INTUNIV Attention Defict Hyperactivity Disorder

Shire pharmaceuticals has announced the release of a new medication for Attention Deficit Hyperactivity Disorder (ADHD). They have received FDA approval to market and sell INTUIV which is a long acting form of the medication guanfacine. Guanfacine is a medication that is used to treat high blood pressure but has long been used as a third or fourth line treatment for ADHD when stimulants, Strattera, or imipramine were unsuccessful or could not be tolerated or safely used. It has a chemical cousin, clonidine, which also has been used. Now guanfacine has been approved as a first line treatment.

Guanfacine has been approved for the use in children and adolescents ages 6 - 17. It is thought to work by affecting norepinephrine receptors in the prefrontal cortex, an area thought to be implicated in ADHD. Gunfacine is not a controlled substance, is not a stimulant, and has no abuse potential. Like many medications it has it's potential drawbacks as well. Common side effects are sedation, headaches, fatigue, upper abdominal pain and small changes in heart rate and blood pressure. In some patients it can cause a potentially dangerous drop in blood pressure and heart rate leading to fainting episodes. It should not be mixed with any othrt medication that can lower the blood pressure or heart rate.

Having another option for ADHD, particularly one that is not abusable is welcome. It is good to have another first line treatment. It does bring up the point I have made before about the need for caution in using any of the ADHD medications as they all have some effects on the cardiovascular system. It is my belief that all patients who are going to take these medications should have a prescreening electrocardiogram to help rule out any underlying heart disease. Not everyone agree with me about this. The American Heart Association does but the pediatric and pediactric psychiatry organizations have not yet adopted this viewpoint. I hope they will.

Thought for the day

All medical treatments have risks as well as benefits.

The Healing Power of Electroconvulsive Therapy, part 2

I said in my last post that I would briefly discuss some aspects of Electroconvulsive Therapy (ECT). We don't do ECT at Cottonwood but I had told the story of someone we referred for the treatment that had called back to let me know it had helped her.

ECT remains the most effective treatment for severe depression. It helps when medication and psychotherapy have failed and that is when it is used today. ECT is not provided in the way it was in the past and is nothing like what a lot of people envision it.

ECT is usually provided in the surgical recovery room of a hospital. There is the psychiatrist, an anesthesiologist, and a trained ECT nurse. The patient is monitored by leads that measure heart rate, blood pressure, oxygen level and brain waves. The patient is given intravenously a short acting anesthetic. A muscle relaxant is given so that the patient's body has no movement during the seizure. The anesthesiologist then hyperoxygenates the patient and the psychiatrist applies an electrical stimulus to the head that induces a brain seizure that last for about one minute and is monitored by the EEG which measures the brain waves. The patient wakes up shortly afterwards and after a half hour or so staying in the recovery room then goes home. It usually takes 6-8 different sessions of this procedure give every other day to achieve a full antidepressant effect.

Like any treatment ECT has it's risks and side effects but is usually effective and is a good treatment to have for depression when nothing else works. It should remain available to those whose sufferings cannot otherwise be alleviated. I welcome any comments or questions on this often misunderstood treatment. For anyone interested in more information about this I recommend the book Shock; The Healing Power of ECT by Kitty Dukakis who has been an ECT patient.

Thought for the day

"I'm trading my sorrow. I'm trading my shame. I'm laying them down for the joy of the Lord. I'm trading my sickness. I'm trading my pain. I'm laying them down for the joy of the Lord".

The Healing Power of Electroconvulsive Therapy

I received a phone message the other day that was very gratifying to hear and once again showed the amazing healing power of Electroconvulsive Therapy (ECT). The message came from a former Cottonwood patient and said "I am well. I had the ECT. It saved my life".

This message was from a patient whom I will call "Maria". Maria is 43 year old married Hispanic woman from San Diego who came to Cottonwood after months of unsuccessful treatment on an outpatient basis for severe agitated depression. The family was at wit's end. She couldn't sleep, she couldn't eat. She was totally unable to function, paced constantly, and would say repeatedly that her life was over. She had no will to live and someone needed to attend her at all times. We treated her with a combination of medications and therapy but to little avail. Medication reduced her anxiety and made it possible for her to eat and sleep normally but she remained fixed and firm in the belief that her life was over and that nothing could be done to help her.

When medication and therapy fails ECT is the treatment of choice. It is often effective for severe depression when other treatments do not work. We do not provide ECT at Cottonwood so we refer patients to other facilities that have the capability of providing ECT. Because of so many misperceptions about ECT and how it is performed it is often difficult to persuade the patients and family to opt for this treatment. It was no different for Maria. She had a tough time deciding but eventually agreed to referral for ECT treatment and as in many cases it was successful. Maria is the second person this year whom we have referred for ECT and both have reported to me a successful treatment.

ECT is associated with a lot of negativity in most people's minds. Healing power are not two words that most people readily apply to ECT. But healing power it has. In my next post I will discuss some misperceptions about ECT and describe how it is used today. I welcome any comments or questions on this often maligned and misunderstood treatment. But for now, I am thankful for Maria and her healing.

Thought for the day

" Take pleasure and rest in one thing only: making your way from one communal duty to another, always remembering God".