Rethinking ADHD Treatment: The Power of Non-Stimulant Medication

Summary

In this video, Dr. Tracey Marks explains how ADHD medications like stimulants (Adderall, Ritalin) focus on attention and hyperactivity but often overlook executive dysfunction. Executive dysfunction includes issues like time management, organization, and emotional control, which stimulants don’t directly address. Dr. Marks introduces non-stimulant medications, including Strattera and the newer Qelbree, which show promise in improving executive function. Unlike stimulants, these meds help with focus and emotional regulation and may even replace stimulants for some. Dr. Marks also highlights recent studies showing Qelbree’s effectiveness, particularly in children, making it an exciting option for adults with ADHD too.

Takeaways

• 😀 Stimulants like Adderall and Ritalin are effective for improving attention, concentration, and hyperactivity but don't address executive dysfunction directly.
• 😀 Executive dysfunction involves difficulties with planning, time management, organization, and emotional regulation, which are common challenges for people with ADHD.
• 😀 Set shifting, or the ability to switch between tasks and return to them later, is a key aspect of executive dysfunction and can severely impact productivity.
• 😀 Stimulant medications can cause individuals to become stuck in 'hyperfocus' mode, making it difficult to shift attention when interrupted, which may cause a loss in productivity.
• 😀 Non-stimulant medications like clonidine, guanfacine, atomoxetine (Strattera), and viloxazine (Qelbree) are used to address executive dysfunction in ADHD, offering benefits beyond just attention and hyperactivity.
• 😀 Qelbree (viloxazine), a newer non-stimulant medication, has shown promise in improving executive function and may be more effective than Strattera, especially in children and adults.
• 😀 Unlike stimulants, non-stimulants like Strattera and Qelbree require daily use and may take a longer time to show effects, sometimes up to a month.
• 😀 Qelbree has been found to significantly reduce executive function deficits in children, with promising results for adults as well, though more research is needed.
• 😀 In some cases, Qelbree can replace stimulant medications, with 85% of participants in studies tapering off stimulants after stabilizing on Qelbree.
• 😀 Insurance coverage for Qelbree may require prior authorization, and some insurance plans mandate trying Strattera before approving Qelbree as a treatment option.
• 😀 Dr. Tracey Marks promotes mental wellness by offering products like shirts, digital workbooks, and canvas prints that encourage mental health conversations and integrate wellbeing into everyday life.

Q & A

What is executive dysfunction, and how does it relate to ADHD?

Executive dysfunction refers to difficulties with tasks such as planning, time management, organizing, and controlling emotions. It is a common issue for individuals with ADHD, as the condition affects the brain's ability to manage these critical functions effectively.

How do stimulant medications like Adderall and Ritalin help with ADHD symptoms?

Stimulant medications such as Adderall and Ritalin are effective in improving attention, concentration, and reducing hyperactivity. However, they primarily target symptoms related to attention and distractibility, not the broader challenges of executive dysfunction.

Why do stimulant medications sometimes fail to address executive dysfunction in ADHD?

While stimulants can help with focus and concentration, they do not directly target the executive functions like planning, organization, and emotional regulation. Once the medication wears off, the symptoms of executive dysfunction often return.

What is set-shifting, and why is it important for individuals with ADHD?

Set-shifting is the ability to switch attention between tasks and return to where you left off. For individuals with ADHD, this can be particularly difficult, as interruptions or distractions can cause significant disruptions in productivity and mental focus.

What happens when someone with ADHD is interrupted while in a hyper-focused state?

For someone with ADHD, an interruption can cause their focus to derail, making it hard to get back on track. The disruption may take a significant amount of time and mental effort to overcome, and productivity can be affected for hours afterward.

What role do non-stimulant medications play in treating ADHD, especially for executive dysfunction?

Non-stimulant medications, such as Clonidine, Guanfacine, Atomoxetine, and Viloxazine, can help address executive dysfunction more directly. They work differently from stimulants and may offer better support for planning, organization, and other executive functions that stimulants don’t fully address.

What are the key differences between Strattera and Qelbree?

Strattera (Atomoxetine) has been around for over 20 years and is a norepinephrine reuptake inhibitor, but it can take weeks to show results. Qelbree (Viloxazine), a newer medication, has shown faster effectiveness (about a week for children, two weeks for adults) and is also more effective in reducing executive function deficits.

Why is Qelbree considered a promising medication for ADHD and executive dysfunction?

Qelbree is promising because it not only improves ADHD symptoms but also significantly reduces executive function deficits, a common challenge for those with ADHD. It has shown faster results compared to other non-stimulants like Strattera, and some individuals can even taper off stimulants after stabilizing on Qelbree.

Can Qelbree be used as a standalone treatment for ADHD?

Yes, Qelbree can be used as a standalone treatment for ADHD, especially for those who find that stimulants aren’t effective or cause undesirable side effects. Some individuals who started on Qelbree were able to taper off stimulants entirely after stabilizing on the medication.

Are there any challenges with getting Qelbree prescribed or covered by insurance?

Since Qelbree is still a brand-name drug, insurance coverage can be a challenge. Some insurance plans may require you to try Strattera before they approve Qelbree, and your doctor may need to complete an insurance authorization process for coverage.