What is ADHD?
ADHD (attention-deficit/hyperactivity disorder) is a common disorder among children, adolescents, and adults. Although the type of ADHD can change throughout the lifespan, ADHD is usually a life long disorder and effects 3%-10% of kids and 4% of adults worldwide. ADHD and ADD treatment can be started at a very young age, as little as elementary school aged kids. Co-morbid psychiatric and learning disorders are common in this patient population.
ADHD Symptoms and ADD Symptoms
Classic triad of symptoms include: impulsivity, impaired attention, excessive motor activity. Although a majority of patients only manifest inattentive symptoms which is classified as attention deficit disorder.
Types of ADHD
There are two types of ADHD. One is attention-deficit hyperactivity disorder which is classified by excessive motor activity and impulsivity. The other type is attention-deficit disorder which is characterized by only inattentive symptoms. Boys are 3-4x more likely to be diagnosed with attention-deficit hyperactivity disorder compared to girls. Girls are more likely to be diagnosed with the inattentive type of ADHD.
Gender Differences in ADHD Diagnosis – Girls Underdiagnosed
Although boys are more typically diagnosed with ADHD/ADD in general, published studies show that girls are frequently underdiagnosed due to referral bias. In an epidemiological evaluation of 3907 children ages 8 to 15 years old, boys and girls were found to meet the DSM criteria for ADHD (51% boys and 49% girls). Interestingly, of these children, girls were more frequently underdiagnosed with ADHD and are not on treatment. This leads to higher adult women prevalence of ADHD.
ADHD and Comorbid OCD, Anxiety and Depression
If you have ADHD, you are more like to have OCD, Anxiety, and Depression
Many studies found that if you have ADHD, you are more likely to have disorders such as multiple anxiety disorders (panic disorder, obsessive-compulsive disorder (OCD), tic disorders), mood disorders (depression, bipolar disorder), learning disorders (dyslexia and auditory processing problems) and substance abuse disorders.
For over 60 years, stimulants have been used to treat ADHD and are well-established pharmacologic treatments in this field. These stimulants include methylphenidate, amphetamine salts and dextroamphetamine. These medications are generally well tolerated but there are side effects with taking stimulants. This includes anorexia, difficulty falling asleep, obsessiveness, dry mouth, anxiety, nightmares, weight loss, irritability. Since those with ADHD are more prone to have co-morbid conditions such as anxiety and stimulants may cause increased anxiety, it can be a concern for some individuals.
Amphetamine Uses and Withdrawal
Amphetamine can be highly addictive for some since it increases energy, attention, wakefulness, concentration, sociability, self-confidence, and decreases appetite. Even more so, at low doses it has been show to improve cognitive performance in healthy adults and those with ADHD. However, too high of a dose can impair cognitive function and may worsen recognition and spatial working memory. Additionally, withdrawal from chronic amphetamine use may cause depressive and anxiety symptoms.
Amphetamines’ effects are produced by increasing dopamine, norepinephrine and serotonin concentrations in the brain. It does this by inhibiting an enzyme (monoamine oxidase) that metabolizes these neurotransmitters, therefore, allowing these neurotransmitters to stay around longer produce those effects.
Alternative treatment for ADHD are currently being sought out by researchers due to the potential of abuse of amphetamine as well as the multiple side effects of amphetamines.
1. Namenda (Memantine) Uses
Researchers are looking into newer non-stimulant medications that are effective in treating ADHD for those who cannot take stimulants due to the side effects. One promising medication used to treat ADHD is Memantine (aka Namenda).
Memantine hydrochloride is an N-methyl-D-aspartate (NMDA) receptor antagonist. Memantine is currently used as a treatment for Alzheimer’s disease. Treatment with memantine has been found to produce significant improvement in memory and cognition in this patient population.
This NMDA receptor is part of the pathway in the glutamate system. Glutamate plays a part in normal brain function; glutamate is central in cognition, memory, and learning. Scientists have recently discovered that the glutamate system may a key player in the pathophysiology of depression. Along with this, memantine works as a receptor blocker of glutamate.
Memantine may also have antidepressant-like effects. It has been noted that memantine may also block serotonin receptors.
Memantine Reduces ADHD Withdrawal Symptoms in Mice
In mice studies, memantine was reported to reduce chronic-amphetamine withdrawal symptoms. More importantly, the antidepressant effects of memantine was stronger than impipramine (an antidepressant drug) in depressive-behavior rats.
Memantine reduced ADHD Symptoms in Humans
Researchers at Massachusetts General Hospital and Harvard Medical school conducted a study in 34 adults who had ADHD. Of these 34 subjects, 28 subjects were given memantine with a maximum dose of 10mg twice a day for 12 weeks. After 12 weeks, a variety of tests were performed to measure ADHD symptoms. The researchers found that memantine administration decreased total ADHD symptoms. Decreased inattentive symptoms and hyperactive symptoms were noted. There were no severe adverse effects.
The result of the study: Memantine was largely well-tolerated and may improve ADHD symptoms and neuropsychological performance.
Memantine may be a promising alternative in the treatment of ADHD. Typically prescribed as a drug to treat Alzheimer’s disease, memantine may have neurocognitive benefits in those with ADHD. Researchers tested memantine on adults with ADHD and concluded that memantine is associated with decreased ADHD symptoms. These findings, however, are preliminary and larger studies must be done in order to reproduce the effects on a large scale.
L-acetyl-carnitine – is a potential “smart brain” drug with little to no side effects that may be used as a supplement to treat ADHD and ADD. It is a neuroprotective compound that can potentially protect the brain and mitochondria from damage. L-acetyl-carnitine is an essential compound for your body to produce energy. It can repair damaged neurons in diseases such as diabetic neuropathy.
When taken orally, it can increase glucose and creatine to brain regions such as the hippocampus in mice. They are also studying carnitine as a supplement to improve cognitive function in Alzheimer’s dementia.
Not surprisingly, taken as a supplement it can increase alertness and attention.
In a study of carnitine on 24 school-aged boys, researchers found a significant improvement in attention problems and hyperactivity in 13 of the boys when supplementing 100mg/kg carnitine (maximum of 4,000mg) daily.
However, other studies have found that carnitine did improve the symptoms when added as a supplemental treatment for ADHD in school children. More studies are concurrently being done to see the value of L-acetyl-carnitine on attention-deficit disorders and it’s use as treatment for ADHD.
The recommended dosage of L-acetyl-carnitine is up to 3g daily (a dosage level that was studied in 21 healthy men). Little side effects of L-acetyl-carnitine have been reported for that dosage level.
3. L-Theanine + Caffeine
L-theanine is mainly found in green tea. It has a synergistic effect when taken with caffeine. L-theanine is known to produce relaxation without sedating qualities and can improve concentration and focus when taken with caffeine. The reduction of stress is an important quality of L-theanine since because less stress can help with memory. L-theanine and caffeine may be used as a supplement to reduce inattentive symptoms. It can be a supplement to ADHD treatment.
Relaxation = increased attention.
L-theanine can cross the blood-brain barrier when taken orally and increased levels have been found in regions the brain important in learning and memory such as the hippocampus.
L-theanine has been shown to improve concentration, reduce anxiety and improve sleep quality.
Many studies show that 2.5 mg/kg body weight of L-theanine and 2.0 mg/kg body weight of caffeine improves concentration in adults and when taken together, there is an additive effect or synergistic effect.
More so, L-theanine is very safe at even high doses and no toxicity in animal studies have been found.