Wednesday, October 19, 2016

Step 2 CK: ADHD treatment

Hello! This post is on the treatment of Attention Deficit Hyperactive Disorder (ADHD)!

Cognitive behavioural therapy is the first line of treatment for ADHD.

As for pharmacotherapy, FDA has approved two types of medications — stimulants and non-stimulants.
Methylphenidate ( > 6 years of age)
Dextroamphetamine ( > 3 years of age)

Non stimulants:
Non-stimulant SNRI (Atomoxetine)
Alpha 2 agonists (Clonidine, Guanfacine)

Why psychostimulants for ADHD? Why stimulate an already active child?
It may seem counterintuitive, but despite their name, stimulants, they actually have a calming effect on hyperactive children with ADHD.
They are believed to increase brain levels of dopamine - a neurotransmitter associated with motivation, attention, and movement.
Stimulants also increase presynaptic NE release resulting in increased frontal lobe activity and impulse control.

Cool things about Atomoxetine:
It is a selective norepinephrine reuptake inhibitor (NRI or NERI) and a non-stimulant - strangely! It has no abuse potential =D

Why isn't Modafinil FDA approved for ADHD?
Studies have shown statistically significant differences favoring Modafinil over placebo in reducing ADHD symptoms, however, there were 3 cases of serious rash including one case of possible SJS among 933 patients exposed to Modafinil. That is why, Modafinil is not approved for use in treating ADHD.

DSM V update: The onset criterion for ADHD has been changed from “symptoms that caused impairment were present before age 7 years” to “several inattentive or hyperactive-impulsive symptoms were present prior to age 12.”
Just thought it was important to know :)

That's all!


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