508- Combination Therapy: Medication Strategies for Hard-to-Treat Complex ADHD
Jun 25, 2024
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Dr. Timothy Wilens discusses new ADHD medications and strategies for complex cases, including combination therapy. Topics include managing coexisting conditions, medication options, challenges in children, medication shortages impact, anxiety management, heart rate concerns, and OCD treatment strategies.
Managing complex ADHD involves combination therapy with stimulant and non-stimulant medications.
Individualized medication dosing and formulations are crucial for effective ADHD treatment.
Addressing comorbid conditions like anxiety, mood disorders, and eating disorders is essential in ADHD management.
Deep dives
Overview of Complex ADHD and Coexisting Conditions
Complex ADHD, when individuals have one or more coexisting conditions like depression, anxiety, mood disorders, and autism, was discussed. Treating these diagnoses with medications, including stimulant medications, atomoxetine, and alpha agonists like guanfenesin extended release, was highlighted.
Medication Strategies for ADHD Treatment
Various medications for ADHD treatment, such as stimulant medications like methylphenidate and amphetamine class agents, were explored. The importance of adjusting medication doses based on individual response and considering different formulations like short-acting and long-acting preparations was emphasized.
Managing Comorbid Conditions and Refractory Cases
The need to address comorbid conditions alongside ADHD, such as mood disorders, anxiety, and bipolar disorder, was discussed. Treatment approaches included using non-stimulants like Straterra, combination therapies, and medication adjustments based on individual needs.
Treatment Considerations for Emotional Dysregulation and Frustration
For individuals experiencing emotional dysregulation and frustration associated with ADHD, treatment options included psychotherapy, resiliency training, and cognitive behavioral therapy. Additionally, pharmacological interventions like beta blockers and tricyclic antidepressants were recommended.
Addressing Co-occurring Eating Disorders and ADHD
The intersection of eating disorders and ADHD, especially in cases with high-risk behaviors, was addressed. Treatment strategies involved first addressing the eating disorder and then considering medication options that can help manage both conditions effectively, with medications like Vyvanse being potentially beneficial.
Managing OCD and ADHD Coexistence
Strategies for addressing OCD and ADHD coexistence included utilizing serotonin-specific reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors to treat OCD. Managing ADHD after stabilizing OCD was recommended, with treatment adjustments based on the individual's response to medication combinations.
Timothy Wilens, M.D., discusses new medications approved for ADHD and strategies to manage hard-to-treat and complex ADHD (attention deficit disorder plus at least one comorbid condition), including the use of a stimulant and nonstimulant medication.
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