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dateTime="2024-11-13T20:05:34.845">November 13, 2024</time></div><h1 class="text-[26px] font-medium leading-8">The Cumulative Risks of ADHD</h1><div class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/peter-s-jensen-md">Peter S. Jensen, MD</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit my-2"></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="The Cumulative Risks of ADHD" aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#3b5998"></circle><path d="M34.1,47V33.3h4.6l0.7-5.3h-5.3v-3.4c0-1.5,0.4-2.6,2.6-2.6l2.8,0v-4.8c-0.5-0.1-2.2-0.2-4.1-0.2 c-4.1,0-6.9,2.5-6.9,7V28H24v5.3h4.6V47H34.1z" fill="white"></path></svg></button><button aria-label="twitter" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg fill="#DC7633" xmlns="http://www.w3.org/2000/svg" width="32" zoomAndPan="magnify" viewBox="0 0 375 374.9999" height="32" preserveAspectRatio="xMidYMid meet" version="1.0"><defs><path d="M 7.09375 7.09375 L 367.84375 7.09375 L 367.84375 367.84375 L 7.09375 367.84375 Z M 7.09375 7.09375 " fill="#000000"></path></defs><g><path d="M 187.46875 7.09375 C 87.851562 7.09375 7.09375 87.851562 7.09375 187.46875 C 7.09375 287.085938 87.851562 367.84375 187.46875 367.84375 C 287.085938 367.84375 367.84375 287.085938 367.84375 187.46875 C 367.84375 87.851562 287.085938 7.09375 187.46875 7.09375 " fill-opacity="1" fill-rule="nonzero" fill="#000000"></path></g><g transform="translate(85, 75)"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" version="1.1" height="215" width="215"><path d="M18.244 2.25h3.308l-7.227 8.26 8.502 11.24H16.17l-5.214-6.817L4.99 21.75H1.68l7.73-8.835L1.254 2.25H8.08l4.713 6.231zm-1.161 17.52h1.833L7.084 4.126H5.117z" fill="#ffffff"></path></svg> </g></svg></button><button aria-label="linkedin" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#007fb1"></circle><path d="M20.4,44h5.4V26.6h-5.4V44z M23.1,18c-1.7,0-3.1,1.4-3.1,3.1c0,1.7,1.4,3.1,3.1,3.1 c1.7,0,3.1-1.4,3.1-3.1C26.2,19.4,24.8,18,23.1,18z M39.5,26.2c-2.6,0-4.4,1.4-5.1,2.8h-0.1v-2.4h-5.2V44h5.4v-8.6 c0-2.3,0.4-4.5,3.2-4.5c2.8,0,2.8,2.6,2.8,4.6V44H46v-9.5C46,29.8,45,26.2,39.5,26.2z" fill="white"></path></svg></button><button title="The Cumulative Risks of ADHD" aria-label="pinterest" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#cb2128"></circle><path d="M32,16c-8.8,0-16,7.2-16,16c0,6.6,3.9,12.2,9.6,14.7c0-1.1,0-2.5,0.3-3.7 c0.3-1.3,2.1-8.7,2.1-8.7s-0.5-1-0.5-2.5c0-2.4,1.4-4.1,3.1-4.1c1.5,0,2.2,1.1,2.2,2.4c0,1.5-0.9,3.7-1.4,5.7 c-0.4,1.7,0.9,3.1,2.5,3.1c3,0,5.1-3.9,5.1-8.5c0-3.5-2.4-6.1-6.7-6.1c-4.9,0-7.9,3.6-7.9,7.7c0,1.4,0.4,2.4,1.1,3.1 c0.3,0.3,0.3,0.5,0.2,0.9c-0.1,0.3-0.3,1-0.3,1.3c-0.1,0.4-0.4,0.6-0.8,0.4c-2.2-0.9-3.3-3.4-3.3-6.1c0-4.5,3.8-10,11.4-10 c6.1,0,10.1,4.4,10.1,9.2c0,6.3-3.5,11-8.6,11c-1.7,0-3.4-0.9-3.9-2c0,0-0.9,3.7-1.1,4.4c-0.3,1.2-1,2.5-1.6,3.4 c1.4,0.4,3,0.7,4.5,0.7c8.8,0,16-7.2,16-16C48,23.2,40.8,16,32,16z" fill="white"></path></svg></button><button aria-label="email" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#7f7f7f"></circle><path d="M17,22v20h30V22H17z M41.1,25L32,32.1L22.9,25H41.1z M20,39V26.6l12,9.3l12-9.3V39H20z" fill="white"></path></svg></button><a class="print-wrap flex justify-center items-center cursor-pointer"><svg id="print" xmlns="http://www.w3.org/2000/svg" width="24" height="24" fill="currentColor" class="print bi bi-printer" viewBox="0 0 16 16"> <path d="M2.5 8a.5.5 0 1 0 0-1 .5.5 0 0 0 0 1z"></path> <path d="M5 1a2 2 0 0 0-2 2v2H2a2 2 0 0 0-2 2v3a2 2 0 0 0 2 2h1v1a2 2 0 0 0 2 2h6a2 2 0 0 0 2-2v-1h1a2 2 0 0 0 2-2V7a2 2 0 0 0-2-2h-1V3a2 2 0 0 0-2-2H5zM4 3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1v2H4V3zm1 5a2 2 0 0 0-2 2v1H2a1 1 0 0 1-1-1V7a1 1 0 0 1 1-1h12a1 1 0 0 1 1 1v3a1 1 0 0 1-1 1h-1v-1a2 2 0 0 0-2-2H5zm7 2v3a1 1 0 0 1-1 1H5a1 1 0 0 1-1-1v-3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1z"></path></svg></a></div><style> .print-wrap { width: 32px; height: 32px; background: #7F7F7F; border-radius: 100%; } .print { background: #7F7F7F; color: white; padding: 2px; border-radius: 100%; } </style></div></div></div></div><div class=" lg:w-full flex flex-col lg:flex-row lg:items-center lg:justify-end"></div><p class="py-2 mb-2 text-sm italic text-gray-600">ADHD doubles the rates of all-cause mortality. How can you best help patients?</p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class="relative"><div class="brightcove-fluid" autoplay=""></div></div><p class="pb-2">Peter S. Jensen, MD, discusses the startling reality of attention-deficit/hyperactivity disorder (ADHD): it doubles the rates of all-cause mortality. That is why he and colleagues at The REACH Institute provide hands-on support and guidance to help assess ADHD. </p><p class="pb-2"><strong>Dr Jensen</strong> <em>is president and CEO of</em> <em><a rel="nofollow" target="_self" href="http://www.thereachinstitute.org/">The REACH Institute</a>. He has previously served as the head of child psychiatry at the</em> <a rel="nofollow" target="_self" href="https://www.nimh.nih.gov/index.shtml"><em>National Institute of Mental Health</em></a> <em>and as director of Columbia University's Center for the Advancement of Children's Mental Health. He is also the author of over 300 peer reviewed articles and chapters and 20 books, and has received awards for his research, teaching, and child advocacy from many national organizations.</em></p></div></div><div class="flex items-center lg:w-3/4 mb-4 pb-12"></div><div class="jsx-19ede9f0a5a45918 py-4 relative bg-primary md:px-8 -ml-6 xs:ml-0 w-screen xs:w-auto"><div class="jsx-19ede9f0a5a45918 px-4 sm:px-0"><div class="flex justify-between items-center py-1 space-x-4 border-0 select-none sm:border-b border-secondary"><div class="text-3xl text-white text-lg sm:text-3xl">Related Videos</div></div></div><div style="scroll-snap-type:none" class="jsx-19ede9f0a5a45918 flex items-start overflow-x-auto space-x-4 py-4 relative mx-auto w-full pl-4"><a id="" class="w-[200px] h-fit space-y-3 flex-none select-none no-underline" style="scroll-snap-align:center;text-decoration:none" href="/view/are-you-attending-the-2024-apsard-conference"><div class="w-full shadow-md shadow-gray-800 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Jensen, MD, discusses the startling reality of attention-deficit/hyperactivity disorder (ADHD): it doubles the rates of all-cause mortality. That is why he and colleagues at The REACH Institute provide hands-on support and guidance to help assess ADHD. \n\nDr Jensen is president and CEO of The REACH Institute. He has previously served as the head of child psychiatry at the National Institute of Mental Health and as director of Columbia University's Center for the Advancement of Children's Mental Health. He is also the author of over 300 peer reviewed articles and chapters and 20 books, and has received awards for his research, teaching, and child advocacy from many national organizations.","description":"ADHD doubles the rates of all-cause mortality. How can you best help patients?","author":[{"@type":"Person","name":"Peter S. Jensen, MD"}]}</script></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-5V9L5PL" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><div id="footerOuterWrap" class="w-full bg-primary flex flex-col items-center justify-center"><div class="container w-[1340px]"><div id="footerInnerWrap" class="bg-primary w-full py-12"><div class="py-4 pl-4 flex flex-row items-center"><div class="flex flex-row flex-wrap w-[55%] h-full"><div class="w-[33%] p-1 my-0 cursor-pointer text-footer-text-color hover:text-footer-text-color/80 hover:underline"><a class="text-md" target="_self" href="/about">About</a></div><div 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New guidelines for managing this disorder are anticipated. Dr. Peter S. Jensen, a prominent figure in child psychiatry and president of The REACH Institute, emphasizes the importance of addressing adult ADHD. With an extensive background in research and advocacy, Dr. Jensen has contributed significantly to the field through numerous publications and leadership roles, underscoring the need for comprehensive mental health assessments.","factCheckAuthorMapping":null,"_rev":"jzkAB1BdluwaE1Zy3px4Fv","_createdAt":"2024-11-08T15:38:25Z","_id":"8d20649a-89a7-44cb-8e94-17662168d06d","gptTakeaways":"• Adult ADHD is gaining recognition as a major issue in psychiatry, necessitating its inclusion in routine screenings. \n\n• New guidelines for adult ADHD management are expected to be released soon, highlighting its growing importance.\n\n• Dr. Peter S. Jensen, a leader in child psychiatry, advocates for addressing adult ADHD alongside other mental health concerns.\n\n• Dr. Jensen's extensive contributions to psychiatry include over 300 peer-reviewed articles and numerous leadership roles.","thumbnail":{"_type":"mainImage","alt":"adult ADHD","caption":"Aninka/AdobeStock","asset":{"_ref":"image-a4170721b434dcbfcb8faf3b905bd42aece270c9-5616x3744-jpg","_type":"reference"}},"drugMentions":"{\"drug_mentions\": []}","url":"adult-adhd-its-time-to-think-outside-the-box","authorMapping":[{"_rev":"GksL79ka788Sw0D3X9XIJ7","_updatedAt":"2024-11-08T15:48:12Z","_type":"author","_id":"56a5699f-9a89-4285-a4c1-bdce2a3be20e","biography":[{"_key":"8ce6a6824c54","markDefs":[{"blank":true,"_type":"link","href":"http://www.thereachinstitute.org/","_key":"7c687b0226b8"},{"blank":true,"_type":"link","href":"https://www.nimh.nih.gov/index.shtml","_key":"2df6e4993d91"}],"children":[{"_key":"a8eec3bab7850","_type":"span","marks":["strong"],"text":"Dr Jensen"},{"_type":"span","marks":[],"text":" ","_key":"44195c7d9ebd"},{"text":"is president and CEO of ","_key":"ba6da17be5f1","_type":"span","marks":["em"]},{"_type":"span","marks":["7c687b0226b8","em"],"text":"The REACH Institute","_key":"a8eec3bab7851"},{"text":". He has previously served as the head of child psychiatry at the ","_key":"a8eec3bab7852","_type":"span","marks":["em"]},{"text":"National Institute of Mental Health","_key":"a8eec3bab7853","_type":"span","marks":["2df6e4993d91","em"]},{"text":" and as director of Columbia University's Center for the Advancement of Children's Mental Health. He is also the author of over 300 peer reviewed articles and chapters and 20 books, and has received awards for his research, teaching, and child advocacy from many national organizations.","_key":"a8eec3bab7854","_type":"span","marks":["em"]}],"_type":"block","style":"normal"}],"url":{"current":"peter-s-jensen-md","_type":"slug"},"authorType":"author","displayName":"Peter S. Jensen, MD","_createdAt":"2024-11-08T15:48:12Z"}],"ExcludeFromPubMedXML":false,"_updatedAt":"2024-11-08T19:16:09Z","published":"2024-11-08T18:00:51.723Z","authors":[{"displayName":"Peter S. 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Magavi, Regional Medical Director for ","_key":"5b621f182f6f0"},{"_type":"span","marks":["8db6b66718ab"],"text":"Community Psychiatry","_key":"5b621f182f6f1"},{"_key":"5b621f182f6f2","_type":"span","marks":[],"text":", in Newport Beach, CA."}],"_type":"block","style":"normal","_key":"5b621f182f6f"},{"style":"normal","_key":"36ac25f77d65","markDefs":[],"children":[{"_key":"36ac25f77d650","_type":"span","marks":["em"],"text":"Transcript abbreviated and edited and clarity. Listen to the podcast for complete information. Identities of patients discussed are obscurred and do not point to any one individual. They are for illustrative purposes only. -Ed"}],"_type":"block"},{"markDefs":[],"children":[{"marks":["strong"],"text":"Laurie Martin (LEM): Welcome, Dr. Magavi. Tell us about yourself.","_key":"e3308c4bbecf0","_type":"span"}],"_type":"block","style":"normal","_key":"e3308c4bbecf"},{"_type":"block","style":"normal","_key":"7eb239fa975c","markDefs":[],"children":[{"text":"Leela Magavi, MD:","_key":"7eb239fa975c0","_type":"span","marks":["strong"]},{"marks":[],"text":" Thank you for inviting me to speak today. I am a child, adolescent, and adult psychiatrist and regional medical director for Community Psychiatry, a California-based company committed to providing affordable, compassionate and evidence-based care to individuals of all backgrounds. I completed my adult psychiatry residency at Georgetown University, and my child psychiatry fellowship at Johns Hopkins. I currently practice in Newport Beach, CA, but my patients reside in various parts of California, from San Francisco to San Diego. As Regional Medical Director, I have the opportunity to work closely with several physicians and clinicians practicing throughout Southern California. In my spare time, I enjoy watching movies, eating my husband’s amazing, home-cooked meals, and spending time with my parents and younger sister.","_key":"7eb239fa975c1","_type":"span"}]},{"children":[{"_type":"span","marks":["strong"],"text":"LEM: What prompted you to pursue a career in child psychiatry? And why do you think medical students and residents should consider pursuing this field?","_key":"d9f37315f0560"}],"_type":"block","style":"normal","_key":"d9f37315f056","markDefs":[]},{"_key":"1992690c8ef4","markDefs":[],"children":[{"text":"Leela Magavi, MD:","_key":"1992690c8ef40","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":" I would highly recommend that medical students and residents consider pursuing a career in child psychiatry. I thoroughly enjoy practicing child and adolescent psychiatry. Other than my unwavering love for children, the reasons are countless.","_key":"1992690c8ef41"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":[],"text":"My father always says, “Everything you need to know you learned in kindergarten.” I always laugh, but I found truth in this statement throughout medical school and residency. I strive to comprehend the origin of patients’ fears. I have realized that many conflicts are rooted in people’s childhoods, and I focus on this during sessions. Lamentably, some patients have never received psychiatric care, although they desperately needed it. I hope to provide early, preventative care to as many children as I can, a privilege that I wholeheartedly embrace. My training in child and adolescent psychiatry has helped me provide better, comprehensive care for my adult patients. Furthermore, I enjoy the team approach warranted to help children and adolescents. When parents, teachers, physicians and members of the community come together, these children do get better, which is an irrefutably beautiful thing.","_key":"0e3a1f4daf9e0","_type":"span"}],"_type":"block","style":"normal","_key":"0e3a1f4daf9e"},{"children":[{"_type":"span","marks":["strong"],"text":"LEM: ADHD is used so casually in pop culture and the media, and in some areas of the country, having a child with ADHD is almost akin to having an Honors Student. What are your thoughts regarding this?","_key":"0720f1dd917e0"}],"_type":"block","style":"normal","_key":"0720f1dd917e","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"3c3de410752e0"},{"_type":"span","marks":[],"text":" ADHD, like many psychiatric disorders such as OCD and bipolar disorder, are used very loosely in day-to-day dialogue. You may be walking down the street, and overhear someone say, “My ADHD is so bad! I can’t stop scrolling through Instagram during my Zoom team meeting!” or someone else say “My mood is all over the place! I’m probably bipolar or something.” Many individuals have intermittent, waxing, and waning symptomatology, which does not cause any distress or decline in functionality. The truth is, all of us have times during which we experience inattentiveness. In fact, during this podcast, our listeners may have already lost their focus, or we may lose our train of thought, but this is simply normal human tendency, and it does not mean we have a clinical diagnosis such as ADHD. In training, it is important to learn and understand normal human behaviors and tendencies to avoid pathologizing normal human behavior or medicating unnecessarily. ","_key":"3c3de410752e1"}],"_type":"block","style":"normal","_key":"3c3de410752e","markDefs":[]},{"markDefs":[],"children":[{"_key":"2a16805e6a460","_type":"span","marks":["strong"],"text":"LEM: How often do you see patients who don’t necessarily meet the diagnostic criteria of ADHD? Do they have other diagnoses, and if so what are these? How do you counsel these parents and patients and address these concerns?"}],"_type":"block","style":"normal","_key":"2a16805e6a46"},{"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"3d443d9f8d460"},{"_type":"span","marks":[],"text":" I enjoy evaluating and treating individuals with various psychiatric diagnoses, but particularly enjoy working with children and adults with autism, ADHD, mood and anxiety disorders. Many children present with a chief complaint of ADHD. Quite a few children and adolescents who carry a diagnosis of ADHD from prior assessments or appear to have symptoms of ADHD do not, in fact, have ADHD. ","_key":"3d443d9f8d461"}],"_type":"block","style":"normal","_key":"3d443d9f8d46","markDefs":[]},{"style":"normal","_key":"3dbcc7cfd48d","markDefs":[],"children":[{"marks":[],"text":"I have encountered many situations in which parents have unrealistic expectations. However, this is a product of systemic changes that have promoted a very competitive schooling atmosphere. It is no longer enough to earn straight A’s or ace the SATs. Let me give you an example. Mary comes home from school and needs to complete a few hours of homework and studying followed by swim practice followed by piano practice followed by a few more homework assignments. Mary repeats this schedule on a daily basis, and becomes demoralized and frustrated. She begins to avoid her friends and family. Her inattentiveness becomes evident to her parents and teachers, and her grades begin to plummet, and her school refers her family to me. In situations like these, I discuss expectations and counsel the family to support the child or teen’s wellness. Mary may be demoralized or depressed. Providing a stimulant may only exacerbate her anxiety, and thereby, worsen her depression. The treatment would involve therapy and possibly an SSRI if warranted. This may even involve redistributing tasks, taking a break from an extracurricular activity, and prioritizing sleep and wellness activities.","_key":"3dbcc7cfd48d0","_type":"span"}],"_type":"block"},{"_type":"block","style":"normal","_key":"1f3e29a86035","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: What are some other prevalent disorders you often see?","_key":"1f3e29a860350"}]},{"markDefs":[],"children":[{"marks":["strong"],"text":"Leela Magavi, MD:","_key":"ec0e6f5f57c60","_type":"span"},{"_type":"span","marks":[],"text":" Oppositional defiant disorder is a prevalent condition. For example, Charlie, presents with verbal aggression and sometimes physical aggression when his father asks him to turn the television off or when his baseball coach gives him feedback. Charlie fares well in school, but is very oppositional toward multiple authority figures. Charlie would benefit from behavioral therapy or parent management training for oppositional defiant disorder. Charlie does not have ADHD, and a medicine would not be helpful. In such cases, when I have shared this information with patients, they have sometimes expressed sadness or frustration about the diagnosis. ","_key":"ec0e6f5f57c61"}],"_type":"block","style":"normal","_key":"ec0e6f5f57c6"},{"_key":"d2e32606db8d","markDefs":[],"children":[{"text":"Many parents present to me hoping their children have ADHD when they do not. You may wonder why they would hope this were the case. Parents, understandably, can experience burnout and fatigue, and look to us physicians to expedite change and provide help. Therapy can take time to work, and medicine sometimes seems like a quick fix. I have open and candid discussions with parents to set expectations and reiterate that there is no magic pill or instant solution.","_key":"d2e32606db8d0","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"children":[{"text":"What I explain to parents is that medicines do not change behavior. Likewise, medicines do not make homework seem more interesting than Fortnite or Call of Duty. Medicine does not simply result in improved grades. Overall, it is pivotal that we have open conversations, and answer questions about the avenues of treatment and the risk of medicating when medication is not warranted.","_key":"acd556d0a4980","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"acd556d0a498","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: What can you say about anxiety in children?","_key":"1375beb4d98c0"}],"_type":"block","style":"normal","_key":"1375beb4d98c"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"5adf36c7ecad0"},{"_type":"span","marks":[],"text":" Anxiety is often misdiagnosed as ADHD as the features overlap. In fact, anxiety is what child and adult psychiatrists see the most in clinic. I evaluate individuals of all ages, and most of my patients see me for anxiety. Anxiety can present as inattentiveness, restlessness, impulsivity and irritability. For example, Sheila presents with restlessness and perfectionistic tendencies. She procrastinates and puts off tasks due to fear of failure. She appears fidgety and nervous in class, and asks her teachers and parents to repeat themselves. ","_key":"5adf36c7ecad1"}],"_type":"block","style":"normal","_key":"5adf36c7ecad"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Sheila has generalized anxiety disorder. Once her anxiety is treated, these symptoms resolve, and her school performance improves. Other kids like Sheila may present with concerns about ADHD, but actually are experiencing symptoms of depression, which can cause increased processing speed and impaired working memory, and thus, affect cognition and academic performance. Similarly, after treating depression, inattentiveness and what appeared to be ADHD symptoms, improve.","_key":"50177eac14530"}],"_type":"block","style":"normal","_key":"50177eac1453"},{"_key":"221670c2894c","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: What are some common comorbidities, and how would you tackle these concerns in the clinic?","_key":"221670c2894c0"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"2e33d01eacf00"},{"_key":"2e33d01eacf01","_type":"span","marks":[],"text":" ADHD often presents with various comorbid disorders inclusive of anxiety, depression and bipolar disorder. In these cases, once the mood and anxiety disorder is stabilized, and if ADHD symptoms continue to impair functionality, a medication for ADHD can be started. In cases where kids have ADHD and ODD, kids would benefit from a combination of therapy and stimulants. In cases where kids have ADHD and tic disorder, they may benefit from habit reversal therapy, an alpha agonist for tics, impulsivity and hyperactivity, and possibly a stimulant as well. "}],"_type":"block","style":"normal","_key":"2e33d01eacf0","markDefs":[]},{"children":[{"_key":"3e87a74e23aa0","_type":"span","marks":["strong"],"text":"LEM"},{"_type":"span","marks":[],"text":": ","_key":"3e87a74e23aa1"},{"_type":"span","marks":["strong"],"text":"Any take-home messages about how ADHD presents in real-world experience that show how treatment can make a significant difference in a child’s life?","_key":"3e87a74e23aa2"}],"_type":"block","style":"normal","_key":"3e87a74e23aa","markDefs":[]},{"_key":"d4281f85406a","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"d4281f85406a0"},{"_type":"span","marks":[],"text":" The take-home is when a child truly has ADHD and he or she receives treatment, the results are evident and life-changing for everyone involved. I have had the invaluable opportunity to treat Mark, a seven-year-old boy suffering from ADHD. During play therapy, I have learned that the reason he often gets angry at school is because he is tired of other children teasing him about “not reading good.” During another session, he used toy cars to share his goal with me, exclaiming, “I want to be a police officer one day!” As Mark improved with weekly therapy and treatment with Focalin extended release or dexmethylphenidate, a stimulant medication, he gained confidence. This experience was particularly memorable and rewarding.","_key":"d4281f85406a1"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: Older adolescents and young adults have been known to abuse ADHD medications to help improve their studying stamina and grades. Besides being illegal, what are some of the dangers associated with this practice?","_key":"df49158136850"}],"_type":"block","style":"normal","_key":"df4915813685"},{"_type":"block","style":"normal","_key":"93a337bc2faf","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"93a337bc2faf0"},{"_type":"span","marks":[],"text":" Each year, academic expectations build. The competition is real and appears to be increasing relentlessly. It is harder and harder to get into colleges. Even kindergarten and first grade seem harder than they ever used to be. Teens and young adults often use their peers’ ADHD medications, or illegally purchase them to gain a competitive advantage, or use them recreationally. Some individuals even take stimulants solely to stay up later because they have so much to finish and so little time.","_key":"93a337bc2faf1"}]},{"children":[{"_type":"span","marks":[],"text":"The truth of the matter is, when someone does not have ADHD, they may not benefit significantly from taking a stimulant. They may feel more energetic, but the data from pilot studies have suggested that cognition itself may not improve. We do not completely understand the dangers associated with use of stimulants in someone who does not have ADHD as ethical concerns limit our ability to study this. Some of my patients who have admitted to using stimulants without a diagnosis of ADHD have experienced concerns including weight loss, anxiety, depression, psychosis, insomnia, hypertension, and other cardiac concerns. I want to encourage all listeners to spread awareness and encourage friends and loved ones to be evaluated by a physician prior to trying medications.","_key":"fbbe113551250"}],"_type":"block","style":"normal","_key":"fbbe11355125","markDefs":[]},{"style":"normal","_key":"bc181e29b22a","markDefs":[],"children":[{"marks":[],"text":"Stimulants can cause myocardial infarction, cardiomyopathy, and even sudden death. Although the risk is low, it is not worth taking. Patients with a personal or family history of cardiac events may require further work-up prior to initiating medications. Due to addiction concerns, some parents do not want their children who have ADHD to take medications. As opposed to those who do not have ADHD, for kids who do have ADHD, we have large, validated studies which indicate the significant and helpful effect of stimulants. Long-term studies suggest that treating ADHD reduces unemployment, divorce and addiction concerns longitudinally.","_key":"bc181e29b22a0","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: ADHD treatment options have come a long, and now include various formulations, long-acting dosing, patches, and even a video interface. How should clinicians decide what medications to prescribe to their patients?","_key":"3ebca9ee93aa0"}],"_type":"block","style":"normal","_key":"3ebca9ee93aa"},{"markDefs":[],"children":[{"text":"Leela Magavi, MD:","_key":"f0c525ee36750","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":" It is important to comprehensively assess the child and learn about his or her genetic predisposition, temperament, behavior and life story prior to selecting a medication. There are many options, and new agents continue to gain approval. For children who are young and primarily impulsive and hyperactive, and if really warranted due to functional impairment, I may consider using an alpha agonist such as clonidine extended release also known as Kapvay, or guanfacine extended release also known as Intuniv. These are blood pressure medications. I often use these alongside stimulants as it allows the use of lower stimulant doses.","_key":"f0c525ee36751"}],"_type":"block","style":"normal","_key":"f0c525ee3675"},{"_type":"block","style":"normal","_key":"561fd504fbce","markDefs":[],"children":[{"text":"Alpha agonists do not target inattention as well as stimulants do, and I explain this to parents who prefer nonstimulant options. Other nonstimulant options are Wellbutrin also known as bupropion, which is an antidepressant, and atomoxetine also known as Strattera, which is a selective norepinephrine reuptake inhibitor, also helpful for anxiety. The common stimulant families are methylphenidates and amphetamines. I always start with methylphenidates, and then transition to amphetamines if warranted due to side effect profiles. I use long-acting agents and add on immediate release if warranted for longer duration of action. Patches, liquid formulations and some capsules are helpful when kids have difficulty swallowing. Lisdexamfetamine or Vyvanse is an option for those who have a history of substance use as this medication is metabolized differently, and decreases addiction potential.","_key":"561fd504fbce0","_type":"span","marks":[]}]},{"children":[{"marks":[],"text":"I think it’s wonderful that we are learning more and more about the brain and medications that could help these children. I’m very grateful to my colleagues who are partaking in research and helping us answer these questions. Most recently, which I am delighted to share with parents and listeners, we have learned that a videogame called Endeavor Rx, has been FDA approved for kids between ages 8 and 12 who have been diagnosed with ADHD. For those who are interested, you may join the online waitlist, made available by the developing company, Akili Interactive.","_key":"6605964aab220","_type":"span"}],"_type":"block","style":"normal","_key":"6605964aab22","markDefs":[]},{"style":"normal","_key":"740d652723b8","markDefs":[],"children":[{"marks":["strong"],"text":"LEM: Are there concrete tools or scales to help diagnose ADHD?","_key":"740d652723b80","_type":"span"}],"_type":"block"},{"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"c781ce68a6970"},{"_type":"span","marks":[],"text":" ADHD is a clinical diagnosis and symptoms need to be present in more than one setting. Scales and tools such as the Child Behavior Checklist, Conners-Wells, Vanderbilt, Swanson Nolan and Pelham are helpful, but not necessary for diagnosis. I view them as additional pieces of information, and occasionally, to monitor progress.","_key":"c781ce68a6971"}],"_type":"block","style":"normal","_key":"c781ce68a697","markDefs":[]},{"style":"normal","_key":"15f14613a2d6","markDefs":[],"children":[{"_key":"15f14613a2d60","_type":"span","marks":[],"text":"I personally use the Vanderbilt scale most often. I find it interesting to ask mom and dad to complete the Vanderbilt scale independently and compare their responses with the teachers. When the numbers align and are high, this is more indicative of ADHD. If the teacher’s scores are very high, but the parents’ scores are low, this may mean that the teacher needs more help in the classroom setting due to high student to teacher ratio, among other things. If the teacher’s scores are low, and the parents’ scores are high, it may mean that the child is exhibiting behavioral concerns at home for particular reasons. Sometimes, only one parent scores high, which may be due to a mismatch in temperament and personality traits."}],"_type":"block"},{"style":"normal","_key":"cf421e336077","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: Are CT, PET, EEG, and MRI reliable diagnostic tools for children?","_key":"cf421e3360770"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"b18578dd856d0"},{"_type":"span","marks":[],"text":" Brain imaging is not warranted for the diagnosis of ADHD. I rarely ever order it unless necessary for another reason. I may consider an EEG or MRI if I am concerned about epilepsy presenting like ADHD or absence seizures during which the child may appear to be staring into space when they are in fact having a seizure. Brain imaging may also be helpful in post-concussion syndrome in which individuals may have difficulty with inattentiveness and mental fatigue, and may benefit from a stimulant although they do not have ADHD.","_key":"b18578dd856d1"}],"_type":"block","style":"normal","_key":"b18578dd856d"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Nevertheless, brain imaging has helped us learn a lot about ADHD. Converging evidence from various imaging studies has helped us assess differences in brain volume, diffusion properties of white matter tracts, and cortical features in typically developing children compared to those with ADHD. Psychoradiology is a developing field and may help guide our treatment planning in the future.","_key":"071fafa784b50"}],"_type":"block","style":"normal","_key":"071fafa784b5"},{"markDefs":[],"children":[{"_key":"a825cba3465b0","_type":"span","marks":["strong"],"text":"LEM: Do you transition patients out of your care to a general psychiatrist?"}],"_type":"block","style":"normal","_key":"a825cba3465b"},{"_type":"block","style":"normal","_key":"3ac92d5f299c","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Leela Magavi, MD:","_key":"3ac92d5f299c0"},{"text":" Some child psychiatrists only evaluate and treat children, but I treat individuals of all ages and enjoy this diversity. I provide a mixture of medication management and therapy, and establish strong bonds with my patients. I always tell my adolescents that there’s no magic button that turns on and makes an eighteen-year-old instantly an adult. Every individual transitions into adulthood at a different pace. Being an adult is tough, and I evaluate patients at all ages who struggle with this transition. For this reason, I do not think child psychiatrists necessarily need to transition their patients to an adult psychiatrist.","_key":"3ac92d5f299c1","_type":"span","marks":[]}]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"LEM: We used to hear that children “grow out of” ADHD. Now, data show that adults can and do have the disorder. Is it possible to outgrow ADHD?","_key":"437543176f8f0"}],"_type":"block","style":"normal","_key":"437543176f8f"},{"_type":"block","style":"normal","_key":"e739231bca74","markDefs":[],"children":[{"marks":["strong"],"text":"Leela Magavi, MD:","_key":"e739231bca740","_type":"span"},{"marks":[],"text":" ADHD is essentially a neurodevelopmental disorder, which can affect individuals at any age. It is chronic in nature, but presentations vary at different life stages. The frontal lobe is the last to develop and mature, and there are many changes that occur with brain plasticity. For example, children display a decrease in symptoms of hyperactivity and impulsivity as they mature. Many children with ADHD still have the condition as adults, and are highly susceptible to other psychiatric disorders. I do evaluate adults who have never been diagnosed with ADHD as children who present to see me for the first time. Some of them experience impulsivity and have difficulty with relationships and work for this reason. Others who were diagnosed as children have relayed that their ADHD symptoms have evolved over time. It is pivotal for physicians to titrate down on medications as warranted and consider discontinuing medication if individuals are faring well off of them and when symptoms no longer affect functionality. In these cases, I like to take a conservative approach and recommend daily exercise, sleep hygiene techniques, and other behavioral strategies.","_key":"e739231bca741","_type":"span"}]},{"children":[{"_type":"span","marks":[],"text":"Finally, every individual with ADHD whom I have had the pleasure of treating has something special to offer. For my kids who ask me if this diagnosis means they are not smart, I remind them that this is not the case. Albert Einstein was suspected to have ADHD and as were other notable people, such as Walt Disney, and Michael Jordan. It is an honor to help kids struggling with ADHD as they grow to recognize their strengths and reach their full potential.","_key":"c4a1175098ca0"}],"_type":"block","style":"normal","_key":"c4a1175098ca","markDefs":[]}],"_createdAt":"2020-07-10T21:50:41Z","factCheckAuthorMapping":null,"documentGroup":null,"summary":"In this podcast, we speak with a psychiatrist about topics ranging from what prompted her to pursue a career in child psychiatry to treatment strategies and common conditions comorbid with ADHD.\n","title":"Treating ADHD in Children: Concerns, Controversies, Safety Measures","url":"treating-adhd-children-concerns-controversies-safety-measures","published":"2020-07-10T04:00:00.000Z","authors":[{"displayName":"Leela Magavi, MD","url":"leela-magavi-md"}],"targeting":{"content_placement":["topics/adhd","topics/child-adolescent-psychiatry"],"document_url":["treating-adhd-children-concerns-controversies-safety-measures"],"document_group":null,"rootDocumentGroup":[],"issue_url":"","publication_url":""},"relatedArticles":[{"title":"Multidisciplinary Inpatient Care for Medically Compromised Youth and Young Adults With Eating Disorders","url":{"current":"multidisciplinary-inpatient-care-for-medically-compromised-youth-and-young-adults-with-eating-disorders","_type":"slug"},"thumbnail":{"caption":"Wanlee/AdobeStock","asset":{"_ref":"image-75e054327354fd399f1c1b0d16066577da5800d1-5000x3500-jpg","_type":"reference"},"_type":"mainImage","alt":"eating disorders"},"published":"2024-11-22T17:00:00.488Z"},{"title":"NeuroStar TMS for Adolescents With Major Depressive Disorder: A Look at the New Data","url":{"current":"neurostar-tms-for-adolescents-with-major-depressive-disorder-a-look-at-the-new-data","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"Melissa Fickey","asset":{"_ref":"image-60a8a242efef4dcca3c2e74f18eefed5676af69d-320x400-png","_type":"reference"}},"published":"2024-11-14T17:30:56.510Z"},{"title":"The Cumulative Risks of ADHD","url":{"current":"the-cumulative-risks-of-adhd","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"ADHD","caption":"BillionPhotos.com/AdobeStock","asset":{"_type":"reference","_ref":"image-7d07b857014bd601a8354e37ae94367ff9c6f686-4341x3000-jpg"}},"published":"2024-11-13T20:05:34.845Z"},{"title":"Analysis of Barriers in Mental Health Care for Foster Children: Challenges and Solutions","url":{"_type":"slug","current":"analysis-of-barriers-in-mental-health-care-for-foster-children-challenges-and-solutions"},"thumbnail":{"asset":{"_ref":"image-272e9d97df5e85f9f828b3d13f881139ec4e379e-3506x1987-jpg","_type":"reference"},"_type":"mainImage","alt":"foster family","caption":"SewcreamStudio/AdobeStock"},"published":"2024-11-13T16:00:44.766Z"},{"title":"Adult ADHD: It's Time to Think Outside the Box","url":{"current":"adult-adhd-its-time-to-think-outside-the-box","_type":"slug"},"thumbnail":{"alt":"adult ADHD","caption":"Aninka/AdobeStock","asset":{"_ref":"image-a4170721b434dcbfcb8faf3b905bd42aece270c9-5616x3744-jpg","_type":"reference"},"_type":"mainImage"},"published":"2024-11-08T18:00:51.723Z"},{"title":"Family and Sports Medicine Physician Shares Thoughts on Annual Conference","url":{"current":"family-and-sports-medicine-physician-shares-thoughts-on-annual-conference","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"Sara Walker","asset":{"_ref":"image-070c6f88f9f2ddeb6b73414cbbe836366d277556-1168x1170-png","_type":"reference"}},"published":"2024-10-30T13:00:00.000Z"}]},{"ExcludeFromPubMedXML":false,"published":"2024-10-16T14:00:00.000Z","authors":[{"displayName":"James M. Greenblatt, MD","url":"james-m-greenblatt-md"}],"factCheckAuthors":null,"title":"Mental Health in the Sun: The Role of Vitamin D Deficiency in Mental Illness","contentCategory":{"_updatedAt":"2020-02-25T09:35:56Z","_createdAt":"2020-02-06T09:15:47Z","_rev":"snQqhhB4O8T5bi1viURsgs","_type":"contentCategory","name":"Articles","_id":"8bdaa7fc-960a-4b57-b076-75fdce3741bb"},"_updatedAt":"2024-10-09T17:01:20Z","authorMapping":[{"url":{"current":"james-m-greenblatt-md","_type":"slug"},"address1":"1008 W CHERRY ST","_rev":"pI9SawGKsTP14Lioy52fLS","_type":"author","_id":"pst_author_323634","_updatedAt":"2020-08-21T07:23:47Z","address2":"STE D","displayName":"James M. Greenblatt, MD","_createdAt":"2020-02-21T11:23:21Z"}],"_rev":"piyJAhpB4yoL7s3CR2emcW","articleType":"News","_id":"547fc9e7-6f7a-49db-9f1f-22df35aace36","is_visible":true,"body":[{"disableTextWrap":false,"widthP":50,"alt":"vitamin d","imgcaption":[{"_key":"be624ff0e182","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Татьяна/AdobeStock","_key":"1f7f72a381a30"}],"_type":"block","style":"normal"}],"asset":{"_ref":"image-821658ab61751cdc3aebd0932bdb2c2e61453d00-5184x3456-jpg","_type":"reference"},"_key":"5bbb1a579b03","disableLightBox":true,"_type":"figure","alignment":"left"},{"children":[{"_type":"span","marks":[],"text":"Of the many researched integrative medicine interventions for the treatment of mental health conditions, perhaps one of the simplest is vitamin D. While controversy around its use remains, including recent guidelines that recommend against testing vitamin D levels for virtually any reason,","_key":"5e0b85aaf29c0"},{"_type":"span","marks":["superscript"],"text":"1 ","_key":"904bcf300b71"},{"_type":"span","marks":[],"text":"my own clinical experience combined with the latest research strongly suggest benefits for a number of mental health conditions.","_key":"b4d40d953108"}],"_type":"block","style":"normal","_key":"af807991850c","markDefs":[]},{"style":"normal","_key":"76973880d3d4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2063eb2850ab0"}],"_type":"block"},{"children":[{"marks":[],"text":"Long recognized for its role in calcium metabolism and bone health, more recent research has been highlighting other important functional aspects of vitamin D. Better described as a steroid prohormone than a vitamin, vitamin D plays a prominent role as a neuroprotective agent, reducing neuroinflammation, supporting serotonin synthesis, and improving brain plasticity.","_key":"03c8a7c7bc700","_type":"span"},{"_type":"span","marks":["superscript"],"text":"2","_key":"fddbefb633e7"},{"_type":"span","marks":[],"text":" These effects are likely why the vitamin is relevant for mental health, with a growing body of research demonstrating vitamin D deficiency may have clinical implications for depression, suicide prevention, attention-deficit/hyperactivity disorder (ADHD), and anxiety treatment.","_key":"42b8903f2b87"}],"_type":"block","style":"normal","_key":"02878c7c898a","markDefs":[]},{"_key":"5b83ccc259fc","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"54834aa849890"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"fd788e1416600","_type":"span","marks":["strong"],"text":"From Bone Health to Brain Health"}],"_type":"block","style":"normal","_key":"d6614df4e684"},{"style":"normal","_key":"164c57282e9c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Vitamin D was initially discovered as the cure for preventing rickets.","_key":"ae20294be5f80"},{"_type":"span","marks":["superscript"],"text":"3","_key":"572c10aa886f"},{"text":" Cod liver oil, rich in both vitamin A and vitamin D, was found to be effective in treating the condition. Since cod liver oil was known to be high in vitamin A, it was assumed that vitamin A was needed for the deposition of calcium in bone. However, careful experiments that removed vitamin A from cod liver oil found that it still prevented rickets, suggesting the presence of a separate nutrient, which later became known as vitamin D.","_key":"4cfa30cdbec0","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"14062782857b0"}],"_type":"block","style":"normal","_key":"c08836aa1bc8"},{"children":[{"marks":[],"text":"Long considered just a vitamin important for calcium absorption and bone health, research near the end of the last century started to find vitamin D receptors throughout most body tissues, including the brain.","_key":"8dbf29982f6b0","_type":"span"},{"marks":["superscript"],"text":"4","_key":"fe7b1bc9e1fe","_type":"span"},{"_type":"span","marks":[],"text":" The receptor was found to influence genetic expression and affect immune function.","_key":"c2bb3e85e928"},{"_type":"span","marks":["superscript"],"text":"5","_key":"66622e00a5d8"},{"_key":"2f3786eaab7b","_type":"span","marks":[],"text":" More recently, it has been shown that vitamin D regulates neurotransmitter levels, including serotonin ("},{"_type":"span","marks":["strong","eb33e5fed70a"],"text":"Figure","_key":"8dbf29982f6b5"},{"_type":"span","marks":[],"text":"), through several different mechanisms.","_key":"8dbf29982f6b6"},{"_type":"span","marks":["superscript"],"text":"6","_key":"f611d82ef98c"},{"_type":"span","marks":[],"text":" Based on this broader understanding of the effects of vitamin D, numerous studies have documented the effects of vitamin D deficiency on mental health.","_key":"53730b795fbc"}],"_type":"block","style":"normal","_key":"88249b0713ff","markDefs":[{"_type":"link","href":"https://www.psychiatrictimes.com/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2Fbff31d73a4f24d7b6b76ab4de19980e241ab42c5-938x352.jpg%3Ffit%3Dcrop%26auto%3Dformat\u0026w=1920\u0026q=75","_key":"eb33e5fed70a","nofollow":true,"blank":true}]},{"disableLightBox":true,"_type":"figure","widthP":70,"blank":true,"alt":"Figure. Vitamin D and Serotonin Synthesis","imgcaption":[{"_key":"7c1a68ac028f","markDefs":[],"children":[{"text":"Figure. ","_key":"9c5c811a798f","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":"Vitamin D and Serotonin Synthesis","_key":"eb098f7e9bdc"}],"_type":"block","style":"normal"}],"disableTextWrap":false,"asset":{"_ref":"image-bff31d73a4f24d7b6b76ab4de19980e241ab42c5-938x352-jpg","_type":"reference"},"_key":"7b2d2b148fc5","alignment":"right"},{"_key":"2e7229263cbb","markDefs":[],"children":[{"text":"","_key":"3653bd445e580","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"style":"normal","_key":"69a8c986b0a5","markDefs":[],"children":[{"marks":["strong"],"text":"Vitamin D and Depression","_key":"dbc9a25b26240","_type":"span"}],"_type":"block"},{"style":"normal","_key":"04a58724a791","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The most well-documented effect of vitamin D on mental health is with depression. Initially, low vitamin D was hypothesized to be a cause of seasonal affective disorder (SAD) because vitamin D levels are lower in the winter. Initial clinical trials showed benefits on mood in healthy subjects and those with SAD over the winter months.","_key":"fe20ebbfc8dd0"},{"marks":["superscript"],"text":"7,8","_key":"1503bd9de567","_type":"span"},{"_type":"span","marks":[],"text":" While not all studies were positive,","_key":"f019c46a10db"},{"_type":"span","marks":["superscript"],"text":"9","_key":"50b21c09c0c7"},{"_type":"span","marks":[],"text":" based on the results, research started exploring benefits in other types of patients with depression. A larger study in individuals who were overweight and had depression found significant benefits with vitamin D,","_key":"deaa21cca35a"},{"marks":["superscript"],"text":"10","_key":"9ee111e00345","_type":"span"},{"_type":"span","marks":[],"text":" as did a separate trial using vitamin D as an adjunctive treatment for depression when combined with standard medication.","_key":"d304d9d35805"},{"_type":"span","marks":["superscript"],"text":"11","_key":"608987bf41be"}],"_type":"block"},{"_key":"914c8017cd8c","markDefs":[],"children":[{"_key":"8b687cf45f700","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"style":"normal","_key":"e61531b55d49","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/topics/major-depressive-disorder","_key":"9cf9bd4d5d66"}],"children":[{"_type":"span","marks":[],"text":"Unfortunately, a lot of the research on vitamin D suffers from poor methodology. Many studies did not test patients' vitamin D status, or they provide the same dose of vitamin D regardless of an individual’s vitamin D levels. Other studies have used lower doses that likely minimize the clinical benefits. Even with these limitations, the latest meta-analyses have found that low vitamin D levels correlate with ","_key":"c62177e2b5170"},{"text":"depression","_key":"4c6ec3e0adc1","_type":"span","marks":["9cf9bd4d5d66"]},{"_key":"5c71d206a514","_type":"span","marks":[],"text":" and that treatment with vitamin D provides significant improvements in depressive symptoms."},{"text":"12,13","_key":"521d9f808c69","_type":"span","marks":["superscript"]}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"","_key":"dc6e6f0a365d0"}],"_type":"block","style":"normal","_key":"de1d7ab5df57","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Vitamin D: A Lifeline in Suicide Prevention","_key":"2588fd404c0f0"}],"_type":"block","style":"normal","_key":"82a39ed5ab72","markDefs":[]},{"children":[{"_key":"c4952507e9de0","_type":"span","marks":[],"text":"The rising rates of suicide in the United States continue to be of major concern. While there are numerous calls for increasing awareness and screening, there is little discussion about direct treatment, especially of underlying biochemical risk factors. One of the more common risk factors for suicide is vitamin D deficiency."}],"_type":"block","style":"normal","_key":"504367c25bff","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2ec68ea0ff6b0"}],"_type":"block","style":"normal","_key":"507f0f844336"},{"markDefs":[],"children":[{"marks":[],"text":"Low vitamin D levels have been found to correlate with suicide risk. A study in 2013 found that low vitamin D was common in active military service members. They also found that the lowest levels were correlated with suicide risk.","_key":"b9e974a42d440","_type":"span"},{"_type":"span","marks":["superscript"],"text":"14 ","_key":"37fcbe9e4c90"},{"_type":"span","marks":[],"text":"A study of patients with depression who attempted suicide found lower levels of vitamin D and higher levels of inflammation in the blood as compared with patients with depression who did not attempt suicide.","_key":"98fa8f690c5c"},{"_type":"span","marks":["superscript"],"text":"15","_key":"77b66bd07153"}],"_type":"block","style":"normal","_key":"98c20ec8957a"},{"_type":"block","style":"normal","_key":"756295107602","markDefs":[],"children":[{"_key":"ae62a33891990","_type":"span","marks":[],"text":""}]},{"_key":"ec69d8aba7b6","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/topics/suicide","_key":"8658269503cb"}],"children":[{"_type":"span","marks":[],"text":"A meta-analysis in 2023 found that low vitamin D was associated with suicidal behaviors.","_key":"419b8058c2c30"},{"text":"16","_key":"afeb2df98cd0","_type":"span","marks":["superscript"]},{"text":" A retrospective study on over 300,000 veterans found that vitamin D supplementation almost halved the risk of ","_key":"4fe62da517ed","_type":"span","marks":[]},{"_key":"3660f4b508ba","_type":"span","marks":["8658269503cb"],"text":"suicide"},{"_type":"span","marks":[],"text":". Those who were dark-skinned or deficient in vitamin D had their suicide risk reduced by 64%.","_key":"3d914b6c69f4"},{"_key":"85d81c2116d7","_type":"span","marks":["superscript"],"text":"17"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"2e49eb13ea20","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b2dd038fcde90"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Vitamin D levels are easy to check and treat when found to be low. Considering the challenges around suicide prevention, adding vitamin D supplements for those who are deficient is a simple approach that could save lives.","_key":"2c238a433e0c0"}],"_type":"block","style":"normal","_key":"3fa191f24874"},{"_key":"658aa9c90bbc","markDefs":[],"children":[{"_key":"00437bac929f0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":["strong"],"text":"Nourishing Young Minds: The Role of Vitamin D in ADHD","_key":"eb8668655aa40","_type":"span"}],"_type":"block","style":"normal","_key":"ee616bf27d14"},{"style":"normal","_key":"6de6a43f2e40","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/topics/adhd","_key":"5d4d4cfa8594"}],"children":[{"_type":"span","marks":[],"text":"As a nutrient, vitamin D appears to be critical for normal brain development in childhood. A systematic review on vitamin D supplementation and mental health in children noted positive influences of the vitamin on numerous aspects of mental health.","_key":"0ed6cede133e0"},{"_type":"span","marks":["superscript"],"text":"18","_key":"c00ee87de836"},{"_type":"span","marks":[],"text":" Vitamin D supplementation is recommended for mothers who are deficient during pregnancy as it appears to be protective against the development of ","_key":"8bf30cfd9ad8"},{"_type":"span","marks":["5d4d4cfa8594"],"text":"ADHD","_key":"6103211160b4"},{"text":" and autism.","_key":"262d367a948a","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"19","_key":"d314e09f7de0"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ca137a6aaf500"}],"_type":"block","style":"normal","_key":"e0110b015231"},{"children":[{"_key":"50814d205fe20","_type":"span","marks":[],"text":"A meta-analysis from 2019 found that vitamin D levels are significantly lower in children with ADHD."},{"_type":"span","marks":["superscript"],"text":"20","_key":"ab547732f983"},{"_type":"span","marks":[],"text":" That same year a separate meta-analysis looked at the effects of vitamin D supplementation on ADHD symptoms. They found that when used as an adjunctive therapy, vitamin D decreased ADHD symptoms and improved vitamin D status.","_key":"8a7807832cc4"},{"text":"21","_key":"bc9a350444c5","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" It was also noted that vitamin D supplementation was devoid of serious adverse effects.","_key":"0526913e9ba1"}],"_type":"block","style":"normal","_key":"a24402e157f1","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"40335aa97ee70"}],"_type":"block","style":"normal","_key":"e110b77fd8ac","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Vitamin D: Potential to Alleviate Anxiety","_key":"889ef1b4ceae0"}],"_type":"block","style":"normal","_key":"b840c6ff1be1"},{"_type":"block","style":"normal","_key":"d36be0670100","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Vitamin D may also have benefits for reducing anxiety symptoms. A small study in patients with generalized anxiety disorder and vitamin D deficiency compared standard treatment with standard treatment plus vitamin D. For the patients treated with vitamin D, anxiety levels decreased by almost one-third compared with no significant change in the group that received standard care alone.","_key":"d40e9b860fa50"},{"_type":"span","marks":["superscript"],"text":"22","_key":"d1cdd0212dbb"}]},{"children":[{"marks":[],"text":"","_key":"673f9d48f07f0","_type":"span"}],"_type":"block","style":"normal","_key":"b1de0ba72bbb","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"A study in women with prediabetes and low vitamin D levels also showed improvements in anxiety with vitamin D supplementation, both with and without the addition of fish oil.","_key":"45b921d5175a0"},{"_type":"span","marks":["superscript"],"text":"23","_key":"e44219208674"},{"_type":"span","marks":[],"text":" With vitamin D alone, anxiety levels decreased 19%. When combined with fish oil, levels were reduced by 30%. In a separate study in adolescents with premenstrual syndrome and severe vitamin D deficiency, vitamin D supplementation reduced anxiety scores by 61% as compared with no appreciable change with placebo.","_key":"89af34376ce6"},{"text":"24","_key":"9c46e3873d66","_type":"span","marks":["superscript"]}],"_type":"block","style":"normal","_key":"dfde8d2414d5","markDefs":[]},{"_key":"c0adc9f27afd","markDefs":[],"children":[{"marks":[],"text":"","_key":"46bf00c057ce0","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[{"href":"https://www.psychiatrictimes.com/topics/anxiety","_key":"9441fa9b7d93","nofollow":true,"blank":true,"_type":"link"}],"children":[{"_type":"span","marks":[],"text":"While these results are promising, it is worth noting that not all studies have found benefits. A study using vitamin D for depression prevention in individuals aged 60 to 80 years old did not find significant benefits for anxiety symptoms.","_key":"2fbb64d649220"},{"_type":"span","marks":["superscript"],"text":"25","_key":"5c775543136a"},{"_type":"span","marks":[],"text":" An earlier trial exploring the effects of vitamin D in patients with lower levels did not find significant changes in depression or ","_key":"4b9fb0ab62b3"},{"_type":"span","marks":["9441fa9b7d93"],"text":"anxiety","_key":"6455849e62bd"},{"_type":"span","marks":[],"text":" symptoms.","_key":"66779f583e97"},{"_key":"7a774dec9b57","_type":"span","marks":["superscript"],"text":"26"},{"_type":"span","marks":[],"text":" However, in the study, depression and anxiety symptoms were quite low at baseline, as the only criterion used for selecting patients was having a low vitamin D level. Arguably, the clinical trial may have found better results if they had treated symptomatic patients with low vitamin D levels vs those without significant mental health symptoms.","_key":"b4d747784192"}],"_type":"block","style":"normal","_key":"66c444bdfdca"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2611ad7188150"}],"_type":"block","style":"normal","_key":"a8c50103966b"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"My own clinical experience has highlighted the importance of testing vitamin D levels in any patient struggling with a mental health diagnosis. In patients with a deficiency, vitamin D supplementation is often helpful in reducing symptoms and improving overall wellbeing.","_key":"5c6af44d1cea0"}],"_type":"block","style":"normal","_key":"99947ec6190f"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1fbdd565c0ee0"}],"_type":"block","style":"normal","_key":"1bb009e6e2a5"},{"style":"normal","_key":"82aa749c3687","markDefs":[],"children":[{"text":"An Essential Yet Overlooked Laboratory Test in Psychiatry","_key":"c6de08cad1d40","_type":"span","marks":["strong"]}],"_type":"block"},{"_type":"block","style":"normal","_key":"b9694c1bc7d3","markDefs":[{"_type":"link","href":"https://www.psychiatrictimes.com/topics/ptsd","_key":"0230ec174287","nofollow":true,"blank":true}],"children":[{"_type":"span","marks":[],"text":"Vitamin D deficiencies are common in patients with mental health diagnoses. The research has found benefits with vitamin D supplementation for depression, anxiety, suicide prevention, and ADHD. Research into levels of vitamin D in patients with obsessive-compulsive disorder has also found their levels to be low.","_key":"c6f46adf3fa30"},{"_type":"span","marks":["superscript"],"text":"27,28","_key":"0b761a251faa"},{"_type":"span","marks":[],"text":" A study on subjects with ","_key":"f8ccf1c8002c"},{"_type":"span","marks":["0230ec174287"],"text":"posttraumatic stress disorder","_key":"f4f8d405ed20"},{"marks":[],"text":" (PTSD) found lower levels of the vitamin.","_key":"557bd1f2b137","_type":"span"},{"_key":"7f90e5da06b9","_type":"span","marks":["superscript"],"text":"29"},{"marks":[],"text":" Interestingly, the researchers also noted genetic polymorphisms of vitamin-D binding protein that correlated with lower vitamin D status in patients with PTSD. Unfortunately, guidelines around vitamin D testing and supplementation overlook most data suggesting benefits beyond bone health.","_key":"5f70bf289310","_type":"span"}]},{"_key":"7ee0d934b305","markDefs":[],"children":[{"_key":"5b4e3f7938100","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I have found vitamin D deficiency to be a key component that is often ignored by psychiatry. The simplest approach to identify patients who need supplementation is through testing. In patients with a severe deficiency, higher doses may be necessary to achieve optimum levels. Testing is also critical to monitor the vitamin D levels of some patients who have poor absorption of vitamin D supplements.","_key":"33d9a8098d6a0"}],"_type":"block","style":"normal","_key":"9c4dd14fc53c"},{"_type":"block","style":"normal","_key":"e92b83157aa8","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3fb830f21e100"}]},{"_type":"block","style":"normal","_key":"560d89dd128d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The core principle of integrative medicine is biochemical individuality: recognizing that all patients are different and have different genetic variability and environmental stressors. Vitamin D testing and treatment can be 1 simple step toward incorporating personalized medicine into psychiatry.","_key":"bf39210b07a10"}]},{"style":"normal","_key":"b3fed6e0c3f2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"88bd1fe17df30"}],"_type":"block"},{"style":"normal","_key":"740ada5f3682","markDefs":[],"children":[{"_key":"39b59d8686ea0","_type":"span","marks":[],"text":"While vitamin D should not be seen as a silver-bullet cure-all for mental health problems, it is a fundamental nutrient that is vital for the normal function of brain neurochemistry. It is also commonly deficient. Supporting vitamin D is foundational for developing a personalized approach to mental health care and for supporting the efficacy of other treatments. Considering how many patients with mental health conditions struggle with residual symptoms even with standard treatment, simple interventions, like vitamin D, could have a profound impact on the health of our patients."}],"_type":"block"},{"_key":"32796c301224","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"df0e6b397d0a0"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"0b9a17879014","markDefs":[],"children":[{"_key":"50b6373a0d5c0","_type":"span","marks":["strong"],"text":"Dr Greenblatt "},{"_type":"span","marks":["em"],"text":"is the chief medical officer of Psychiatry Redefined, an online educational platform for integrative and functional psychiatry.","_key":"bf042ba33a21"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"bf8ada1315490"}],"_type":"block","style":"normal","_key":"0e1290948096"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"0d31ddc7da9d0"}],"_type":"block","style":"normal","_key":"bc05e00f9d41"},{"style":"normal","_key":"f030e38b40fd","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/38828942/","_key":"4b2fa5b98115"}],"children":[{"_type":"span","marks":[],"text":"1. Shah VP, Nayfeh T, Alsawaf Y, et al. ","_key":"a452d6fc13110"},{"_key":"a452d6fc13111","_type":"span","marks":["4b2fa5b98115"],"text":"A systematic review supporting the Endocrine Society Clinical Practice Guidelines on vitamin D."},{"_type":"span","marks":[],"text":" ","_key":"dd0505603571"},{"_type":"span","marks":["em"],"text":"J Clin Endocrinol Metab","_key":"a452d6fc13112"},{"_type":"span","marks":[],"text":". 2024;109(8):1961-1974.","_key":"a452d6fc13113"}],"_type":"block"},{"markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/38303529/","_key":"e6a5208f00da"}],"children":[{"marks":[],"text":"2. Menéndez SG, Manucha W. ","_key":"ed13fd991c170","_type":"span"},{"_key":"ed13fd991c171","_type":"span","marks":["e6a5208f00da"],"text":"Vitamin D as a modulator of neuroinflammation: implications for brain health."},{"_key":"7fd40fc2c0f3","_type":"span","marks":[],"text":" "},{"_key":"ed13fd991c172","_type":"span","marks":["em"],"text":"Curr Pharm Des"},{"_type":"span","marks":[],"text":". 2024;30(5):323-332.","_key":"ed13fd991c173"}],"_type":"block","style":"normal","_key":"fa51e2977c1a"},{"markDefs":[{"href":"https://www.sciencedirect.com/science/article/pii/S0021925818857830","_key":"ba5ba63e6aa2","blank":true,"_type":"link"}],"children":[{"_key":"566ae7478f0c0","_type":"span","marks":[],"text":"3. McCollum EV, Simmonds N, Becker JE, Shipley PG. 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A randomised trial among older women.","_key":"0120983746101"},{"_type":"span","marks":[],"text":" ","_key":"4797274a2206"},{"_type":"span","marks":["em"],"text":"J Nutr Health Aging","_key":"0120983746102"},{"_type":"span","marks":[],"text":". 2006;10(2):151-153.","_key":"0120983746103"}],"_type":"block","style":"normal","_key":"79c858f7fc3d","markDefs":[{"_key":"64ff62afde4e","blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/16554952/"}]},{"markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/18793245/","_key":"662f345ec623"}],"children":[{"_type":"span","marks":[],"text":"10. Jorde R, Sneve M, Figenschau Y, et al. 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","_key":"82b37001e5da0"},{"marks":["403f2f6249f3"],"text":"Vitamin D deficiency and depressive symptoms: meta-analysis of studies.","_key":"82b37001e5da1","_type":"span"},{"_type":"span","marks":[],"text":" ","_key":"a061a98eedf4"},{"_type":"span","marks":["em"],"text":"Psychiatr Pol","_key":"82b37001e5da2"},{"text":". 2022;56(6):1327-1344.","_key":"82b37001e5da3","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"bade3829b15a","markDefs":[{"href":"https://pubmed.ncbi.nlm.nih.gov/37098201/","_key":"403f2f6249f3","blank":true,"_type":"link"}]},{"_key":"328d4c734562","markDefs":[{"_key":"5d26ae39cfad","blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/36716601/"}],"children":[{"_type":"span","marks":[],"text":"13. Srifuengfung M, Srifuengfung S, Pummangura C, et al. ","_key":"5059633117f70"},{"marks":["5d26ae39cfad"],"text":"Efficacy and acceptability of vitamin D supplements for depressed patients: a systematic review and meta-analysis of randomized controlled trials.","_key":"5059633117f71","_type":"span"},{"marks":[],"text":" ","_key":"85dfdc8e7ead","_type":"span"},{"marks":["em"],"text":"Nutrition","_key":"5059633117f72","_type":"span"},{"_type":"span","marks":[],"text":". 2023;108:111968.","_key":"5059633117f73"}],"_type":"block","style":"normal"},{"markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/23308099/","_key":"a77a725e4dc4"}],"children":[{"_type":"span","marks":[],"text":"14. Umhau JC, George DT, Heaney RP, et al. 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aim to standardize adult ADHD care in the US, improving patient outcomes.","factCheckAuthorMapping":null,"authorMapping":[{"displayName":"Leah Kuntz","_createdAt":"2020-10-06T13:25:26Z","_id":"eae211d2-ac5b-40d6-9e4b-b25ee06057f2","_updatedAt":"2020-10-06T13:25:26Z","firstName":"Leah","lastName":"Kuntz","_rev":"AHAMphbTGS6uc0RcJHCpre","_type":"author","url":{"current":"leah-kuntz","_type":"slug"}}],"gptSummary":"New data from the CDC highlights the prevalence and treatment challenges of adult ADHD in the US, with 6% of adults currently diagnosed. A significant medication shortage affects those on stimulant therapy, and over half of adults with ADHD were diagnosed in adulthood, with notable gender discrepancies. Telehealth has facilitated care for 46% of diagnosed adults. The upcoming APSARD guidelines aim to standardize adult ADHD care in the US, addressing the current lack of national guidelines and improving patient outcomes.","_updatedAt":"2024-10-10T17:04:51Z","articleType":"News","_createdAt":"2024-10-10T16:39:36Z","factCheckAuthors":null,"_id":"3b0ad9b0-8d49-48ef-bd0e-585de87089b9","_rev":"iwIk0EhdBdoIVjJwZAJkPF","_type":"article","thumbnail":{"asset":{"_ref":"image-7d07b857014bd601a8354e37ae94367ff9c6f686-4341x3000-jpg","_type":"reference"},"_type":"mainImage","alt":"adult adhd","caption":"BillionPhotos.com/AdobeStock"},"summary":"The CDC just released new data that highlight issues around adult ADHD prevalence, diagnosis, and treatment. ","authors":[{"displayName":"Leah Kuntz","url":"leah-kuntz"}],"documentGroupMapping":null,"is_visible":true,"taxonomyMapping":[{"name":"ADHD","_id":"pst_taxonomy_8_adhd","pixelTrackingCode":null,"_rev":"37333Uv1mHMuPikcnyAeyc","_type":"taxonomy","_updatedAt":"2023-03-31T19:04:55Z","identifier":"topics/adhd","cmeType":"per","parent":{"_id":"pst_taxonomy_53202_clinical","isMainTopic":true,"_rev":"uvXJooXtzvjNOyx50HTt8m","name":"Topics","_updatedAt":"2023-03-31T19:15:59Z","identifier":"topics","_createdAt":"2020-03-26T06:11:21Z","parent":null,"_type":"taxonomy"},"perKeywordMapping":["Psychiatry","Neurology"],"_createdAt":"2020-03-26T06:11:21Z"}],"title":"New CDC Data Highlights the Need for Guidelines on Adult ADHD","contentCategory":{"_rev":"snQqhhB4O8T5bi1viURsgs","_type":"contentCategory","name":"Articles","_id":"8bdaa7fc-960a-4b57-b076-75fdce3741bb","_updatedAt":"2020-02-25T09:35:56Z","_createdAt":"2020-02-06T09:15:47Z"},"audioUrl":"https://s3.us-east-1.amazonaws.com/ai-generated-audios/www.psychiatrictimes.com/3b0ad9b0-8d49-48ef-bd0e-585de87089b9_1728578392678.1b31139a-9525-4de4-a4e2-0ffb4fb3fe92.mp3","body":[{"imgcaption":[{"markDefs":[],"children":[{"text":"BillionPhotos.com/AdobeStock","_key":"fea3695b08f60","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"7c73ef9dede0"}],"asset":{"_type":"reference","_ref":"image-7d07b857014bd601a8354e37ae94367ff9c6f686-4341x3000-jpg"},"widthP":50,"_type":"figure","alt":"adult adhd","alignment":"left","disableTextWrap":false,"disableLightBox":true,"_key":"3feebba5927d"},{"children":[{"text":"The US Centers for Disease Control and Prevention (CDC) today released new data that highlight issues around attention-deficit/hyperactivity disorder (ADHD) in adults. The October 10, 2024, Morbidity and Mortality Weekly Report (MMWR) provides crucial updates on the burden of adult ADHD, sharing information specifically on prevalence, treatment barriers, and telehealth.","_key":"cc5abc72dcab0","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"1","_key":"5ef59c303293"}],"_type":"block","style":"normal","_key":"cc90c6637364","markDefs":[]},{"children":[{"_key":"56aa4544ed910","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"6f9acdc132cc","markDefs":[]},{"markDefs":[],"children":[{"marks":[],"text":"Using the National Center for Health Statistics Rapid Survey System (RSS) data collected from October through November 2023, investigators found that 6% of US adults had a current diagnosis of ADHD, with 8% of US adults reporting a past or present diagnosis. About 7 in 10 of those receiving stimulant pharmacotherapy reported trouble obtaining their ADHD medication due to a shortage. The RSS also reports that more than 50% of adults with ADHD were diagnosed in adulthood, with larger discrepancies for woman than men; 45% of men and 25% of women were diagnosed before 11 years of age, whereas 40% of men and 61% of women were diagnosed in adulthood.","_key":"331528af43010","_type":"span"}],"_type":"block","style":"normal","_key":"d9c295d7b12d"},{"_key":"2350b227c10c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b41924b966360"}],"_type":"block","style":"normal"},{"_key":"febcba60b1e9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"On the positive side, telehealth during the COVID-19 pandemic allowed a total of 46% of adults with a current ADHD diagnosis to receive care.","_key":"6f9a656713620"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6e51ac18e40a0"}],"_type":"block","style":"normal","_key":"225ebd1a5210"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"According to Gregory Mattingly, MD, and Ann Childress, MD, these data demonstrate the need for the upcoming American Professional Society of ADHD and Related Disorders’ (APSARD) Adult ADHD Guidelines.","_key":"685336400f6e0"},{"_type":"span","marks":["superscript"],"text":"2,3","_key":"63d3f52b4ca5"},{"_type":"span","marks":[],"text":" A set of guidelines would help improve patient outcomes by standardizing care among all mental health clinicians who see adult patients with ADHD.","_key":"81902b849384"}],"_type":"block","style":"normal","_key":"bd0eff8267b8"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d9326793fc410"}],"_type":"block","style":"normal","_key":"df385ca8774a"},{"markDefs":[],"children":[{"text":"“These will be the first US guidelines for the diagnosis and treatment of adults with ADHD and will provide a valuable framework of treatment for clinicians and families. While many unanswered questions remain, these findings bring us one step closer to a deeper understanding of the needs of adults with ADHD,” wrote Mattingly and Childress.","_key":"28035404077a0","_type":"span","marks":[]},{"marks":["superscript"],"text":"2","_key":"647f111a5393","_type":"span"}],"_type":"block","style":"normal","_key":"0947167882ef"},{"_key":"8a0c79c6de78","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b82e0a883f8c0"}],"_type":"block","style":"normal"},{"style":"normal","_key":"25a457721754","markDefs":[],"children":[{"_key":"7dbaf51845bc0","_type":"span","marks":[],"text":"“The CDC shakes up things we have taught for years,” Mattingly told "},{"_type":"span","marks":["em"],"text":"Psychiatric Times","_key":"7dbaf51845bc1"},{"_key":"7dbaf51845bc2","_type":"span","marks":[],"text":" in an exclusive video."}],"_type":"block"},{"markDefs":[],"children":[{"text":"","_key":"2dee1da93a490","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"840dc2b3a034"},{"markDefs":[{"_type":"link","href":"https://apsard.societyconference.com/v2/","_key":"5da33bbe73ee"}],"children":[{"_type":"span","marks":[],"text":"Back in January 2024, Psychiatric Times spoke with David W. Goodman, MD, an adult psychiatrist, assistant professor in the department of psychiatry and behavioral sciences at Johns Hopkins Hospital School of Medicine, and a clinical associate professor at the State University of New York. Goodman hosted a town hall discussion of the adult ADHD guidelines at the ","_key":"3884c8971e070"},{"_type":"span","marks":["5da33bbe73ee"],"text":"APSARD 2024 Conference","_key":"3884c8971e071"},{"_type":"span","marks":[],"text":".","_key":"3884c8971e072"}],"_type":"block","style":"normal","_key":"ad2afcc03739"},{"markDefs":[],"children":[{"_key":"a5dd722266cf0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"db95e1ce304f"},{"_type":"block","style":"normal","_key":"dc2bb60081d7","markDefs":[],"children":[{"_type":"span","marks":[],"text":"“We don't have guidelines for adults with ADHD, like we do for children and adolescents. Now there are international guidelines developed in Canada, Europe, South Africa, Australia, and the UK. We've been slow in the United States to address this because it is an arduous and scientific endeavor that requires a number of experts,” Goodman shared. “We're looking to standardize the care of patients with ADHD in adults in the United States. We want clinicians to come up to speed with the clinical practice guidelines and clinical practice of taking care of patients. It also affects patients and their family and the general public. 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The highest risk was seen in patients taking 30 mg or more of dextroamphetamine, which corresponds to approximately 40 mg of Adderall. While previous research linked stimulants to psychosis and mania risk, there was little information on whether dosing impacted risk. With prescribing rates for stimulants to treat attention-deficit/hyperactivity disorder (ADHD) at an all-time high, it is an important issue to note.","_key":"4978a0a18e630"}]},{"_type":"block","style":"normal","_key":"a878366997e0","markDefs":[],"children":[{"text":"","_key":"5d1deb232eea0","_type":"span","marks":[]}]},{"children":[{"marks":[],"text":"“New-onset psychosis or mania is a rare but serious side effect of prescription amphetamines. Currently, US Food and Drug Administration labels do not have recommended upper limits on doses for the most commonly prescribed mixed amphetamine salts (Adderall). Our study found that doses higher than 30 mg dextroamphetamine equivalents, which is 40 mg of the mixed amphetamine salts (eg, Adderall), are associated with a more than 5-fold increase in the risk of psychosis or mania,” Lauren Moran, MD, a pharmacoepidemiology researcher at McLean Hospital and a member of the Mass General Brigham health care system, shared with ","_key":"2c4aed7d75a20","_type":"span"},{"marks":["em"],"text":"Psychiatric Times","_key":"2c4aed7d75a21","_type":"span"},{"text":". “Caution should be exercised when using high dose amphetamines, and we recommend screening for symptoms of psychosis or mania when patients need high doses of prescription amphetamines.”","_key":"2c4aed7d75a22","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"cbb158ced763","markDefs":[]},{"_type":"block","style":"normal","_key":"1f7cf7802820","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a9c3531b24e20"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Investigators reviewed electronic health records of patient encounters at Mass General Brigham between 2005 and 2019, focusing on adults aged 16 to 35. All patients were admitted to McLean Hospital following referrals from other hospitals in the Mass General Brigham health care system. The researchers identified 1374 cases of individuals presenting with first-episode psychosis or mania, compared with 2748 control patients with other conditions like depression or anxiety. They conducted a comparison analysis of stimulant use over the preceding month and accounted for other factors, including substance use, to isolate the effects of stimulants.","_key":"2bf7fc454be20"}],"_type":"block","style":"normal","_key":"b03e7a74fd4c"},{"_key":"1299c62de328","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f53a375601f10"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"They found the attributable risk percentage among those exposed to any prescription amphetamine was nearly 63% and for high dose amphetamine was 81%. These findings suggest that among individuals who take prescription amphetamine, 81% of cases of psychosis or mania could have been eliminated if they were not prescribed the high dose. While a significant dose-related risk increase was seen in patients taking high doses of amphetamine, no significant risk increase was seen with methylphenidate (Ritalin) use. This is consistent with previous research.","_key":"093f6f184ee00","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"3","_key":"ad25ee3dbcab"},{"marks":[],"text":" Limitations of the study include inconsistencies with how electronic health records are kept. Additionally, the findings may not be generalizable to the entire United states, as the research took place in a psychiatric hospital in the Boston area that sees many patients with psychosis.","_key":"ea3194891333","_type":"span"}],"_type":"block","style":"normal","_key":"85a0c8e3965e"},{"markDefs":[],"children":[{"_key":"63468059872c0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"2a43eaaa0ffc"},{"children":[{"marks":[],"text":"Moran shared that the current study was born out of her observations and experiences as an inpatient psychiatrist.","_key":"6b9328acffa10","_type":"span"}],"_type":"block","style":"normal","_key":"3ef68b3c64d2","markDefs":[]},{"children":[{"text":"","_key":"1b3a748af4790","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"a7d1def29d35","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“As a psychiatrist who treated patients on the schizophrenia and bipolar disorders inpatient unit at McLean Hospital, we were seeing patients admitted for new onset psychosis and/or mania in setting of prescription stimulant use, most commonly on high doses of prescription amphetamines,” Moran exclusively told ","_key":"8484112feaca0"},{"_type":"span","marks":["em"],"text":"Psychiatric Times","_key":"8484112feaca1"},{"_type":"span","marks":[],"text":". “I started doing research on this topic several years ago to raise awareness of this issue and determine what stimulant type was associated with higher risk. In previous work, we found that prescription amphetamine use was associated with a higher risk of psychosis than methylphenidate. The current work builds upon our prior work by finding a dose response effect.”","_key":"8484112feaca2"}],"_type":"block","style":"normal","_key":"7e20cd0257c3"},{"style":"normal","_key":"a78306da1018","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8baa394938640"}],"_type":"block"},{"_type":"block","style":"normal","_key":"cff1226fcbb4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Moran has a few ideas as to amphetamine alternatives, which she shared with ","_key":"c2bebc03bc980"},{"_type":"span","marks":["em"],"text":"Psychiatric Times","_key":"c2bebc03bc981"},{"_type":"span","marks":[],"text":": “Alternative strategies include use of methylphenidate, which was not associated with an increased risk of psychosis or mania, or using non-stimulants such as atomoxetine or guanfacine. The totality of evidence in this study (across main and secondary analyses) does not suggest there is an increased risk of psychosis/mania in individuals taking \u003c= 15 mg dextroamphetamine equivalents (equivalent to 20 mg of Adderall). Behavioral strategies in combination with stimulants can be helpful, for example, working with patients on developing better time management skills.”","_key":"c2bebc03bc982"}]},{"style":"normal","_key":"771e796f2b62","markDefs":[],"children":[{"text":"","_key":"f56bfe6d6c380","_type":"span","marks":[]}],"_type":"block"},{"children":[{"_key":"51c77cb9190b0","_type":"span","marks":[],"text":"While the current study does not prove causality, the investigators note there is a plausible biological mechanism in neurobiological changes that include a release of higher levels of the neurotransmitter dopamine from amphetamines, that parallel dopaminergic changes observed in psychosis."}],"_type":"block","style":"normal","_key":"482c6c9b6ee4","markDefs":[]},{"style":"normal","_key":"3f5c0dfa4513","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ca74d2e1abab0"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"Moran said the findings need not create alarm but should lead to extra caution when these medications are prescribed, especially for those who have risk factors for psychosis and mania.","_key":"40a8d0c857180"}],"_type":"block","style":"normal","_key":"189b96749792","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3f76c6c16b2b0"}],"_type":"block","style":"normal","_key":"f6fcc00a8912"},{"children":[{"text":"“The risk of psychosis and mania is a rare side effect of stimulants, and there certainly are patients who may benefit from higher doses of amphetamine if they are still having significant impairment from ADHD symptoms. It is likely that individuals who have been on high doses for a long time without any significant side effects are at minimal risk. When using high dose amphetamines, I would recommend screening for symptoms of psychosis or mania. 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