Adult ADD:
A Huge Problem With A Great Answer!
Do you know anyone who is extremely intelligent, but who has underachieved all of his or her life? Do they have regular moments of brilliance, fantastic ideas, great intuition, and shrewd insights, yet they can't seem to ever finish anything, or get ahead in life? Are they very distractible, lacking in focus and follow through? Yes, we all know such people. Many of us are living with, or have lived with them. No concept of time, not a shred of organizational capacity despite their best efforts? Born procrastinators? Yes, those are the people I am talking about. Do they suffer from apparent anxiety and/or depression? Did they have problems in school when they were younger? If many of these charactreistics fit the person you are thinking of, then there is a very good chance that this person is suffering from (and probably has suffered from it all his or her life) adult attention deficit disorder.
There are many neurologic pathways in adult ADD that are blocked or disturbed that account for the wide variety of peculiar yet distinctive personality traits these patients present. They are often mistaken for inadequate personalities, neurotics, or depressives. Sometimes they are thought to be just plain stubborn and lazy. But in truth, they suffer in common from neurologic disorganization predicated upon inadequate nerve impulse transmission in certain key parts of the brain. In the 70's when this constellation of symptoms was first described, it was called "minimal brain dysfunction". Today it is known as attention deficit disorder, a plague that can affect adults as well as children, and often persists through an entire lifetime in those who at an early age were affected by it.
Although there are stimulant medications that can sometimes truly help these patients function better, a treatment that more finely tunes in and works with existing neurologic pathways for the long term is what these patients really need. The drugs have both short and long term side effects, of course. And the long term negative effect that I am most struck by and concerned with is that they may make the underlying deficiencies of certain specific brain chemicals known as neurotransmitters even worse. That is why medication is often found to work for a while and then to stop working. Doses of medication get progressively increased in a cycle that produces diminishing returns. Basically, the drugs attempt, in their own heavy handed manner, to compensate for weak nerve impulse transmission in parts of the brain that provide structure and organisation to the thought processes by forcing neurotransmitter out of the end of weakened and depleted nerve cells. Is there another, better way to accomplish this? You bet. Amino acids.
Certain amino acids act in a way that is completely unlike how drugs act. Instead of forcing depleted neurotransmitters out of cells where they act briefly and then become further depleted because they diffuse away or get broken down by enzymes, the specific amino acid precursors of the major brain chemicals act naturally to INCREASE the amount of available neurotransmitters. This effect will, to a great extent, compensate for weak neurotransmission in the affected nerve bundles in the brains of ADD patients. Over the last 4 years I have become a strong proponent of targeted amino acid therapy for a variety of clinical conditions, but especially for weight problems, depression (where the success rate is nearly 100%), and for ADD. Please be aware that supplementation with free form amino acid capsules or powder is NOT going to get the job done here. What is needed is the specific precursors in the proper (fairly high) doses, given at the right time and in the right combination. And for some patients, there will also be one more key element for success. There is a level of urinary excretion of the neurotransmitters that precedes the resolution of symptons. At that "right dose" level, urinary excretion increases several fold. Patients who are not responding quickly to an escalating dose schedule of the amino acid preparations may need several urinalyses done while doses are adjusted in order to find the effective dose.
There are psychological tests that can help determine if someone is suffering from ADD. I use a clinical questionairre from the book "Driven To Distraction" to screen my own patients for this problem. It is one of the few excellent resources for adults (and children) with suspected ADD. Read the book, by two MD's who suffered from ADD themselves (Hallowell and Ratey), get the whole descriptive story about what ADD is like for its sufferers, and then if you are interested in going beyond stimulant drugs (which was all that was available when the book was written), and for a more precise and longer lasting "fix" for the neurologic deficits, call me for an appointment.
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