print documentPrint Page

Supplement May Help With Marijuana Cravings

Posted on 29 May 2015

At WellStep Atlanta, we ask the patients discontinue all illicit and mood-altering substance when in recovery. This includes marijuana. However, heavy marijuana users may experience cravings and other withdrawal-type symptoms when stopping. Recent studies suggest that the supplement N-Acetylcysteine may help patients stay abstinent from marijuana. The effective dose appears to be 1200 mg twice daily. The mechanism of action is not known, but may be linked to the effect of N-Acetylcysteine on the Glutamate and/or Dopamine neurotransmitter sytems.

New Opiate Detox Study Announced

Posted on 22 October 2014

At WellStep Atlanta, we usually utilize buprenorphine (Subutex/Suboxone/Zubsolv) to help patients detox from opiates such as heroin, oxycodone and hydrocodone. Because patients typically request to stay on buprenorphine longer than a 7 to 10 day detox period, they normally become dependent on buprenorphine and have to go through a slow taper in order to avoid withdrawal symptoms from coming off this medication.

Now there is another option to help patients detox (on an inpatient basis).  At the American Society of Addiction Medicine, a study was reported which compared the use of a three drug combination: tizanidine (Zanaflex), gabapentin (Neurontin) and hydroxyzine (Vistaril/Atarax) over a 4 day period to buprenorphine alone. The three drug combination was found just as effective for symptom control as buprenorphine and superior for retention in treatment.

This study was done on patients admitted to the hospital for detox. Our office cannot offer this specific treatment protocol on an outpatient basis due to the need for observation and monitoring.  The dose and frequency of hydroxyzine administration alone requires an inpatient setting.

If a modified outpatient protocol is developed, we will definitely post this information.  Meanwhile, buprenorphine remains the best option for outpatient/office-based treatment for most patients.

Preventing Teen Drug Abuse

Posted on 29 March 2014

 

At WellStep  Atlanta, we treat an increasing number of teens for drug and alcohol abuse.  Many of these cases could have been prevented by early parental intervention.

The following are a few strategies to prevent your teen getting involved in drugs:

Monitor your child’s psychological health. If you suspect he or she is suffering from depression, manic phases or other mood abnormality, make sure and get professional help.

Pay attention to your teen’s activities. Determine which positive, adult-supervised activities your teen is interested in and encourage him or her to get involved.

Establish rules and consequences (and enforce these rules consistently).

Know your teen’s friends.

Make sure your teen does not have access to prescription drugs at home.

Provide support. Offer praise and encouragement when your teen succeeds.

Set a good example (don’t abuse drugs yourself).

Consider home drug testing or taking your son or daughter for a substance abuse evaluation if you suspect that your teen is using drugs.

(Adapted from Mayo Clinic)

Preventing Teen Drug Abuse

Posted on 29 March 2014

 

At WellStep  Atlanta, we treat an increasing number of teens for drug and alcohol abuse.  Many of these cases could have been prevented by early parental intervention.

The following are a few strategies to prevent teen drug abuse:

Monitor your child’s psychological health. If you suspect he or she is suffering from depression, manic phases or other mood abnormality, make sure and get professional help.

Pay attention to your teen’s activities. Determine which positive, adult-supervised activities your teen is interested in and encourage him or her to get involved.

Establish rules and consequences (and enforce these rules consistently).

Know your teen’s friends.

Make sure your teen does not have access to prescription drugs at home.

Provide support. Offer praise and encouragement when your teen succeeds.

Set a good example (don’t abuse drugs yourself).

(Adapted from Mayo Clinic)

Preventing Teen Drug Abuse

Posted on 29 March 2014

 

At WellStep  Atlanta, we treat an increasing number of teens for drug and alcohol abuse.  Many of these cases could have been prevented by early parental intervention.

The following are a few strategies to prevent teen drug abuse:

Monitor your child’s psychological health. If you suspect he or she is suffering from depression, manic phases or other mood abnormality, make sure and get professional help.

Pay attention to your teen’s activities. Determine which positive, adult-supervised activities your teen is interested in and encourage him or her to get involved.

Establish rules and consequences (and enforce these rules consistently).

Know your teen’s friends.

Make sure your teen does not have access to prescription drugs at home.

Provide support. Offer praise and encouragement when your teen succeeds.

Set a good example (don’t abuse drugs yourself).

(Adapted from Mayo Clinic)

Drug Abuse Prevention for Middle School Students:

Posted on 13 November 2013

Prescription drug abuse and dependence are the number one problems we see at WellStep Atlanta. A new study conducted by researchers at Penn State found that teen and young adults decreased their overall prescription drug misuse by 65% when part of a community-based prevention program while in middle school. The research was published in the American Journal of Public Health. Researchers also found significant decreases in methamphetamine, marijuana, alcohol, cigarette and inhalent use. This study is particularly important in showing that family-focused and school based programs as early as middle school are effective in helping stop the epidemic of prescription drug abuse. 

New Info On E-Cigarettes From CDC

Posted on 8 September 2013

 

At WellStep Atlanta, we have found that overall e-cigarettes have really helped our adult patients quit smoking. However, there is a big public health concern about increasing teen use of e-cigarettes

The Center for Disease Control reported this month that e-cigarette experimentation and use doubled during 2011 and 2012 with an estimated 1.78 million students having ever used e-cigarettes as of 201. In addition, an estimated 160,000 students who reported ever using e-cigarettes had never used conventional cigarettes. These are remarkable statistics as a doubling of a population engaging in a risky behavior in just one year is rarely seen in the U.S.

The primary concern is that e-cigarettes might act as a gateway to conventional tobacco products since approximately 90% of all smokers began smoking as teenagers. In addition, many e-cigarettes themselves have harmful constituents such as lung irritants, genotoxins and carcinogens. Tobacco companies are actively marketing to young people with flavors such as “cotton candy” and “bubble gum”. Look for the FDA and states to step up the  regulation of e-cigarette dramatically in the coming months.

 

 

New Info On E-Cigarettes From CDC

Posted on 8 September 2013

 

The Center for Disease Control reported this month that e-cigarette experimentation and use doubled during 2011 and 2012 with an estimated 1.78 million students having ever used e-cigarettes as of 201. In addition, an estimated 160,000 students who reported ever using e-cigarettes had never used conventional cigarettes. These are remarkable statistics as a doubling of a population engaging in a risky behavior in just one year is rarely seen in the U.S.

The primary concern is that e-cigarettes might act as a gateway to conventional tobacco products since approximately 90% of all smokers began smoking as teenagers. In addition, many e-cigarettes themselves have harmful constituents such as lung irritants, genotoxins and carcinogens. Tobacco companies are actively marketing to young people with flavors such as “cotton candy” and “bubble gum”. Look for the FDA and states to step up the  regulation of e-cigarette dramatically in the coming months.

Smoking and Addiction Recovery

Posted on 23 March 2013

At WellStep Atlanta we encourage patients being treated for opiate addiction or alcoholism to start thinking about cutting down or quitting smoking soon after detox. While patients often say that smoking enables them to cope with stress during recovery, studies show that long-term recovery is actually adversely affected by continuing to smoke.

For patients interested in cutting back or quitting smoking, we often suggest a prescription nicotine inhaler (Nicotrol).

Even over the counter nicotine gum can double quit rates.  Nicotine gum is marketed in 2 strengths, 2 mg and 4 mg. Individuals who smoke 1 pack per day should use the 4-mg pieces; those who smoke less than 1 pack per day should use the 2-mg pieces. Patients should chew the gum at least hourly for initial cravings for the first  2 weeks, then gradually reduce the amount chewed over the next 3 months. An over the counter nicotine patch is available as well (ie, Nicoderm)

We also encourage smokers to try "electronic cigarettes" which provide nicotine through a much safer vaporization process.

 

 

Transdermal Buprenorphine for Chronic Pain

Posted on 8 July 2012

Transdermal buprenorphine (Butrans) is an option for many patients for whom opiates are no longer effective or cannot tolerate the typical opiate side effects.

Butrans became available in the United States in early 2011 and is
approved and indicated for the management of moderate to severe chronic pain in
patients requiring a continuous, around-the-clock opioid analgesic for an
extended period of time.

Sublingual buprenorphine formulations (Suboxone and Subutex), which are FDA-approved for the treatment of opioid addiction, have been prescribed off-label for pain management since they became available in 2002. While Butrans at the highest dose seems to be sufficient for the vast majority of patients, sublingual buprenorphine at doses higher than 16 mg is sometimes more effective.

Butrans seems to be especially useful in neuropathic pain but can be prescribed for musculoskeletal and headache pain as well.

There are several distinct advantages to the buprenorphine patch over pure opiates, such as percocet and morphine.

Like sublingual buprenorphine, the Butrans patch does not usually cause a "drugged up" feeling. Also, tolerance (the need to increase dose) is not seen as often with the patch as with pure opiates. Finally, allodynia, or increased pain sensitivity, often is a problem with pure opiates but appears much less common with the patch.

While expensive, the patch is covered by most health insurance plans.

 

Buprenorphine Implant Found Effective in Opiate Treatment

Posted on 9 June 2012
Suboxone(buprenorphine/naloxone)is currently preferred by most addiction specialists for the maintenance treatment of opiate dependence. In the near future there may be another medication available for this purpose. Titan Pharmaceuticals recently announced that new phase 3 study data found that buprenorphine implants demonstrated efficacy in treating opiate addiction. The buprenorphine implant is inserted during a ten minute, in-office procedure under local anesthesia and can be left for six months, after which time the implant is removed, again under local anesthesia. A new drug application is in process and is expected to be submitted to the FDA in September, 2012. If approved, the drug could potentially be on the market by mid-2013. Dr. Banov, Medical Director of WellStep Atlanta, served as a clinical investigator at Northwest Behavioral Research Center’s Alpharetta site in earlier trials of this medication.

“Synthetic Marijuana”/ “Spice”

Posted on 25 March 2012

The March 12 issue of Pediatrics reviewed the problem of synthetic cannabinoid products which have become more and more popular in the United States with adolescents and young adults. Many of these individuals are even ending up in critically ill in emergency rooms. The herbs and spices in these products (street names: K2, Spice, Aroma, Mr.Smiley, Zohai, Eclipse, Black Mama, Red X Dawn, Blaze and Dream) have been sprayed with very toxic chemical compounds which produce effects similar to marijuana. The report noted that synthetic marijuana products can cause agitation, aggressive behavior, catatonia, intense sweating, and difficulty speaking. There is no “antidote” for acute intoxication and there is concern over the possibility of long term effects such as memory loss, psychiatric complications, dependence and even an increase in cancer risk. Since these products don’t show up in drug tests, they have become increasingly popular.

We have started to see patients at WellStep with a “synthetic marijuana” abuse problem and anticipate, unfortunately, that we will be seeing many more in the near future.

 

Atlanta ADHD Research Studies Recruiting Teens and Children

Posted on 21 February 2012

ADHD Research News in Atlanta: Along with depression and anxiety, addictions are often co-morbid (clinically associated) with ADHD (attention-deficit/hyperactivity disorder). Two new research studies at Northwest Behavioral  Research Center in Alpharetta involving ADHD are currently recruiting subjects.

Teens: Does Your Teen have ADHD?

Northwest Behavioral Research Center in north metro Atlanta (Alpharetta)  is recruiting teenagers (age 13-17) to take part in a research study to evaluate a non-stimulant investigational medication to better understand and treat attention deficit/hyperactivity disorder (ADHD)

To be eligible, the participant must:

1. Be 13-17 years of age

2. Be able to come to the doctor's office for 15 weeks.

3. Have a parent/legal guardian who is willing and able to comply with study procedures and restrictions.

You may be compensated for your time and travel. If you are interested in having your teen participate, please call 678-992-0109 or visit www.psychatlanta.com

 

Children: Is ADHD Still Affecting Your Child After Treatment?

Inattentive, daydreamer, disorganized, impulsive, talkative hyperactive......

 

Northwest Behavioral Research Center in metro north Atlanta (Alpharetta) is currently recruiting children and teenagers (age 6-17) to take part in an investigational research study to better understand and possibly treat ADHD.

Study qualifications include:

1. Children between 6-17 years of age.

2. Diagnosed with ADHD.

3. Have tried one ADHD treatment and still continue to have symptoms.

If interested in learning more about this these trials please call 678-992-0109 or visit www.psychatlanta.com

(For more information on Adult ADHD, please visit www.Atlanta-ADHD.com or www.WellStep.com)

 

Vyvanse for Adult ADHD Maintenance Treatment

Posted on 11 February 2012

The  FDA has approved Vyvanse (lisdexamfetamine dimesylate) as maintenance therapy for adults with attention deficit hyperactivity disorder (ADHD).

The  approval is based on results from a randomized study designed to evaluate the efficacy of the drug in 123 adults aged 18 to 55 years who were receiving treatment with Vyvanse for a minimum of 6 months before enrolling in the study and who were responsive to the drug.  8.9% of patients in the active treatment group experienced a relapse of symptoms compared with 75% of those in the placebo group during the 6-week double-blind withdrawal phase of the study Shire, the drug’s manufacturer, stated in a press release that “Vyvanse is the first medicine both proven to work and approved to maintain efficacy in adults with ADHD.” The FDA approval included the proviso that Vyvanse should be used as part of a total treatment program that may include counseling or other therapies. The FDA also noted that physician who elects to use Vyvanse for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient.The bottom line is that Vyvanse, while previously approved for adult ADHD,  now has been definitely shown to be  effective for long term treatment of this condition.For more information on the Atlanta Center for Adult ADHD please visit www.Atlanta-ADHD.com, www.ADHD-ADD-Atlanta or call 770-753-9898

Atlanta Alcohol Treatment Campral Update

Posted on 11 February 2012

At our Atlanta alcohol treatment program, we often prescribe Campral, which is helpful in maintaining abstinence (no drinking at all) in patients who have stopped drinking by the time the medication is started.
The effectiveness of Campral in preventing relapse has not been demonstrated in individuals who have not undergone detox and have not achieved alcohol abstinence prior to beginning Campral treatment. In another words, Campral will probably not be helpful if a patient continues to drink while taking it. Campral will not reduce withdrawal symptoms in a detox situation.
How Campral works to maintain abstinence is not well understood but it is felt to influence the GABA and Glutamate neurotransmitter system.
The dosage of Campral is two 333mg pills three times a day and Campral may be taken with or without food.
Patients who cannot take Campral are individuals who have a hypersensitivity to acamprosate and patients whose have severe renal impairment. Since Campral is not metabolized in the liver, it is usually safe for patients with mild to moderate hepatic (liver)impairment. Patients must discontinue Campral immediately if any suicidal thoughts arise and families and caregivers of patients should monitor for symptoms of suicidal thinking.
For more information on Campral or our Atlanta alcohol treatment program, please visit www.WellStep.com , www.Atlanta-Alcohol-Treatment.net or call 770-753-9898

Alcohol Treatment Atlanta Update on Vivitrol

Posted on 2 February 2012

In our Alcohol Treatment Program, WellStep Atlanta, located in Roswell, Georgia, utilizes Vivitrol (naltrexone) as one of several medications that help reduce alcohol cravings. Since Vivitrol is still relatively new and not very familiar to most people, some information on this drug is provided here:

What is Vivitrol? Vivitrol is an injectable form of naltrexone, an opiate blocker, that has a one month duration of action.
What is Vivitrol used for? According to the official prescribing information, “Vivitrol is indicated for the treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment with VIVITROL. Patients should not be actively drinking at the time of initial Vivitrol administration ” In other words, Vivitrol is designed for patients who still have cravings after stopping drinking. (Vivitrol has also shown to reduce the number of “heavy drinking days” so the medication may be effective for “binge drinkers” as well.)
How does Vivitrol work? From the official prescribing information: “The neurobiological mechanisms responsible for the reduction in alcohol consumption observed in alcohol-dependent patients treated with naltrexone are not entirely understood. However, involvement of the endogenous opioid system is suggested by preclinical data." In other words, how Vivitrol works is not entirely understood. But scientists feel it may affect the “reward system” by working as an opiate blocker, so that alcohol does not produce the same pleasurable action as previously.
Where is this shot given? The injection is intramuscular and is given in the gluteal area.
Who cannot take Vivitrol?
Patients with acute hepatitis or liver failure
Patients receiving opioid analgesics
Patients with current physiologic opioid dependence
Patients in acute opioid withdrawal
Any individual who has failed the naloxone challenge test or has a positive urine screen for opioids
Patients with an allergy to carboxymethylcellulose, or any other components of the diluent
Is Vivitrol expensive? Yes, however most health insurance plans appear to be covering Vivitrol at the moment.
For more information on Vivitrol, visit www.Vivitrol.com . For specific questions on how Vivitrol is used at WellStep Atlanta, please visit www.WellStep.com or www.Atlanta-Alcohol-Treatment.net

Alcohol Treatment Atlanta Update on Vivitrol

Posted on 2 February 2012

In our Alcohol Treatment Program, WellStep Atlanta. located in Roswell, Georgia, utilizes Vivitrol (naltrexone) as one of several medications that help reduce alcohol cravings. Since Vivitrol is still relatively new and not very familiar to most people, some information on this drug is provided here:

What is Vivitrol? Vivitrol is an injectable form of naltrexone, an opiate blocker, that has a one month duration of action.
What is Vivitrol used for? According to the official prescribing information, “Vivitrol is indicated for the treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment with VIVITROL. Patients should not be actively drinking at the time of initial Vivitrol administration ” In other words, Vivitrol is designed for patients who still have cravings after stopping drinking. (Vivitrol has also shown to reduce the number of “heavy drinking days” so the medication may be effective for “binge drinkers” as well.)
How does Vivitrol work? From the official prescribing information: “The neurobiological mechanisms responsible for the reduction in alcohol consumption observed in alcohol-dependent patients treated with naltrexone are not entirely understood. However, involvement of the endogenous opioid system is suggested by preclinical data." In other words, how Vivitrol works is not entirely understood. But scientists feel it may affect the “reward system” by working as an opiate blocker, so that alcohol does not produce the same pleasurable action as previously.
Where is this shot given? The injection is intramuscular and is given in the gluteal area.
Who cannot take Vivitrol?
Patients with acute hepatitis or liver failure
Patients receiving opioid analgesics
Patients with current physiologic opioid dependence
Patients in acute opioid withdrawal
Any individual who has failed the naloxone challenge test or has a positive urine screen for opioids
Patients with an allergy to carboxymethylcellulose, or any other components of the diluent
Is Vivitrol expensive? Yes, however most health insurance plans appear to be covering Vivitrol at the moment.
For more information on Vivitrol, visit www.Vivitrol.com . For specific questions on how Vivitrol is used at WellStep Atlanta, please visit www.WellStep.com

Suboxone and Pain Management

Posted on 27 December 2011
Many patients coming to our WellStep Atlanta for treatment have ongoing pain issues. Fortunately, buprenorphine(Suboxone/Subutex) can be very helpful in managing moderate to moderately severe pain. A new study published in the Annals of Emergency Medicine (November 25, 2011) found that for adults with acute bone fractures, a sublingual dose of buprenorphine relieves pain as effectively as intravenous morphine. Adverse effects were similar with both treatments, although more patients developed hypotension (low blood pressure) with morphine. Buprenorphine has been approved for pain management by regulatory agencies in many European countries and a buprenorphine patch now has an FDA indication for pain.

What are the Success Rates On Buprenorphine Treatment and Afterwards?

Posted on 20 December 2011
A study published this month in the Archives of General Psychiatry has shed some light on this question. In the study, entitled, “Adjunctive Counseling During Brief and Extended Buprenorphine-Naloxone Treatment for Prescription Opioid Dependence: A 2-Phase Randomized Controlled Trial” , more than 600 treatment-seeking outpatients addicted to prescription opioids received Suboxone in combination with brief standard medical management, in which physicians evaluated treatment effectiveness and recommended abstinence and self-help participation. Results showed that approximately 49 percent of participants reduced prescription painkiller abuse during extended (at least 12-week) Suboxone treatment. The success rate dropped to 8.6 percent once Suboxone was discontinued. At WellStep Atlanta, we often prescribe Revia or Vivitrol (naltrexone), an opiate blocker, after patients are tapered off Suboxone . A waiting period of at least 10 days after discontinuing Suboxone is necessary before starting naltrexone. The use of naltrexone after Suboxone treatment has helped our patients tremendously in avoiding relapse through reduction of opiate cravings and blocking impulsive use of opiates.

New Protocol For Opiate Detox Using Suboxone

Posted on 5 September 2011

 

The most popular treatment for opiate addiction (pain pill dependence) involves the use of buprenorphine (Suboxone or Subutex) to help patients comfortably detox from the addictive medications. Most patients choose to stay on Suboxone for over a few weeks. However,  while it is easier to come off Suboxone than most pure opiates, there are withdrawal symptoms from Suboxone even after only a few weeks unless the dose is tapered down very slowly.  Even when the Suboxone dose is reduced slowly, there are often some symptoms of anxiety, restlessness or cravings.

 

For patients not wanting to become dependent on Suboxone, WellStep Atlanta has developed a protocol for a unique one week detox program. Patients are prescribed low doses of Suboxone as well as medications to reduce anxiety, restlessness, aches/pains, and nausea. The most helpful medication is neurontin, a medication which is  FDA approved for seizure disorders but which is also useful for anxiety and restlessness. Zofran or phenergan may be used for nausea. Occasionally small doses of other anti-anxiety medications, such as chlordiazepoxide (Librium), are prescribed under closely monitored conditions for carefully selected patients. Medications to aid sleep such as Trazodone may also be prescribed.

 

Detox for opiate addiction using this new protocol requires that the patient not drive or operate  hazardous machinery. In addition, we recommend that patients take time off from work or school since they may still experience some withdrawal symptoms as well as sleepiness from medications.

 

In addition to the advantage of not becoming dependent on Suboxone, this protocol will allow patients to detox while saving on the costs of buprenorphine, a very expensive medication.

Alcohol Treatment: Outpatient or Inpatient Detox?

Posted on 31 July 2011

               For very heavy drinkers, stopping alcohol suddenly can cause a wide range of symptoms, from mild to life threatening, including seizures and delirium tremens (DT’s). Yet it is often very difficult to taper alcohol slowly, even with the anti-craving medication available today.

               Alcohol detox programs allow patients to discontinue alcohol completely and safely while controlling unpleasant withdrawal symptoms. This is done through the use of medications such as benzodiazepines (ie, diazepam and lorazepam) or through the use of carbamazepine (Tegretol), which is FDA approved for seizure control but very effective in controlling alcohol withdrawal symptoms as well.

               Most patients can go through alcohol detox on an outpatient basis, without the expense and inconvenience of hospitalization. However, other times hospitalization is necessary for closer monitoring and care. Factors that would favor outpatient alcohol treatment are: cooperative patient, able to be monitored 24/hours a day by a responsible adult, no severe, acute medical conditions, and no severe, coexisting psychiatric disorders. Factors that would weigh against outpatient detoxification are: uncooperative patient, lives alone with no close relatives or individuals available for monitoring, and acute or unstable medical and/or psychiatric problems. In addition, outpatient alcohol treatment is usually not warranted if there have been seizures, DT’s or other severe withdrawal symptoms in the past. If a patient is already in withdrawal, a withdrawal assessment scale (CIWA-Ar) is used by the clinician to help decide if the situation can be safely handled on an outpatient basis.

               At WellStep’s outpatient, office-based program, the patient comes in for an initial assessment and to be prescribed appropriate medications to get him or her comfortably through the next week without any alcohol. The patient is seen daily for at least 4-5 consecutive days for withdrawal and vital sign assessment and medication adjustments. A responsible adult is required to drive the patient and to stay with the patient at home during this time in order to call for immediate medical attention if necessary. After the detox period is complete, the patient will usually take medications that are FDA approved for alcohol cravings (ie, acamprosate and naltrexone) and begin counseling to learn techniques to stay sober and avoid relapse.

               Outpatient alcohol detox is safe, effective and low cost. For the majority of heavy drinkers who need alcohol treatment, this is a great way to start a successful recovery program. Please visit http://www.wellstep.com/atlantaalcoholtreatment.php for more information.

 

Adult Adhd Treatment in 2011- An Update

Posted on 23 July 2011

               At our new Atlanta Center for Adult ADHD, we utilize proven, effective medication for ADHD. In 2011, there are five medications which are FDA approved for Adult ADHD: Extended-release mixed amphetamine salts (Adderal XR), lisdexamfetamine (Vyvanse), OROS methyphenidate (Concerta), extended release methylphenidate (Focalin XR), and atomoxetine (Straterra). These are all long acting medications. 
               The first four medications are stimulants, which are generally felt to be more “robust” (more effective) than Straterra. However, Straterra would be preferable in cases of past stimulant abuse, when stimulants cannot be used for certain health reasons, and when the patient just does not want to take a stimulant class medication. Although Straterra takes 4-5 weeks to achieve a high enough blood level, it eventually provides 24 hour ADHD coverage.
               Bupoprion (Wellbutrin) is a non-FDA approved medication that can be used in many cases of ADHD when stimulants or Straterra cannot be taken.
               Stimulants can be divided into two groups, amphetamines and methylphenidate. 
               Adderal XR and Vyvanse are considered amphetamines and Concerta and Focalin belong to the methylphenidate class. Some patients do better with amphetamines and some with methylphenidate. Other patients do equally well with either medication. In my experience, amphetamines are better tolerated as far as side effects than methylphenidate so I usually start patients with an amphetamine class medication. Since there are many health conditions that would prevent safe use of stimulants, such as certain types of heart disease, abnormal heart beat, history of mania or psychosis, seizure disorder, untreated hyperthyroidism, untreated drug abuse, or glaucoma, it is important for you and your doctor to discuss all current and past medical problems before starting a stimulant. 
               Duration of action of the long acting stimulants varies in each patient. In general, Adderal XR lasts about 12 hours, Vyvanse lasts about 12+ hours, Focalin XR lasts about 10-12 hours and Concerta lasts about 10-12 hours. If longer action is needed, a short-acting stimulant can be added although insomnia can result from taking a stimulant to late in the day.                
               Since it is difficult to predict which stimulant will best improve the ADHD symptoms and have the least side effects, trying more than one medication is often helpful.

Atlanta Center for Adult ADHD Opens

Posted on 15 July 2011

We are happy to announce the opening of the Atlanta Center for Adult ADHD at our Roswell office, offering state of the art medical and behavioral treatment for this condition. Dr. Banov is especially interested in ADHD and has participated in FDA regulated ADHD trials as a Clinical Investigator. Attention Deficit Disorder is a common condition among children and adolescents and has been diagnosed with increasing frequency among adults as well. Research shows that up to 60% of children with ADHD continue to have symptoms through adolescence and into adulthood. In addition, studies have shown that individuals with untreated ADHD have a much higher rate of substance abuse problems. Here at WellStep, we have seen a high rate of untreated ADHD in our patients being seen for substance or addiction problems. Symptoms of Adult ADHD can include difficulty paying close attention to details, making careless mistakes, finding it hard to organize activities or finish a task, having difficulty following instructions or conversations and being forgetful in daily activities as well as frequently losing things. Some adults with ADHD are quite restless and fidgety. ADHD diagnosis involves clinical evaluation, behavioral testing and the Quotient ADHD System, a computerized device that accurately measures motion and shifts in attention. The test takes 20 minutes for adolescents and adults. Treatment of ADHD usually involves medication, either stimulant (such as Dexedrine or methyphenidate) or non-stimulant (such as amoxetine). We also offer ADHD coaching and cognitive therapy. We look forward to helping many adults in the Atlanta area dramatically improve their quality of life with effective ADHD treatment at our new center.