads, or Eckhart Tolle’s concept of being present, being in the now.

• Would you expect to go from not running to trying to run for 30 minutes the first time? Then don’t expect to meditate 15-20 minutes at the beginning. Try 2-3 minutes at first everyday and slowly work up.

9. Tutors or Educational Psychologists that know about ADHD. See this section on teaching students with ADHD, or this one.

10. Professional Business and Personal Help. Professional Organizers that know about ADHD, bookkeepers, virtual assistants, secretarial help, cleaning services etc. Smart, successful people delegate what they don’t like, or aren’t good at. Especially if you have your own business, hiring someone to do the paperwork should be the first thing you pay for, it can make the difference between success and constant struggle and frustration. In Canada try Professional Organizers of Canada, and in the US try Napo.

What are some ways you manage your ADHD?

ADD Resources has a great list of links to dozens of ADHD related CME’s (continuing medical education) courses for medical professional and available to the general public as well. They also have links to podcasts and videos.

Next time you hear your Doctor/Psychologist/Psychiatrist say “I don’t know enough about ADD to diagnose or treat it”, show them this webpage.

One way to fight ignorance and stigma against ADHD in the medical profession and the media is knowledge about the condition, diagnosis and treatment.

Sometimes ADHD Adults and parents of ADHD kids need to help educate their Doctors/Psychologists/Psychiatrists about ADHD, since it still isn’t covered very well by medical schools (according to many doctor’s well versed in ADHD that I’ve talked to, who tend to be self educated).

Another great place to go for free clinical information on ADHD is CADDRA’s (Canadian ADHD Resource Alliance) Canadian ADHD Practice Guidelines for 2007-8. It has quite an extensive amount of free information to teach medical professionals how to diagnose and treat ADHD in children, adolescents and adults including various rating scales, how to manage medication side effects, etc.

It’s designed for ADHD clinicians but should also be read by people with ADHD and parents of children with ADHD. Or anyone that wants to learn more about ADHD.

Here’s a list of the subjects that the ADD Resources CME’s cover:

* ADHD Diagnosis
* ADHD Treatment for Adults
* ADHD Treatment for Children
* Medicines
* Depression and Comorbid ADHD
* ADHD and Comorbidities in Adults
* ADHD and Comorbidities in Children
* ADHD and Substance Abuse
* Quality of Life Issues in Adults with ADHD
* Quality of Life Issues in Children with ADHD
* General Topics
* Research

Here’s a link to a quick Adult ADHD screener test by Harvard, NYU and the WHO.

Here’s a link to 34 Articles & Ebooks and Manuals on Teaching Students with ADD.

The term Fisking, or to Fisk, is blogosphere slang describing detailed point-by-point criticism that highlights errors, disputes the analysis of presented facts, or highlights other problems in a statement, article, or essay.

Karin Klein an LA Times editorial staff writer wrote an editorial in the August 20th, 2007 issue entitled “Pens, Pencils and Meds”, which I thought just piled more unneeded stigma on people with ADHD. It unfortunately got picked up by many other newspapers, websites and blogs, further spreading the stigma and ignorance. I recently got an email from her saying she was on the Pulliam Fellowship, so she can work full time on an in-depth project in ADD and asked me to help her find mothers with ADD to interview. Being the curious type, I googled her and found this editorial Karin Klein wrote last August. I wrote back saying I declined and citing her article and made a few point about the stigma against ADDers it created, and that I didn’t want to help her create more stigma against ADDers.

However Gina Pera, a journalist and mental-health activist, did a much more thorough job than me rebutting Karin Klein’s editorial, and with her kind permission I’m reprinting Gina’s rebuttal. Karin Klein’s editorial is in blockquotes, Gina Pera’s comments are in regular text.

If you think that this sort of content stigmatizing people with ADD doesn’t belong in the LA Times you might want to let her editor Jim Newton jim.newton@latimes.com know how you feel.

Enjoy.

Pencils, Pens, Meds

As kids head to class, pharmaceutical companies ramp up their drug marketing — and it works.

It works because too many parents don’t realize their children have ADHD — and their doctors don’t, either — until they get to school! It works because many parents themselves have undiagnosed ADHD, and they do not recognize it as such in their children. It works because our society is in massive denial about ADHD and sometimes the most effective method is appealing directly to the people who know that it is real – and it is significant.

By Karin Klein

August 20, 2007
Back-to-school season is in full swing. Time to pick out a backpack, sneakers and a stimulant medication for attention-deficit hyperactivity disorder.

Disgusting lead. Cheap, cheap shot.

Nearly 2 million children in the United States are diagnosed with ADHD, which is marked by poor concentration, lack of self-control and/or hyperactivity. Besides time off from school, many kids with ADHD get a summer “vacation” from the prescription medications that help them focus in class.

That is outmoded thinking. Experts today recommend no medication “holidays” because ADHD impairments extend far beyond “focusing in class.” They include deficits in social skills and driving/sports safety and vulnerability to substance use, promiscuous sex, STDS, unplanned pregnancies, and many other risky behaviors.

So, not only is she reinforcing old ideas — that there are medication holidays and that medication is used solely for focusing the classroom — but she is also implying that all children receive stimulant medication callously. Instead, for the vast majority of parents that I know, it is a very painful process of coming to accept the medical nature of their child’s difficulties—-usually after a long process of trying every other alternative–and finding the best way to help them. They don’t need Ms. Klein heaping ignorant blame on their heads.
(Full disclosure: I have no children, and if I did, I know this would be a tough decision. But I have met many, many parents who have helped their children immensely by seeking medical treatment for them. For many, family life can still be quite tough. These parents deserve all the support we can muster, not fear-mongering.)

So August has become a prime time to market the idea that a change in drug for the new school year (Concerta to Adderall?) might help the kids focus better, keep them going longer or have fewer side effects. Direct-to-parent marketing of ADHD drugs — most of which are stimulants — has grown pervasive over the last few years, despite a United Nations treaty banning most of it. Use of such medications increased by more than 60% from 2001 to 2005, according to the International Narcotics Control Board.

Why does Ms. Klein not cite the studies showing that general practitioners aren’t comfortable with their ability to accurately diagnose or treat ADHD — hence the need for the advertisements in the first place?

At least here she does give one useful piece of information, though accidentally, I’m sure: Some people do respond much better to one class of stimulant over another. And, what does she mean.,..”keep them going longer,” as if these parents are trying to create little Energizer bunnies? That is preposterous.

This month’s homemaker-targeted magazines, such as Family Circle, Woman’s Day and Redbook, feature advertising spreads for Vyvanse, Shire US Inc.’s new entry in the growing stable of ADHD medications. The ads show “Consistent Kevin through the day, even through homework,” picturing a well-groomed boy smiling as he wields his pencil through a work sheet, and “Consistent Sarah,” who even at 6 p.m. contentedly pecks away at the piano keys.

Homemaker???? What decade is she living in?

Ms. Klein might deride the benefits of a child being “consistent,” but for many children it is their dearest wish. Instead, they think it is their failing that they cannot be consistent. Consistently do as well as they know they can. Consistently make and keep friends.

Ms. Klein obviously has an agenda. With her education in psychology and linguistics, perhaps she is of the mindset that these children are being forced into mindless conformity. She can’t be bothered with good old shoe-leather reporting. She’s making this up as she goes.

ADDitude magazine, published for people with ADHD, has ads for four medications. One ad touts a flavored, chewable form of methylphenidate with the slogan, “Give me the grape.” (Methylphenidate is best known under the trade name Ritalin, which is not among those drugs advertised.)

Many people with ADHD have sensory sensitivities, including one that precludes swallowing pills. How else do you suggest getting sensory-defensive children surrounded by stigma to adopt a more comfortable relationship with taking a medication?

And, are not children’s eyeglasses made in appealing styles, so that children feel less stigma about wearing them? (And adults’ eyewear as well?) But in truth, this type of flavored medication is in the minority. Again, she is cherry-picking to suit her biased purposes.

Ads for candy-flavored methylphenidate are a far cry from the vision set forth in 1971 by the Convention on Psychotropic Substances. So far, 159 countries, including the U.S., have agreed to ban consumer-targeted marketing of psychotropic medications — which all these ADHD drugs are — that carry the potential for addiction or dependency. For decades, pharmaceutical companies abided by its provisions.

Since when is grape a candy? But, finally a news peg, such as it is. Why not just focus on that, instead of the preceding diatribe? Because that would not suit her bias?

The fact is, in 1971, we knew very little about the brain or that medical disorders related to the brain might not be obvious. Perhaps the true point of the story should be the need for revising this musty convention. There are all kinds of forgotten laws on the books, ones that no longer apply to modern life.

I would have to see which 159 countries want to ban such marketing. Perhaps their worst fear is an educated populace — one that would learn about the possibilities of medication and then start demanding it. How odd that a journalist would be promoting censorship.

But in 2001, one company began buying ads in the September issue of women’s magazines in the U.S. to draw attention to Metadate CD, a long-acting form of methylphenidate. Other companies quickly followed suit.

Called on the carpet by the U.S. Drug Enforcement Administration,

that great arbiter of neuroscience and mental health.

lawyers for the drug companies vowed to defend themselves under the umbrella of 1st Amendment speech rights. According to former DEA officials, the Department of Justice was unwilling to test this one in court.

Perhaps with good reason.

Six years later, the results are dramatic. Doctors and therapists increasingly see parents seeking to change their child’s medication or coming in with their own diagnosis of ADHD and suggestions for medications they have seen advertised. Many of the companies offer coupons for a free trial supply.

HOGWASH. Critical thinking, please! Research, please! Ms. Klein is drawing a clear correlation between ads and an increase in diagnosis? I should tell that to the thousands of volunteers that I know who have worked doggedly to get this issue on the map — and are still doing so: “Folks, it’s nothing you’ve done. It’s all the ads! Gee, we could have all relaxed and gone to the beach.”

Ms. Klein needs to learn the first rule of science ( I think I learned this in journalism school): CORRELATION IS NOT CAUSATION.

Children in the U.S. are 10 times more likely to take a stimulant medication for ADHD than are kids in Europe. In fairness, children in Europe are also somewhat less likely to be diagnosed with ADHD because of a stricter set of criteria. But that doesn’t nearly account for the difference in prescription rates. The U.S., the only nation to violate the U.N. treaty, consumes about 85% of the stimulants manufactured for ADHD.

Well, I’m glad she’s trying to be “fair.”
In the UK alone, alcoholism rates are through the roof—just one of the presumed side effects of untreated ADHD. Reports from fellow volunteers throughout the rest of the world absolutely bemoan the lack of medications in their home countries and the ignorance of their national health systems. The ones who can afford it come here, load up on medications, and fly home. The ones who don’t suffer. Does Ms. Klein know about this? Or does it not fit her paradigm – or the hypothesis for her book?

The medications are very expensive. NHS usually doesn’t want to pay for them. You want stories of the pain and loss of human potential this causes? I can supply them in spades. People in other countries are in awe of our medical advances; they are envious.

Though the drugs do not appear to be habit-forming in children with ADHD, there’s a rising black market for methylphenidate and similar drugs. A report last year by the National Institute on Drug Abuse found that teenage abuse of prescription stimulants was rising.

It is no surprise, when papers like yours stigmatize the use of medication — and the very idea of ADHD — that many people go undiagnosed and instead go “underground” with their need for stimulant medication. Don’t even get me started on the methamphetamine connection to undiagnosed ADHD in our nation’s rural areas.

But again, what is Ms. Klein’s point? That the ads are causing this stimulant abuse? Again, hogwash. In my college days, students abused speed or No-doz.

Drug companies would argue that increased production and use of ADHD drugs are the result of better diagnosis and treatment.

Many medical and epidemiological experts would argue that, too. And as for the people with ADHD, they cheer on Big Pharma, because they know that novel medications and delivery systems mean that each person has a better chance of finding a medication that works best for them.

But the International Narcotics Control Board holds advertising responsible. In a report earlier this year, the board noted that from 2001 — when the ads first appeared — to 2005, medical consumption of methylphenidate increased by 64%.

The International Narcotics Control Board????? You’ve got to be kidding. Is that the best Ms. Klein can do? This is supposed to be some big scoop? Who cares what this “quasi-official” body thinks? Why don’t you talk to our own National Institute for Drug Abuse (NIDA), where the brilliant scientist Dr. Nora Volkow could set you straight about the ADHD, the brain and substance abuse.

This just gets worse and worse.

“That large increase was mainly a result of developments in the United States, where the substance is advertised in the media, directly to potential customers,” according to the report.

By continuing to cite this report from this very controversial body, she is giving more credence to it. Yet, she has not quoted one authoritative medical expert. Time to enter the 21st Century, Ms. Klein.

Ms. Klein accepted this grant to be an editorial writer at the LAT with this statement, sounding more like a psychodynamic-oriented psychologist with an agenda than a journalist:

“I am so very grateful to the Society of Professional Journalists and the Sigma Delta Chi Foundation for the opportunity to pursue a project that has been of enormous interest to me. The Pulliam Fellowship will allow me to extend our understanding of a population that has in large part been quietly struggling, and to probe our own, unexplored attitudes about normalcy, differentness and isolation,” said Klein.

Back to Karin Klein’s piece

The Food and Drug Administration should move forward with rules to bring the U.S. into compliance — in conjunction with the Justice Department. There’s legitimate debate about Americans’ rush to diagnose and medicate children who fall problematically outside the norm. In some cases, the drugs are the only thing that keeps a child from being expelled for aggressive behavior, or falling into the foster-care system, or believing that he is an impossibly bad or stupid kid. Yet other countries are making do with far less of the medications.

Making do? Making do? People aren’t making do. They are hobbling through – and suffering tremendously. What is Ms. Klein arguing for? Dumbing down the medical care in this country to meet the low standards of the rest of the world?

Oh, and there’s her throw-away line — just so no one can accuse her of being totally ignorant about ADHD. Sorry, that’s not nearly enough to get her off the hook and convince anyone that she has a modicum of knowledge on this condition, especially not coming on the heels of so much drivel.

Powerful psychotropic medications should be an option of last resort and uninfluenced deliberation, not another brand-name product to add to the back-to-school shopping list.

As if that is how parents make this decision? They most certainly don’t, but Ms. Klein will do her best to make them ashamed of their action and reconsider it — against all good reason.

And deliberation uninfluenced by what? Scientific evidence? Medical opinion? A desire for a happy, self-actualized life?

And why a last resort? On whose authority? Should people be denied eyeglasses unless they can’t see but two feet in front of them? Who the heck is she to decide how much access someone has to his or her brain? Does she have any clue about the comorbid physical conditions often accompanying untreated ADHD? Does she know about the health risks from on-the-job accidents, and all the rest?

Oh, please. This is an embarrassment to a large daily newspaper. Please do better.

One thing that’s not mentioned in the previous ABC 20/20 report about prescription medication errors is the doctors who write out prescription with sloppy, often unreadable handwriting. I’ve actually gone back to one doctor after getting a prescription and get him to verify what he scribbled because I couldn’t understand what he wrote.

I think Doctors should be required to either write prescriptions by printing them off a computer, or some type of portable label making device or use single space printing, NOT cursive writing. Yes I know you’re busy, but your patients shouldn’t have to risk injury or death because you’re not willing to take the time or make the effort to write out our prescriptions legibly.

Many ADD adults take medications for ADD as well as other medications. We tend to be impulsive, easily distractible and forgetful. ADDers have been known to forget to talk their meds. It’s not too much of a stretch to think that we may be more likely to not double check things like prescription accuracy.

I think everyone should verify when they pick up their prescription medication that:

1. They have the right prescription. For example, if their prescription was for Strattera, make sure that it says Strattera on the bottle and ideally learn what the particular pill should look like and what is printed on the actual pill.

2. That they have the right dose, and how often to take it.

3. That they tell the pharmacist (not a technician) what other medication or herbal medicine they’re taking to make sure there are no interactions. I.e., don’t take St. John’s Wort with SSRI’s because you’re double dosing

4. That they ask the pharmacist what possible interactions there are with the drug and if there’s anything they need to know about taking it. I.e., side effects, don’t take with citrus, take before or during meals etc. If you really want detailed clinical info on the prescription medication your taking you can read things like the Compendium of Pharmaceuticals and Specialties in Canada.

Prescription medication can be very useful, but like other things that are powerful you need to know what you’re getting and how to use it properly.
So before getting the prescription filled you might to write down on a separate piece of paper exactly what you were supposed to get, the dose and how often and when to take it. Then compare your note to the final prescription.

This is not to trash all pharmacists or people working in pharmacies. While all people make mistakes, most retail mistakes aren’t likely to cause permanent injury or death. The ABC report implied the main problem with the prescription errors was corporate greed, employee abuse and irresponsibility.

Patients need to be responsible consumers. Maybe more of us should think about what kind of pharmacy we buy our medications from and how they staff their pharmacies and how they treat and train and pay their employees. 15 minutes or less is not always the most important thing when buying medication. Maybe consumers should start thinking about the consequences of always demanding the lowest possible price and what some companies are willing to sacrifice in order to get those lower prices and how those sacrifices might impact you.

20/20 did an undercover investigation of pharmacies at America’s big chain stores like Walgreens. Here’s the video. They found that there were errors in filling prescriptions in more than one in five cases. They talked about how

Overworked pharmacist are pushed to fill prescriptions at a fast food pace

How many mistakes are made? No one knows,

because except for 4 states, drugstores are not required to report the mistakes they make. Even in cases of serious injuries or death.

Here’s part of the interview between ABC’s Chief investigative correspondent Brian Ross and Mary Ann Wagner R. Ph, Senior Vice President, Policy and Pharmacy Regulatory Affairs of the National Association of Chain Drug Stores

ABC’s Brian Ross: Shouldn’t it (the pharmacy’s mistakes) be publicized?

Mary Ann Wagner: I don’t so. I don’t think it should be publicized.

later she claims

… Patient safety is our number one concern

ABC’s Brian Ross: But you don’t even keep track of errors?

Mary Ann Wagner: No, no we don’t keep track of them.

ABC’s Brian Ross: So how can say this industry is taking serious steps to prevent errors if they don’t know how big the problem is?

Mary Ann Wagner: I don’t but i can tell you that the chains consider one error too many.

ABC’s Brian Ross: But they don’t know how many there are. There could be one, a million, ten million. do you have any idea?

Mary Ann Wagner: I don’t have any idea how many there are.

Yes, I see how apparent it’s your number one concern. Not.

Despite federal and state laws that require pharmacists to provide counseling to customers picking up new medications, patient counseling was only offered in 27 out of 100 purchases of new prescriptions, less than a third, in the ABC-Auburn Study.”

Particularly alarming to the Auburn experts was the chain pharmacies’ failure to warn patients of potentially harmful interactions when they purchased certain over-the-counter medications, such as adult strength aspirin with Coumadin, a blood thinner. In only eight cases out of 25 were the customers given a verbal warning.

Finally, the study revealed that some pharmacies appear to be misleading customers into signing away their right to patient counseling.

Sounds like more government regulation is required. I wonder if Canadian pharmacies are required by law to report mistakes? Are we doing better or worse than the US in tracking and reporting errors? In committing them? This should be mandatory in all jurisdictions, if there’s no reporting how do we know if there are common problems? You can’t fix what you’re unaware of.

If, as Mary Ann Wagner claimed, patient safety was truly the big drugstore’s number one concern, at the barest of minimums they would track when their patient’s safety was being compromised.
Check out some of the stories in the viewer comments section of the story, quite disturbing. Here’s some pharmacists reactions.

When pharmacists say they have to work 10-12 hour shifts with no breaks that’s disturbing.

I’ve been lucky so far, haven’t had a problem with my local pharmacies. But after watching that report, especially the part about 16 year olds counting out pills, and filling out the forms, I’m definitely going to be more vigilant. Again check out 20/20′s video

Have you had prescription errors from pharmacies? If so how did the pharmacy handle it?

Health Canada Issued a news release late last month with the title “New Information Regarding Uncommon Psychiatric Adverse Events For All ADHD Drugs” Here’s their first paragraph from their release

OTTAWA – Health Canada is informing Canadians that the prescribing and patient information for all drugs used for the management of ADHD (Attention Deficit Hyperactivity Disorder) is being revised to provide information about the potential for psychiatric adverse events, including rare reports of agitation and hallucinations in children.

When I read how different media outlets covered the news release and read the release myself, my first thought was, what’s going on here? This is not new information, this is OLD information.

There’s nothing new about the rare reports for psychiatric adverse events on ADD medications, I read about them more than a decade ago in the compendium of pharmaceuticals, which is published by the Canadian Pharmacists Association It’s “The definitive Canadian source of drug information” which doctors and pharmacists use and is available for consumers to look at in Canadian drugstores.

This was the day after my Vancouver Adult ADD support group’s Navigating ADHD presentation for Vancouver ADD awareness day so I was pretty wiped out after helping to organize, promote and be one of the 2 speakers at the event so I didn’t jump on this right away.

Canadian Drug manufacturers are required to list every side effect reported by people who have used their products, it doesn’t necessarily mean that the medication caused the side effect, in some case it did, but it could be caused by other factors as well, and even if there is no causal link, it has to be listed.

To put the “psychiatric event” in perspective, The CBC has mentioned that last year there were 2 million ADD prescriptions written in Canada and

Canadian adverse drug reaction reports from 2000 to 2005 list about two dozen cases of mood, personality and psychological reports among ADHD drug users, but there is no way of knowing whether the drugs caused the problems.

So 2 dozen out of say 7 to 10 million is a pretty small number. That number could represent a lof of things, taking pills with alcohol/drugs or exceeding the recommended dose, other comorbid conditions not properly identified or other factors not releate to the medication at all other than it happened while they were on it.

I started looking at how different Canadian media outlets covered the event to see if there was any new report, new study or any new evidence at all that would justify this as a “new warning”, since that was the headline that many outlets used. I found nothing.

So, being a naturally curious ADDer, I phoned up the person listed in Health Canada’s press release for media inquiries Paul Duchesne and asked him what “new information”, study or report they had that would justify saying there’s “New Information Regarding Uncommon Psychiatric Adverse Events For All ADHD Drugs”, since it seemed like decade old news to me.

He said there was no new information, no new research. He also said that there was no new information on causality.

They were just standardizing the information on the warning labels so all the drugs in that category (ADD stimulants and strattera) said the same things.

I said from reading the press release it sounded like there was new information, new dangers and he said no, that’s not the case. I mentioned that many of the media reported it like it was and thus possibly adding more stigma to those who have ADD or might be consider getting diagnosed. ADD medication is so deeply tied into the condition of ADD that slamming it without evidence does effect people who have ADD as well as Non ADDers opinions about ADD. ADD medications can be very useful, but they’re not a complete solution for people with ADD, they’re just one part of the solution. Pills don’t teach skills.

He then said it probably could have been worded better. He said that he would issue a clarification, but I still haven’t seen it on Health Canada’s website.

This is not the first time Health Canada’s mislabelled an”ADHD warning”. See my previous post’s on their mistake on pulling Adderall XR off the shelves for a reason that turned out to be incorrect (I.e., it was supposedly pulled of the market for adverse cardiac events i.e. heart attack and sudden death when the death rate in the general population NOT taking Adderall XR was apparently higher) without first checking with Canadian ADHD medical experts here, here and here They eventually put it back on the shelves.

The US FDA consults with US doctors and psychiatrists who are ADHD experts before issuing warnings on ADHD medications. Seems like Health Canada doesn’t. Given their recent poor track record on ADD warnings Health Canada needs to get out of their bubble and start consulting with Canadian ADHD medical experts too. Canadian ADDers and their families and doctors and psychiatrists should start demanding it.

Here’s how some Canadian media outlets covered the press release.

Globe and Mail New ADHD drug info to warn about agitation, hallucinations

Health Canada is revising its prescribing and patient information for all ADHD drugs in Canada to add the “potential for psychiatric adverse events.”

Canadian adverse drug reaction reports from 2000 to 2005 list about two dozen cases of mood, personality and psychological reports among ADHD drug users, but there is no way of knowing whether the drugs caused the problems

CBC Health Canada to boost warnings on ADHD drugs

Health Canada will add tougher warnings to the labels of Ritalin, Adderall, Concerta and similar drugs that treat attention deficit hyperactivity disorder, CBC News has learned.

AM 640 Radio Health Canada Warns Parents of ADHD Medications

Attention parents, if your kid is on ADHD drugs there is a new warning about potential side effects. Health Canada says the medication may cause your child to hallucinate – or have other adverse psychological episodes. This isn’t the first time Health Canada has raised red flags about the drugs… More than 2-million prescriptions were written for the medication in Canada last year.

Vancouver Sun. ADHD drugs to get new safety warning about psychotic effects

Canada.com New warning over ADHD drugs. Health Canada says some may trigger psychotic reactions

Go to google and type in “health canada” adhd psychiatric” “september 2006″, and you’ll get more than 21,000 hits. Not every one is related to this but most are. This got a lot of coverage in the mainstream media, and on health and pharmacy related consumer and industry blogs and websites.

After talking to the Health Canada media rep, it’s obvious that these headlines (and associated website/blog posts) are not accurate representations of reality. Maybe the media organizations and health/pharmaceutical blogs/websites need more curious/skeptical reporters/bloggers/editors, or ones with more background in ADHD, since it seems like I was the only one calling Health Canada to ask them questions on what study/report is the basis of this “new information”. Hopefully they will all do follow up articles or corrections.

I’m not the only one who thinks this isn’t new. This CBC news article quotes

Dr. Umesh Jain, a child psychiatrist who is head of the Canadian ADHD Resource Alliance, said yesterday that Health Canada is right in its message that doctors should “be cautious, be prudent”—but he doesn’t think the advice is anything new.

A properly diagnosed patient on ADHD drugs, taking the correct dosage, would not have a problem with agitation and hallucinations, he said. “Because what’s happening is you’re taking the patient to a normalization state with the medications,” he explained. “When medications are diverted and abused, they are potentially at risk for developing hallucinations, delusional beliefs, etc.”

The new ADHD medications are long-acting, once-a-day preparations and have “low diversion potential,” added Jain, who works at the Centre for Addiction and Mental Health and Toronto Hospital for Sick Children.

“If you were somebody who was going to use an excess amount, well beyond that of the range of the ADHD profile, yeah, they can potentially cause those problems.” He said Health Canada is trying to be cautious in alerting the population about all potential risks—“partly, I think, because the medications are being so widely used.” Jain conceded the Health Canada statement likely will cause some patients to be worried.

“We have to find ways of calming our patients down and say ‘Look, these aren’t going to cause you hallucinations and delusions in the doses that we prescribe to you,’” he said.

If there is new information that suggests there’s a need for a new warning on ADD medication or ANY medication, definitely get the word out. But if there’s not don’t be pretending there is, many of these media outlets, blogs and health/pharmaceutical websites won’t know about this new info and won’t tell their readers that there is no new dangerous info on these drugs and it’s not a warning but simply a standardization so all the labels have the same information. Something that probably should have been done years ago.

So if you read any of these media/blog/websites with articles on this subject and they don’t know this warning is not a real warning, please let them know. You may also want to contact Health Canada to give your opinion on this too. Seems like this is their related website The Therapeutic Products Directorate their email is sipdmail@hc-sc.gc.ca Phone number is (613) 957-0368

It would probably be better would be to let the Canadian Minister of Health know your feelings on these matters.
Minister Tony Clement
Email: Minister_Ministre@hc-sc.gc.ca
Ph: (613) 952-1154

Update: CADDRA has suddenly changed the website address of the ADHD Practice Guidelines. The new one is at
http://www.caddra.ca/english/phys_guide.html

Here’s a complete answer to the above complaint I hear and read far, far too often all over North America.

The CADDRA (Canadian ADD Resource Alliance) Canadian ADHD Practice Guidelines 2006.

The site has 22 documents with 103 pages of great information. Even if you’re not Canadian, they are definitely worth a look. Tell them to download and read these guidelines and as Vancouver Psychiatrist and BC ADHD Clinic director Dr. Margaret Weiss said when she talked about the shameful 1 year wait to get diagnosed for ADHD at the BC ADHD clinic due to govt neglect and underfunding, “it’s all you need to know to diagnose and treat ADHD.”

This is an ABSOLUTE GOLDMINE of Free comprehensive ADHD information for medical professionals to diagnose and treat ADHD medically in Adults, children and teenagers.

I have never seen so much comprehensive information on the diagnostic and medical treatment of ADHD available all in one place as this, and I spent a far too much time on the net searching for ADD material.

Adult with ADHD, parents of children with ADHD, employers and teachers of students with ADHD should also go over some of these free PDF’s. There is a huge amount of useful information here. Knowledge is power.

Note that in #12 CADDRA Physical Exam and Feedback Form – Adult, they have a behavioral treatment checklist that says:

Getting a life-coach or assistant
Engaging in an exercise program
Cognitive Behavioural Therapy
Entering into an adult ADHD support group

Here’s the list of the CADDRA Canadian ADHD Practice Guidelines. The PDF’s are free to download on their site. Tell others who have or work with people with ADHD about it.

Section 1 – Family Physicians and Primary Care Pediatricians

Chapter 1: Consensus-Based Practice Guidelines for ADHD Simple – Children. 6 pages.

Section 2 – Specialty Pediatrics and Psychiatry CADDRA Guidelines Steering Committee

Chapter 1: Assessment and Treatment of ADHD Simple – Children
Medical Treatment of ADHD Simple – Children. 9 pages

Chapter 2: ADHD Complex – Children. 2 pages.

Chapter 3: Assessment and Treatment of ADHD Simple – Adolescents. 5 pages.

Medical Treatment of ADHD Simple – Adolescents

Chapter 4: ADHD Complex – Adolescents. 2 pages.

Chapter 5: Intervention with Parents of Children with ADHD. 5 pages.

Chapter 6: Appendices – Child and Adolescent Assessment

1 CADDRA Assessment Form #1 – Child and Adolescent. 6 pages.

2 CADDRA Physical Exam and Feedback Form – Child and Adolescent. 6 pages.

3 Checkmate Plus® – CADDRA Version – Teacher’s Form or CADDRA Symptom Inventory. “At the time of printing, CADDRA was in negotiations to see if Canadian physicians could obtain access to this questionnaire.

CADDRA is producing its own CADDRA Symptom Inventory which will be in the public domain and free for all Canadian physicians. It will be made available on the CADDRA website www.caddra.ca in the spring of 2006. The intent of the authors is to allow physicians to make an effective diagnosis with a consideration of all comorbid illnesses so that the clinician can establish a treatment plan. It is also hoped that any questionnaire should be computer scored and allow the clinician to have a hard copy for their medical records.”

4 SNAP IV Parent and Teacher Rating Scale. ” At the time of printing, CADDRA was in negotiations to see if Canadian physicians could obtain access to this questionnaire.”

5 Checkmate Plus® – CADDRA Version – Parents’ Form or CADDRA Symptom Inventory. “At the time of printing, CADDRA was in negotiations with the authors to determine whether it could be used free of charge, with unlimited access by Canadian physicians with a site license being paid by CADDRA. Currently clinicians may access five free visits on the Checkmate Plus website www.checkmateplus.com CADDRA is producing its own CADDRA Symptom Inventory which will be in the public domain and free for all Canadian physicians. It will be made available on the CADDRA website www.caddra.ca in the fall of 2006.”

6 DSM-IV-TR Criteria for ADHD. 2 pages.

7 Weiss Functional Impairment Rating Scale – Parent Report (WFIRS-P). 3 pages.

8 DSM-IV-TR Criteria for Depression. 1 page.

9 Request to School for Psychoeducational Testing (also in MS Word). 1 page.

10 School Accommodations Letter (also in MS Word). 1 page.

Chapter 7: Assessment and Treatment of ADHD Simple – Adults. 10 pages.

Chapter 8: ADHD Complex – Adults. 4 pages.

Chapter 9 Adult Assessment

11 CADDRA Assessment Form #2 – Adult. 13 pages.

12 CADDRA Physical Exam and Feedback Form – Adult. 5 pages.

13 Adult Self Report Scale (ASRS-V1.1, 18 item). 3 pages.

14 Checkmate Plus® – CADDRA Version – Adult Form or CADDRA Symptom Inventory. “At the time of printing, CADDRA was in negotiations with the authors to determine whether it could be used free of charge, with unlimited access by Canadian physicians with a site license being paid by CADDRA. Currently clinicians may access five free visits on the Checkmate Plus website www.checkmateplus.com”

15 Weiss Functional Impairment Rating Scale Self-Report (WFIRS-S). 3 pages.

16 Adult ADHD Developmental History. 4 pages.

Chapter 10 Appendices – Medications for ADHD

17 Medications for ADHD. 14 pages.

18 Management of Simple Medication-Induced Side Effects. 3 pages.

19 CADDRA Side Effect Rating Scale. 1 page.

References. 1 page.

Who wrote these guidelines?

CADDRA steering committee for the Canadian ADHD practice guidelines

Umesh Jain MD PhD FRCPC. Chair, Guidelines Committee Medical Director, Better Behaviour Services Medical Director, YEARS Services Centre for Addiction and Mental Health Toronto, On.

Margaret Weiss PhD MD FRCPC. Associate Professor of Psychiatry, University of British Columbia. Director BC ADHD Clinic, Vancouver, BC

Lily Hechtman MD FRCPC. Professor of Psychiatry and Pediatrics Community, McGill University, Montreal, Que.

Cheryl Mutch MD FRCPC. Community Pediatrician Vancouver, BC

Declan Quinn MD FRCPC. Associate Professor of Psychiatry, University of Saskatchewan, SK.

Diane Sacks MD FRCPC. Assistant Professor of Pediatrics, University of Toronto, On.

Atilla Turgay MD FRCPC. Director, ADHD Clinic, Training and Research Institute, Scarborough Hospital, Toronto On.

John Yaremko MD FRCPC. Assistant Professor Community Pediatrics, McGill University, Montreal, Que.

Michel Maziade MD FRCPC. Professor of Psychiatry, Laval University, Scientific Director, Centre de recherche Universite De Laval Robert-Gifford, Quebec Que.

Editorial Consultants

Heidi Bernhardt. National Director CADDRA

Mary-Ellen Ross Veira. Senior Writer and Editor, McCleery McCann Healthcare Toronto, ON

Update: They shut down the BC Adult ADHD clinic and abandoned the patients. No other hospital has opened a similar clinic to deal with the needs of Adults with ADHD.

There’s a one year wait to get diagnosed at the main place that does it in Vancouver, the ADHD clinic at Children’s hospital according to the clinic’s director Dr. Margaret Weiss. This was mentioned at last week’s CHADD Vancouver meeting, where she spoke. She was very informative and entertaining, if you ever get a chance to see her do go. Her dog does seem to have ADD, as others have mentioned, but I got along with it fine. I’ve been trying to get our non profit Vancouver Adult ADD Support group listed on their website for more than a year.

She said she told the BC Government how long the wait was and asked for more funding but was declined. I guess people with ADD don’t count for much in BC.

Is it really acceptable that people with ADD have to wait for a whole year to get diagnosed? We’re 5% of the population (adults, children are about 8%), why are we treated like 2nd class citizens?

I have a list of people who have been known to diagnose and treat ADD in the Vancouver, BC area that I email out, but many just deal with children and some have long waiting lists and some are probably not even taking people for their waiting list. Some of them are psychologists and if you don’t have extended medical to cover it, you have to pay out of pocket, and it’s not cheap. The ADHD Clinic at Children’s hospital probably does most of the diagnosis of ADD in the lower mainland, if not BC.

Unfortunately you can’t assume most doctors know about ADD.

I’ve heard and read far too many stories (not just Vancouver but across Canada and in the US) of people saying that “my doctor/psychologist/psychiatrist doesn’t have a clue about ADD/denies it exists.” Even if they do know, many don’t accept new patients for ADD testing because the BC government only pays for 15 minutes and you can’t diagnose ADD in 15 minutes. Margaret suggests doing a serial diagnosis to cover that, i.e., 15 min one day, 15 the next etc. It’s a good short-term solution. But the BC government should really pay adequately for people to properly diagnosis ADHD.

Diagnosis is the starting point. How can you deal with a problem when you don’t what it is? It may be ADD, maybe something that looks like ADD, may be ADD and one or more comorbid or coexisting conditions.

I answer the CHADD Vancouver phone lines and hear the stories of people who think they might have ADD and are sometimes going through hell because of it and really need a diagnosis and treatment. Some can’t afford ADD coaching or a psychologist who knows ADD, and most of the psychiatristc that do know ADD and are taking patients, or a wait list, only do medication not therapy and the ADHD clinic only does diagnosis and getting people with ADD initially stabilized on ADD meds. If you see someone that doesn’t know about ADD they can do you more harm than good.

Medication is one part of ADD treatment but pills don’t teach skills or develop awareness and change attitudes and behaviors. They are useful, and can help increase the odds of learning those things but they’re not by themselves a complete solution. Sometimes some of these people are on the verge of losing their jobs, their apartments, their marriages, their families.

If I tried helping all of them I’d be out of business. Sometimes I feel like saying to them,

I’m sorry sir/madam, you unfortunately have a condition that’s only popular as a scapegoat to all of society’s perceived ills. The government, the media (many of which have ADD) and society at large don’t really care about people with your condition at all. Some in fact doubt that it exists even though every major medical and psychological association say it is a real condition and there is plenty of evidence of that.

Others with ADD don’t bother getting organized to change things for the better, they know from personal experience it’s a real problem and the suffering others go through, but most of them just say things like “I’m too busy, I’m too overloaded, I’m not organized enough, I can’t make a difference, I’m not an expert, I’m powerless” etc. and expect someone else to do something. Well there is no one else. Unless ADDers and their families and friends get organized and demand services it won’t happen.

There should be adequate resources to help you, but there’s not. My apologies, but you’re screwed.

I don’t actually say that to them, but sometimes I feel like saying it.

Any suggestions other than just press releases that might actually change this condition and reduce the wait list?

Has anyone got their local government/health authority to adequately deliver services for ADD or even moderately adequately? If so how did you do it?

In the next post I’ll cover a site with all the tests medical professionals need to diagnose and treat ADHD in adults and children, it includes ADD medications, their side effects and how to mange those side effects.