A press release just came out today - publicizing a report which is available for purchase about the nature of the pharmaceutical market in ADHD. The press release documents that the ADHD market is worth $3.85 billion per year, and will have a compound annual growth rate of 1.2% over the next 10 years. They document that the adult ADHD ‘market’ is largely untapped, and they predict that it will likely be twice as big as the pediatric ADHD market.

I have to say that I always have a mixed response when I read statistics like this.

On the negative side - this type of data makes it seems that the pharmaceutical companies are just trying to make sure that more prescriptions are written, and they see people with ADHD as just consumers of their drug and ‘dollars and cents’. Additionally, these data help to fuel the ‘ADHD nay-sayers’ to talk about how ‘over treated’ and ‘over medicated’ ADHD is. (I can hear them saying - ‘almost $4 billion dollars of drugs sold per year???’).

On the other side - this type of just report documents facts…
It’s been documented that it costs over $1 billion USD to bring a new medicine to market. The fact that there is a profit in the ADHD market - and an opportunity for companies to expand sales in the future - means that there will be more research and thus more new treatments introduced in the coming years.

This is ultimately good for people with ADD or ADHD.
New treatment options coming out in the future is a good thing…

In summary - although this type of statistic can be shocking to some - I believe it is important to know that it means that the pharma companies will be willing to invest new monies into ADHD research and treatments.

The danger here is how this statistic can be sensationalized, and how people can get too fixed on the ‘medication only’ treatment of ADHD.

Please remember that the best approach to treatment of ADHD is multimodal - meaning including medication with non-medication approaches (including behavioral therapy, parenting supports, academic/occupational support, coaching, alternative approaches, etc.).

To read a special report that I wrote about ADHD Medication, please visit: Medication Mastery.

Please share your thoughts in the comments section below.

Dr. Kenny

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Thirty percent of children with AD/ADHD cannot tolerate taking stimulant medications.

For these individuals, the recent news that Shire is one step closer to gaining FDA approval for its time-released non-stimulant INTUNIV is welcome news.

Intuniv provides a 24-hour evenly released dose of the medication guanfacine. Specifically, guanfacine improves the symptom of the inability to concentrate in children with ADD/ADHD.

When given in conjunction with stimulants, it may also help reduce the aggression and the insomnia normally associated with the use of these drugs.

In fact, some physicians already prescribe it – in an immediate release version and under various brands – to their patients with ADD/ADHD along with other medications. The most common brand used is Tenex. This medication, however, appears not to be very effective at alleviating either the attention deficit or the distractibility seen in children with ADD/ADHD.

Two advantages of INTUNIV

Manufactured and marketed as INTUNIV, though, this form of the medication would hold two distinct advantages over what is currently being used. First, it would be approved specifically for the treatment of ADD/ADHD. And secondly – and most importantly to those whose concentration is low – it would relieve the unevenness produced by the immediate-release version of guanfacine.

Guanfacine works well in improving concentration, but it only lasts several hours, and once the medication wears off attentiveness wanes again.

Recent clinical trials conducted as part of the FDA approval process show that INTUNIV is extremely effective at boosting concentration levels consistently for a 24-hour period

The data the FDA scrutinized included the pooled analysis of results from two double-blind trials. Both of these studies used the teacher based ADHD Rating scale as the criteria for improvement.

One group of children received INTUNIV for the other group received a placebo which contained no medication.

All groups which received the medication scored significantly better in the rating scale than those who received the placebo.

The studies also examined the length of time the medication was effective for these children. Assessments were made at 12, 14 and 24 hour periods following the administration of this drug. Again the data showed significant improvement in the concentration of the children at each of these points in time.

Mild and moderate side effects of INTUNIV

Between 75 and 80 percent of the children, did display mild adverse side effects while taking INTUNIV, most of which appeared within the first two weeks and eventually tapered off. These seemed to be dose-related and included: upper abdominal pain, constipation, dizziness, hypotension, sedation, dry mouth, and drowsiness.

The most common of these side effects were related to sedation.

The medical community has been examining guanfacine for its effectiveness since 2001. That year a study appeared in the American Journal of Psychiatry showing that guanfacine to be a safe and effective treatment for children with ADHD and those who suffer with tic disorders.

The medication, according to the journal article, produced a mean improvement of 37 percent in the total score on teacher-rated ADHD Rating Scale following eight weeks of treatment. This was compared to the eight percent improved for those who received the placebo.

INTUNIV is not a controlled substance — as stimulants are — and does not appear at this time to carry any risk for either potential for abuse or dependence.

The FDA has issued an “approval letter” for INTUNIV, which means that it is prepared to approve the new drug application as soon as certain conditions are met, such as any requests for additional information.

How guanfacine works

Guanfacine works, according to Shire, by acting indirectly on the prefrontal cortex of the brain. Located directly at the very front of the brain and directly below the forehead, the prefrontal cortex controls what are known as the executive functions. This includes the resolution of conflicting thoughts, the choices involved in “right or wrong” and “good and bad” decisions, as well as the prediction of future events.

This section of the brain also governs social control that is it is the area used when we suppress or emotional urges.

Guanfacine is a selective alpha-2A-agonist medication.

Admittedly, the treatment of ADD/ADHD is a highly individualized challenge. Discovering the most effective combination the proper medications and other forms of therapy may mean attempting to use several medications in various combinations as well as varying doses. What is appropriate for one child or adult, may not be either appropriate or effective for another.

Nearly 8 percent of all school-aged children have been diagnosed with ADD/ADHD, according to the U.S. Centers for Disease Control and Prevention. While not normally thought of as a disorder affecting adults, some 4.4 percent of all adults, ages 18 to 44 are affected.

The major characteristic of ADD/ADHD is an inattention or hyperactivity-impulsivity that exceeds those normally observed in most individuals. Official diagnosis of this disorder can not be made until the symptoms have been observed for at least six months.

References:

Pro-drug gets attention,
http://www.sciam.com/article.cfm?id=pro-drug-gets-attention, accessed 11 Jun08

Guanfacine, http://www.depression-guide.com/guanfacine.htm, accessed, 7 Jun 08

Intuniv reduces ADHD symptoms, http://www.realmentalhealth.com/adhd/adhd_toc.asp, accessed 6 Jun 08

Shire Investigational Nonstimulant INTUNIV Showed Significant Efficacy In Reducing ADHD Symptoms, http://www.medicalnewstoday.com/articles/106801.php, accessed 10 Jun 08.

What is prefrontal cortex?, http://www.wisegeek.com/what-is-the-prefrontal-cortex.htm, accessed, 11 June 08

Larry Scahill, M.S.N., Ph.D., Phillip B. Chappell, M.D., Young S. Kim, M.D., Robert T. Schultz, Ph.D., Lily Katsovich, M.S., Elizabeth Shepherd, M.A., Amy F.T. Arnsten, Ph.D., Donald J. Cohen, M.D., and James F. Leckman, M.D. A Placebo-Controlled Study of Guanfacine in the Treatment of Children With Tic Disorders and Attention Deficit Hyperactivity Disorder, http://ajp.psychiatryonline.org/cgi/content/abstract/158/7/1067, accessed 11Jun08

Technorati Tags: Intuniv, Shire, ADHD, ADD, ADHD Medication, ADD Medication

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We know that medications for ADD or ADHD help to improve concentration in those who have ADD and ADHD.
Some people - even if they don’t have the condition, take these medications to help to improve their focus and productivity (so called: ‘brain steroids’).
Each year, the press comes out with one or two stories (usually during exam time) talking about college students taking adderall to get through exams.
I must admit that the reason that I watched an episode of ‘Desperate Housewives’, was because a patient told me that one of the mothers on the show took her kid’s ritalin (I think that was in the first season).

Wired magazine did a story on using ‘brain enhancing medications’ for people who don’t even have ADD or ADHD.

It is surprising to hear of how many people use these medications to help with focusing and being productive. (Many of these people are scientists and researchers!)
In the first part of the article, the authors discuss the issue.
In the second part, they share some of the medication ‘regimens’ that people are using. They are generally a combination of ADHD medications like: Concerta, Ritalin, Focalin, Adderall, as well as Modafinil (provigil).

This is a concerning development - and one which can be quite dangerous.
In the past two years, the FDA has issued several warnings about ADHD medications including risks of cardiovascular concerns, psychiatric side effects- including hallucinations, agitation and suicidal ideas.
Most of the people taking these medications as performance enhancers - are taking these medications without proper medical supervision.

My suggestion: if you need a pick me up - have a large Starbucks (or even a Red Bull), but stay away from ADHD medications unless you’ve been properly diagnosed with ADHD and you are being medically monitored.

Please share your thoughts on this topic.
Since I know that the vast majority of my blog readers have ADD/ADHD or support a loved one with ADD/ADHD, please share your experiences with this topic - maybe it’s friends trying to get some of your pills!

All the best,
Dr. Kenny

Technorati Tags: ADHD Medication, Adderall, Vyvanse, Concerta

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On April 24, 2008, the US Food and Drug Administration approved Lisdexamfetamine - known as Vyvanse - to be used for adult ADD and ADHD. Prior to this announcement, the medicine was just approved for use in children aged 6-12.

Although people often think of Attention Deficit Hyperactivity Disorder as just a disorder of childhood - it often carries on into adult life - and studies have shown that over 4% of US adults have ADD or ADHD.

Despite the fact that Vyvanse has just received approval for use in adults - it has been used by some doctors previously, through ‘off label usage’ (see my previous article on this: Vyvanse in Adults).

The study which led to the approval included 414 adults, aged 18-55 years old. Over 4 weeks, they were tried on Vyvanse or placebo. Generally, the adults noted significant improvement within 1 week of starting the medicine. All doses used (i.e. 30 mg, 50 mg and 70 mg) were all found to be helpful.

The most common side effects experienced by the adults in the study with Vyvanse were: decreased appetite, difficulty falling asleep, and dry mouth.

To read more details about the study, please click here.

Does this mean that you should try Vyvanse if you are an adult with ADD or ADHD?

Not necessarily…
It just means that this is a good treatment option, and that the research has now been done to prove that it is effective for use in adults with ADD and ADHD.
It is best to talk to your doctor about your medication (and non-medication) treatment options.

As I have previously mentioned, as a doctor working in Canada, I have not been able to prescribe Vyvanse, because it has not yet come to Canada.
So, I have asked readers of this blog if Vyvanse works. To read over 275 responses, click here: Does Vyvanse Work?

Other Vyvanse articles on my blog:
Vyvanse Overview
Vyvanse Dose
No Addiction with Vyvanse

Please leave your thoughts or comments below.

Dr. Kenny

Technorati Tags: Vyvanse, ADD, ADHD

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Here is an article about drug maker Shire. Shire is the company which makes Adderall XR and now Vyvanse.
This article points out that Shires approach of creating medication to help with specialists is an approach which seems to be working. It also points out the reality that Shire is aiming to get doctors to write more prescriptions for Vyvanse - because Adderall XR is going ‘generic’ in the near future. (when Adderall XR goes generic, Shire will lose the income that they currently make from it).

Although the medication treatment of ADHD can be controversial - medication treatment can also change people’s lives - i.e. dramatically improve it. This article gives a view into the strategy that a pharmaceutical company is using to protect its income - i.e. trying to switch the market toward vyvanse rather than Adderall XR.

Do you think that this will have an impact on the treatments your doctor offers you?

Enter your thoughts or comments below.

Dr. Kenny

p.s. This is an issue which is going on in the US right now. In Canada, Vyvanse has not even come to market yet - and likely won’t for another 6-18 months…

Technorati Tags: Vyvanse, Adderall XR, ADHD, Medication

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LiquADD is a new formulation of Dextroamphetamine for ADD/ADHD, which will come in a liquid. It was just announced that the FDA has approved this medicine and it will be released in the US in the second quarter of 2008.

What is LiquADD?

LiquADD is a liquid preparation of dextroamphetamine sulfate. This is a shorter acting stimulant medicine for ADHD. The advantage of this preparation is that it can be swallowed by children who have trouble swallowing pills.

Prior to LiquADD, the only liquid ADHD medication was Methylin - though it is a preparation of Methylphenidate, and this is of a different stimulant - i.e. Dextroamphetamine.

LiquADD is chemically similar to Adderall, though there are minor differences.

As LiquADD is a short acting stimulant, there is a chance of abuse of the medication, and caution will need to be exercised when prescribing it to teens at risk of drug abuse.

This is a welcomed addition to the medications for ADD and ADHD, as it will help for kids who cannot swallow pills.
As a reminder - there are medications which can be ’sprinkled’ (i.e. capsules which can be opened and sprinkled to facilitate swallowing), and they include:

1. Ritalin LA
2. Metadate CD
3. Biphentin (in Canada)
4. Focalin XR
5. Dexedrine Spansules
6. Adderall XR

There is also the Daytrana patch available in the US - which is a patch of Methylphenidate - so that the medication is absorbed through the skin, rather than by pill.

Dr. Kenny

p.s. The article referenced above indicates that ADHD Medication is a $3.5 Billion a year market. If you are concerned, confused or want to get the straight facts about these medicines, please visit Medication Mastery for a free special report.

Technorati Tags: LiquADD, Adderall, Vyvanse, Daytrana, ADHD, ADD, Medication, Parenting

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Online news just reported that some teens were arrested for selling prescription drugs. While this likely happens all over North America on a regular basis - it raises a very important issue and is thus worth reviewing.

Which medicines were these teens selling?

Adderall.

The short acting stuff.

Let’s get a few things straight:

* ADHD Medication is not addictive - if it is taken as prescribed.
* Treatment with ADHD medication has been proven to actually reduce the risk of drug addiction in adolescence/adulthood.
* The long acting stimulants are virtually not abusable (i.e. Concerta, Adderall XR, Metadate CD, Ritalin LA, etc.)
* The Daytrana patch is not abusable.
* The new prodrug Vyvanse is not abusable at all
* The non-stimulant Strattera is not abusable at all.

So why do kids buy ADHD medication for abuse?

If the short acting medicines are crushed and snorted - they can produce a ‘high’. In the Toronto area, a regular (short acting) Ritalin pill (of 10 mg) sells for approximately $5.

This is medically dangerous on many levels - not only is this unsupervised use of the medication, but generally teens will take a higher than recommended dose. This can cause cardiovascular issues.

What to do about this?

If you have a teen who has any history of substance abuse - including cigarettes, marijuana, or drinking, and he/she gets interested in taking their short acting Ritalin or Adderall - think of this article - and get suspicious!
I have experience with teens who realized that their dealer doesn’t want Concerta - so they come back to the doctor with a story about how they want short acting Ritalin. It is not necessarily for their ADHD - they may see it as an easy way to pay for their habits with marijuana or other street drugs.

If you are able to - get your child/teen onto one of the newer medications which is not abusable at all.

Please share your thoughts or comments below.

Dr. Kenny

p.s. To get all of the information that you need to know about Medication for ADD and ADHD, visit: Medication Mastery

Technorati Tags: ADHD, ADD, parenting, Medication, Adderall, Ritalin, Vyvanse, Daytrana, Strattera, Metadate, Concerta

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Daytrana, the skin patch for ADD/ADHD now has research demonstrating that it is safe over a 12 month period. The research was reported at the annual meeting of the American Academy of Child and Adolescent Psychiatry, in Boston in October 2007.

This is important research, to help to establish the safe longer term use of this medicine.

Daytrana is the first skin patch of the medicine methylphenidate. Methylphenidate is the same active ingredient as Ritalin, Concerta,
Metadate CD, Methylin and Biphentin. It can play a role in the treatment of ADHD, especially in children who have trouble swallowing tablets or pills.

Daytrana is one option used in the medication treatment of ADD/ADHD. Research has proven that the best treatment for ADD/ADHD is a comprehensive, multimodal approach.

To get free information about the medication treatment of ADHD, please visit: ADHD Medication Mastery to download a free report that I’ve written for you.

Dr. Kenny

Technorati Tags: ADD, ADHD, Daytrana, Medication, Ritalin

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I hate when this happens…

The news was buzzing today about a British story that ADHD Medications don’t work at all.

I am currently in Montreal, for a meeting of the Canadian Academy of Child Psychiatry. The TV news channels were calling myself and other ADHD experts to get our take on this new story. I interrupted a lunch session to be interviewed (and it had to be quick, because I was presenting a research workshop on ADHD at 1:45 pm).

When the story aired, my interview was edited enough that it didn’t represent what I said.

So, using the power of ‘new media’, I want to bring you the ‘rest of the story’.

Please watch this YouTube video so that you can understand why ADD/ADHD Medications still work, and hear the full version of the story:

You can learn more about medication for ADD and ADHD by downloading my 25 page free report here: Medication Mastery.

So remember, ADD/ADHD medications still work, and you need to monitor for stunted growth - but please watch the video above to learn the facts and speak to your doctor if you have any questions.

All the best,

Dr. Kenny

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I am just in the process of launching my ‘ADHD Medication Mastery Course’. I have shared information with my readers and subscribers, and the response has been tremendous.

One of the questions that’s been asked relates to people who want access to this training (because they know it can help them so much…), but they are worried that the cost is a barrier.

I will remind you that if you register by Monday November 5th, you’ll qualify for an ‘early bird’ discount of $60.

But I was concerned that that may not be enough for everyone.
After a review with my team, we have come up with a plan:

We will award 3 FULL Scholarships to the course.

Here’s how it works:

1. 3 scholarships will be awarded (i.e. no charge to you if you are awarded the scholarship)
2. To qualify, you will need to scroll down, and post a comment on this specific article, explaining why you feel that you qualify to get the scholarship.
3. Your comment must be submitted by Saturday night November 4th 2007 at 11:59 pm eastern time.
4. My staff and I will review the applications, choose three winners, and announce them on Monday morning, by email, and on this blog.
5. All decisions are final (i.e. you can’t appeal them), and the scholarships cannot be redeemed for money.
6. By submitting your application, you agree to allow me to use your comments, name and location on my blog, website or emails.

You can find all of the details about the Medication Mastery Course here.

If you have already purchased your copy of the course, and you are awarded the scholarship, you will be refunded your tuition.

So, take a moment and type in your application below. (it will take a short while for your post to appear on the blog - as all comments are reviewed before being added to this blog).

And be sure to pass this along to any of your family or friends who may benefit from this course and this scholarship.

Dr. Kenny

p.s. in the ADHD Medication Mastery Course, you will get 13+ hours on ADD/ADHD Medication. This will improve your treatment for ADD/ADHD, improve your quality of life, and may even cut down on the costs of doctors visits!

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