Study: Children with ADHD and congenital heart disease can take stimulants

According to a recent study, it is safe for children with both ADHD and congenital heart disease to take stimulant medication.

A new study finds that children with congenital heart disease and ADHD can take stimulant medications without fear of significant cardiovascular side effects.

In a study to be presented at a national meeting Oct. 4, researchers at Cincinnati Children's Hospital Medical Center have found no increased risk for death or changes in cardiac vital signs, such as blood pressure or heart rate, even for children with ADHD and severe heart conditions. They also found that when treated with stimulant medications, patients had significant improvements in ADHD symptoms as measured by standardized rating scales.

"Children with congenital heart disease are at high risk for ADHD, but fears about cardiovascular side effects, including sudden death, limit the use of stimulant medications," says Julia Anixt, MD, a developmental and behavioral pediatrician at Cincinnati Children's and senior author of the study. "This study indicates that stimulants are both effective and safe when prescribed with appropriate monitoring and in collaboration with the patient's cardiologist."

The study will be presented by Pon Trairatvorakul, MD, a fellow in the division of Developmental and Behavioral Pediatrics at Cincinnati Children's, at the annual meeting of the Society for Developmental and Behavioral Pediatrics in Las Vegas.

The researchers studied 44 children between the ages of 6 and 18 seen in the Cincinnati Children's Heart Institute Kindervelt Neurodevelopmental and Educational Clinic. They compared these patients to those with similar heart disease but who were not treated with stimulants. The researchers' next step is to study the effect of stimulant medications on electrocardiograms (EKGs), which measure electrical activity of the heart.

Since 2006, the U.S. Food and Drug Administration has required labeling of stimulant medications to include a warning that they generally should not be used in children and adolescents with serious structural cardiac abnormalities, cardiomyopathy or arrhythmias. However, stimulants are the most effective medication to treat ADHD symptoms, and patient families, cardiologists, and developmental pediatricians must together weigh the risks and benefits of medication treatment options for each individual patient, according to Dr. Anixt.

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ADHD medication to help with binge eating

A study found that ADHD medication may be an effective treatment for binge eating disorders.

A drug approved for the treatment of attention deficit-hyperactivity disorder (ADHD), lisdexamfetamine dimesylate, cuts the number of binge eating days in people with binge eating disorder, according to a study published in JAMA Psychiatry^[1].

There is currently no approved medicine for binge-eating disorder, an eating disorder characterized by recurrent episodes of excessive food consumption, a sense of loss of control and psychological distress, and being overweight or obese.

Guidance from the UK’s National Institute for Health and Care Excellence, published in 2004, recommends that patients follow an evidenced-based self-help programme as a first step or a trial course of a selective serotonin reuptake inhibitor. Patients may also be offered a course of cognitive behavioural therapy (CBT), which has been shown to have an impact on binge eating behaviour, it says.

In this study, researchers from the Lindner Center of HOPE in Mason, Ohio, compared 11 weeks of treatment with 30mg/day, 50mg/day or 70mg/day lisdexamfetamine (marketed at Elvanse in Europe and as Vyvanse in the United States) with placebo in a randomised trial including 260 adults with moderate to severe binge-eating disorder.

The number of binge eating days per week decreased in the 50mg/day and 70 mg/day treatment groups compared with placebo – log-transformed binge eating days per week decreased with the 50-mg/day (least squares [LS] mean [SE] change, −1.49 [0.066]; P = .008) and 70-mg/d (LS mean [SE] change, −1.57 [0.067]; P < .001) but not in the 30 mg/day group (LS mean [SE] change, −1.24 [0.067]; P = .88).

Fewer patients also achieved four-week binge eating cessation in the placebo group (21.3%) compared with the 50 mg/day (42.2%) and 70 mg/day (50%) treatment groups.

Patients who took lisdexamfetamine also lost weight over the 11 weeks: the mean (SD) change in body weight was −3.1kg (3.64) for 30mg/day, −4.9kg (4.43) for 50mg/day, and −4.9kg (3.93) for 70mg/day (P < .001). The weight of patients in the placebo group remained unchanged at −0.1kg (3.09).

The authors say their findings support the need for further assessment of lisdexamfetamine as a treatment option for decreasing binge eating behaviour in adults with moderate to severe binge-eating disorder. “Confirmation of these findings in ongoing clinical trials may result in improved pharmacologic treatment for moderate to severe binge-eating disorder,” they say.

“Increased efficacy with increasing dosages of lisdexamfetamine suggests a dose-response relationship” was involved, they add, and “the lisdexamfetamine safety profile was generally consistent with findings in adults with ADHD”.

Susan Ringwood, chief executive officer of Beat, the charity that supports and campaigns on behalf of people with eating disorders, says: “We know how important it is for people to get evidence-based psychological treatment for their eating disorder, and that pharmacological treatment is not sufficient by itself. This study seems to be saying that because it isn’t easy to access CBT and other evidence-based psychological treatments, these drugs are an alternative.”

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What is causing the global surge in ADHD diagnoses?

What is causing the global surge in ADHD diagnoses? This article believes it has to do more with marketing than medicine.

You can't catch attention deficit hyperactivity disorder (ADHD). Yet the diagnosis and treatment of this behavioral condition is spreading like a contagion -- surging as much as tenfold in some countries.

Call it an economic and cultural plague, but not necessarily a medical one, says Brandeis professor Peter Conrad. In a recent paper in the journal Social Science and Medicine, Conrad and coauthor Meredith Bergey examined the growth of ADHD in the United Kingdom, Germany, France, Italy and Brazil.

Until recently, North America tallied by far the most ADHD diagnoses, and the United States consumed 90 percent of all Ritalin, one of the most common ADHD drugs. ADHD diagnoses continue to grow in the U.S., but Americans account for only 75 percent of Ritalin users today.

Conrad and Bergey attribute ADHD's growth to five trends. Drug companies are effective lobbyists, and have spurred some countries to relax marketing restrictions on stimulants. Psychoanalytic treatment with talk therapy is giving way to biological psychiatry -- treating psychological problems with drugs. More European and South American psychologists and psychiatrists are adopting the American-based Diagnostic and Statistical Manual (DSM) standards, which are broader and have a lower threshold for diagnosing ADHD. Vocal ADHD advocacy groups work closely with drug companies to promote pharmaceutical treatment. Lastly, the easy availability of ADHD information and self-diagnosis via the Internet empowers consumers to ask for prescription treatment.

Many websites promoting ADHD drugs offer checklists with questions like these:

• Do you fidget a lot?
• Is it hard for you to concentrate?
• Are you disorganized at work and home?
• Do you start projects and then abandon them?

"These checklists turn all kinds of different behaviors into medical problems," Conrad says. "The checklists don't distinguish what is part of the human condition and what is a disease."

According to the study, in the U.K., diagnosis of the disorder in school-age children grew from less than one percent in the 1990s to about five percent today. In Germany, prescription ADHD drugs rose from 10 million daily doses in 1998 to 53 million in 2008.

Growth in Italy and France has been slower, in part due to those countries' more restrictive pharmaceutical drug laws. However, even those nations are becoming more lax, says Conrad. In Brazil, a rising number of ADHD advocacy groups, many with close ties to the pharmaceutical industry, are raising awareness of the disorder.

"There is no pharmacological magic bullet," says Conrad. No drug can account for nonmedical factors that may contribute to behavior. A fidgety student may be responding to the one-size-fits-all compulsory education system, Conrad says, not a flaw in his brain chemistry.

ADHD continues a long history of medicalizing behaviors, especially in the U.S., Conrad says. A century ago, masturbation was considered a disease. Men and women diagnosed with masturbatory insanity were institutionalized or subjected to surgical treatment.

"I think we may look back on this time in 50 years and ask, what did we do to these kids?" Conrad says.

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ADHD stimulants often abused by college students

This article discusses how stimulant use for ADHD is often abused by college students.

Nearly one in every five college students abuses prescription stimulants, according to a new survey sponsored by the Partnership for Drug-Free Kids. The survey also found that one in seven non-students of similar age also report abusing stimulant medications.

Young adults aged 18 to 25 report using the drugs to help them stay awake, study or improve their work or school performance. The most commonly abused stimulants are those typically prescribed for attention-deficit/hyperactivity disorder (ADHD), such as Adderall,Ritalin and Vyvanse, the survey found.

"The findings shed a new and surprising light on the young adult who is abusing prescription stimulants," said Sean Clarkin, director of strategy and program management for the Partnership for Drug-Free Kids. "While there is some 'recreational' abuse, the typical misuser is a male college student whose grade point average is only slightly lower than that of non-abusers, but who is juggling a very busy schedule that includes academics, work and an active social life."

Clarkin said the findings point to the need for parents and educators to increase their efforts to help young people develop effective time-management skills to balance academics, work and social activities.

"The profile that emerges is less that of an academic 'goof-off' who abuses prescription stimulants to make up for lost study time than a stressed out multitasker who is burning the candle at both ends and trying to keep up," Clarkin said.

The nationally representative study, conducted by independent researcher Whitman Insight Strategies, surveyed more than 1,600 young adults online this past summer, including approximately 1,000 college students.

Half of the students reported they took stimulant drugs to study or improve their academic performance, the survey noted. And, the survey found that two-thirds of those students believed the drugs helped them get a better grade or be more competitive at school or work. Around 40 percent took the drugs to stay awake. About a quarter of abusers said they took the stimulants to improve their work performance, according to the study.

These are the same reasons former user Linda Stafford said she began using the drugs.

Stafford began taking Adderall and Vyvanse without any prescriptions while she was a college student in Statesboro, Ga.

"I wanted to go to school, work and party, and Adderall helped me to focus pretty well at first," Stafford said. In reality, however, she said taking the stimulant did not change her test grades much. "Then," she said, "I got hooked."

Stafford began experiencing depression, paranoia and social anxiety and became unable to communicate even with her closest loved ones, she said.

"I was totally incapable of handling life," Stafford said. "I could not manage a simple job, my class assignments or relationships. Adderall was the center of my life."

Stafford has since been through recovery and uses a support network and support groups to manage, but her story is one that Miami University staff psychiatrist Dr. Josh Hersh has heard often.

"These survey findings have confirmed a lot of the things I have seen clinically," Hersh said. "Young adults are mainly using prescription stimulants to improve academic and work performance and to stay awake."

Although Hersh said some of the students taking these drugs may feel the invulnerability of youth, others are simply desperate to juggle everything even while they know the possible risks of taking the drugs, such as anxiety or panic attacks even with occasional use.

"The fact that students often use these drugs around deadlines, when their natural adrenaline is already high, elevates the risk even more," Hersh said. "Sporadic use can lead to severe sleep deprivation and cause stimulant-induced psychosis, when a student gets paranoid and may hallucinate."

He said snorting the pills can lead to internal nasal damage and regular use can lead to addictions that are destructive and difficult to treat.

Even young adults who are legally prescribed stimulants for specific health conditions can risk becoming more addicted, as happened to the son of Kathleen Dobbs, a retiree who co-founded the grass roots coalition Parent to Parent, Inc.

Her son was diagnosed with ADHD at age 8 and began taking Ritalin at age 10, but by high school doctors switched him to various other drugs before Dobbs requested no more prescriptions. By then, however, he was seeking out Ritalin from classmates and then moved on to cocaine to "feel normal," Dobbs said.

"Children with ADHD will do anything to fit in, to be able to learn and be like other kids," said Dobbs, adding that the addiction tore their family apart. "When you have a child who is addicted, it is like a bomb goes off in your home and everyone scatters. I prayed and did all the right things, but it creeps into your life and destroys your entire family and leaves you with pain and loss."

Her son is now married, sober and in ongoing recovery, but she recommends that parents remain vigilant and educate themselves about drugs, especially those their children are prescribed.

The survey found that 28 percent of people legally prescribed stimulants have exaggerated their symptoms to get a larger dose. The same percentage reported sharing their medicine with friends. Just over half the adults surveyed said stimulants were easy to obtain, usually from friends, and most said their friends abused them as well.

Red flags that parents can watch for in their children, Hersh said, include having dilated pupils, anxiety or manic behavior, talking about not sleeping for days and "crashing" when home from college, such as sleeping often and having difficulty concentrating.

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Teenagers proscribed anti-anxiety or sleep medications more likely to abuse them

When teenagers are proscribed anti-anxiety or sleep medication, they are more likely to abuse those drugs later in life.

The medical community may be inadvertently creating a new generation of illegal, recreational drug users by prescribing anti-anxiety or sleep medications to teenagers, say University of Michigan researchers.

Teens prescribed anxiety or sleep medications are up to 12 times more likely to abuse those drugs than those who had never had a prescription, either by using someone else's prescription pills or to get high or experiment, according to a study from the U-M School of Nursing.

Nearly 9 percent of the 2,745 adolescent study participants had received a prescription for anxiety or sleep medications during their lifetime, and more than 3 percent received at least one prescription during the three-year study period.

"I recognize the importance of these medications in treating anxiety and sleep problems," said the study's first author Carol Boyd, the Deborah J. Oakley Professor of Nursing. "However, the number of adolescents prescribed these medications and the number misusing them is disturbing for several reasons."

Anxiety and sleep medications can be addictive or even fatal when mixed with narcotics or alcohol, said Boyd, who is also a professor of women's studies and research professor at the Institute for Research on Women and Gender and at the U-M Addiction Research Center in the Department of Psychiatry.

"What happened to [actor] Heath Ledger could happen to any teen who is misusing these medications, particularly if the teen uses alcohol in combination with these drugs," Boyd said.

Examples of anti-anxiety medications include Klonopin, Xanax and Ativan; sleep medications include Ambien, Restoril and Lunesta. These are controlled substances partly because of the potential for abuse, and it's a felony to share them, Boyd said.

The U-M study included students from five Detroit-area schools grouped into three categories: those never prescribed anxiety or sleep medications; those prescribed those medications within the three-year study period; and those previously prescribed those medications but not during the study period.

Key findings include:

Adolescents prescribed anxiety medications during their lifetime, but not during the study, were 12 times more likely to use someone else's anxiety medication than participants who had never been prescribed such drugs.

Those prescribed anxiety or sleep medications during the study period were 10 times more likely to abuse them within two years, to get high or to experiment, than teens without prescriptions.

White students were twice as likely as black students to use others' medications, and females older than 15 and teens who had prescriptions for longer periods of time were more likely to abuse the medications.

It's the first longitudinal study to determine whether teens' recent medical use of anxiety or sleep medications is associated with later taking somebody else's prescription medication illegally, either for self-treatment or recreational use.

Boyd said the group intended to write a paper about teens abusing their own prescriptions, but changed course when the results became clear.

"I looked at these numbers and said, 'There's a story here.' It just catches you off guard that so many adolescents are being prescribed these medications," Boyd said. "Why is it that our youth are anxious and sleepless? Is it because they are under stress, consuming too much caffeine or seeking an altered state? "

The study recommends better education for parents and adolescents prescribed these medications, monitoring refills and making it standard practice to give teens a substance use assessment before prescribing these drugs.

Boyd's co-authors include Elizabeth Austic, Quyen Epstein-Ngo, Philip Veliz and Sean Esteban McCabe of the U-M Institute for Research on Women and Gender. Epstein-Ngo also has appointments at the U-M Injury Research Center and Institute for Clinical and Health Research.

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Medication to help children with life threatening seizures

Research has shown that an investigational medication can help treat children with potentially life threatening seizures.

In its first clinical application in pediatric patients, an investigational medication developed and manufactured at UC Davis has been found to effectively treat children with life-threatening and difficult-to-control epileptic seizures without side effects, according to a research report by scientists at UC Davis and Northwestern University.

The investigational formulation of allopregnanolone was manufactured by UC Davis Health System's Good Manufacturing Practice Laboratory. Two children were treated with the allopregnanolone formulation, one at UC Davis Children's Hospital, the other at the Ann & Robert Lurie Children's Hospital in Chicago. Both children were weaned from general anesthetics and other seizure treatments and their seizures resolved. In both instances the children are recovering.

The research is published online in Annals of Neurology, an official journal of the American Neurological Association and the Child Neurology Society.

Super-refractory status epilepticus is a condition diagnosed in patients with refractory status epilepticus being treated with infusions of general anesthetics when seizures continue for longer than 24 hours, despite anesthesia, or when seizures recur on reduction or withdrawal of the anesthesia. Super-refractory status epilepticus has high morbidity and mortality. There are no Food and Drug Administration (FDA)-approved treatments for the condition.

Allopregnanolone is a positive allosteric modulator of GABAA receptors in the brain. Research in animals has shown that allopregnanolone protects against seizures and can stop status epilepticus. Although the allopregnanolone used to manufacture the investigational treatment was produced by chemical synthesis according to procedures regulated by the FDA, it is synthesized normally in small quantities in the body from progesterone.

"Our laboratory studies have shown that allopregnanolone is effective in stopping status epilepticus that is refractory to treatment," said Michael Rogawski, professor in the UC Davis Department of Neurology and a co-author of the report.

In both of the clinical cases, the patients continued to have seizures despite weeks of intensive treatment with medications, including infusion of anesthetics. Emergency treatment with the investigational medication was approved by the FDA; the two patients received the medication over a five-day period, during which time both were weaned from anesthetics and other seizure medications. Status epilepticus did not recur after treatment. There were no adverse drug effects, the researchers said.

Mortality rates in super-refractory status epilepticus can be as high as 50 percent, and those who survive experience high rates of subsequent neurological impairment. The authors note that progesterone and ganaxolone, a chemical analog of allopregnanolone, have been studied in clinical trials for epilepsy and have shown benefit. Researchers at UC Davis, led by Rogawski, currently are investigating the use of allopregnanolone as a treatment for traumatic brain injury.

"Neurosteroids, including allopregnanolone, are a promising treatment for epilepsy and refractory status epilepticus that may overcome resistance to benzodiazepines and barbiturates and facilitate the withdrawal of these agents by preventing rebound seizures, a key problem in treatment of super-refractory status epilepticus," Rogawski said.

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Difficulties of treating epilepsy while pregnant

This article explains the difficulties of pregnant mothers with epilepsy treating the condition while pregnant.

A new study published in The Cochrane Library, highlights the difficult decisions women with epilepsy have to face when they become pregnant. Taking certain drugs used to control epilepsy during pregnancy may be linked to developmental problems in children. The authors of the study say evidence on the safety of anti-epileptic drugs is limited and that more research is needed to ensure women and their doctors make the most informed choices.

Studies on children born to women with epilepsy increasingly suggest that some anti-epileptic medications affect development in the womb. However, most women with epilepsy rely on these medications to control seizures during pregnancy.

To assess the safety of taking anti-epileptics during pregnancy, the researchers drew together evidence from 28 studies. They measured children's global cognitive ability using either intelligence quotient (IQ), for school aged children, or developmental quotient (DQ), for younger children, to provide a summary of development across a range of cognitive skills. The researchers looked at DQ and IQ scores in the children of three groups of women: those with epilepsy who took anti-epilepsy medication, those with epilepsy who did not take epilepsy medication and those without epilepsy.

The children of women who took one drug, sodium valproate, had lower DQs and IQs than the children of women in the other groups. Higher doses of this drug were linked to larger effects on IQ or DQ. However another drug, carbamazepine, did not appear to have any significant effects on DQ or IQ. Younger children born to women who took carbamazepine did have lower DQs but the researchers concluded that this effect was due to random variation between the results of studies.

"This review highlights the need for preconception counselling in women with epilepsy," said Rebecca Bromley, lead researcher of the study based at the Institute of Human Development at the University of Manchester in Manchester, UK. "Counselling should take account of the fact that many pregnancies are unplanned and cover the risks of anti-epileptic drugs, whilst considering how well they control epileptic seizures."

"The review also highlights the need to counsel patients about risks and benefits of treatment alternatives at the time of epilepsy diagnosis and treatment initiation, so that informed decisions can be made. This is particularly important for women with idiopathic generalised epilepsy for whom valproate is the most effective treatment. Some women may choose to initiate valproate as they have no plans to conceive, while others may choose to avoid valproate and try a less effective drug accepting the associated risk of further seizures." Tony Marson, Coordinating Editor Cochrane Epilepsy Group, University of Liverpool.

Some studies made comparisons between different drugs. The children of women who took valproate had lower IQs than children exposed to carbamazepine or lamotrigine in the womb. They also had lower DQs and IQs than children born to women who took phenytoin. There were no differences between the IQs of children exposed to either carbamazepine, phenytoin or lamotrigine.

Only a few studies analysed the effects of newer anti-epileptic drugs like lamotrigine, levetiracetam and topiramate. "Data was not available for all anti-epileptic drugs that are in use today and data on newer anti-epileptic drugs was especially scarce," said Bromley. "This makes it difficult for women and their doctors to know which medications are safe to use during childbearing years. Future research needs to be carried out in a timelier manner to ensure that when prescribing decisions are being made the risks are already established. Women should however not stop or make alterations to their medication without first seeking medical advice."

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Few children with ADHD get behavioral therapy

A study found that children who take ADHD medication get little psychotherapy or behavioral treatment to complement their medication.

Few children who take medication for attention-deficit/hyperactivity disorder (ADHD) also undergo behavioral therapy, and the rates vary six-fold across counties in the United States, a new study finds.

Medication alone can manage symptoms for many children with ADHD, but some do better if they also receive behavioral therapy (psychotherapy), the Rand Corp. researchers noted.

The researchers analyzed data in more than 1,500 counties across the United States that included more than 300,000 privately insured children, aged 17 and younger, who were prescribed ADHD drugs. Less than a quarter of them received any psychotherapy in the same year they took ADHD medications; 13 percent had at least four therapy visits, and seven percent had at least eight therapy sessions.

In some counties, fewer than 10 percent of kids taking ADHD drugs got behavioral therapy, according to the study, which was published as a research letter in the Sept. 22 issue of the journal JAMA Pediatrics.

Those who lived in counties with fewer licensed psychologists were less likely to receive psychotherapy while taking ADHD drugs, the data showed. But even in some counties where the number of psychologists were the same, the rates varied.

In California's Sacramento County, almost half the kids with ADHD received therapy along with drugs, compared to only about 20 percent of those in Florida's Miami-Dade County, the researchers noted.

"Treatment of ADHD in children generates lots of controversy, primarily because of potential for overuse and abuse of stimulant medications," study author Dr. Walid Gellad, an adjunct scientist at Rand, said in a news release from the nonprofit research organization.

"We wanted to find out among those who receive ADHD medications, how many are also receive billed psychotherapy services? The answer is few, but it actually depends on where you live," Gellad said.

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Medication absorption for children with autism

Research indicates that medication absorption in children with autism should be examined more closely due to the connection between autism and gastrointestinal issues.

Recent research has revealed that many children and adults with autism experience gastrointestinal symptoms and that such symptoms can impact the absorption and availability of medications.

Because approximately 35% of people with autism take at least one psychotropic medication to help control their symptoms, the authors of a Journal of Clinical Pharmacology commentary are calling for a formal evaluation of the potential relationship between gastrointestinal symptoms and the effectiveness of autism medications. Alternative modes of drug administration may be needed to provide more effective therapy for patients.

"Admittedly, there are a number of variables that can influence medication response but given how common gastrointestinal issues are for those with autism, it seems the relationship should be examined more closely," said senior author Dr. Maria Valdovinos.

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Adulthood with ADHD Podcast

At the link below, view a podcast about the transition from childhood to adulthood for a person with ADHD.

ADD and ADHD don’t just affect children. More and more adults are being diagnosed with the condition, especially young women. According to a recent report, between 2008 and 2012, the number of women taking ADHD drugs jumped 85 percent. This hour we’ll talk about the disorder, how adults are affected and how they live with it.

Listen to the podcast here

Medications for shift workers show little effectiveness

A review of medications shift workers take both for alertness and to help them sleep have little effectiveness.

Shift workers are taking drugs to help them stay awake or get to sleep despite weak evidence for their benefit, according to a new Cochrane review. The authors of the review found only small numbers of trials testing over-the-counter and prescription drugs used by shift workers, and the results suggest that for some people they might do more harm than good.

In most developed countries, at least 10% of the workforce is involved in some form of shift work. European statistics suggest that as many as three quarters of the population have 'non-standard' working hours. Disturbances to normal sleeping and waking patterns increase the risk of accidents and affect shift workers' health. It is therefore important to avoid shift work where possible and improve shift work schedules to help shift workers achieve more normal sleeping and waking patterns. In jobs where shift work cannot be avoided, such as health care, the police force or the military, drugs can potentially offer short-term benefits.

The review included 15 trials involving a total of 718 people. In nine trials, the over-the- counter hormone drug melatonin helped shift workers sleep for around 24 minutes longer during the night or day, compared to placebos. However, it did not help them get to sleep any quicker. Data from only one trial of the hypnotic drug zoplicone was available. The drug was no more effective than placebos for helping shift workers sleep during the day.

The remaining trials focused on caffeine and two drugs, modafinil and armodafinil, that are prescribed for sleepiness during night shifts. In one trial, caffeine reduced sleepiness during night shifts, when workers also napped before shifts. Modafinil and armodafinil, used by shift workers in one and two trials respectively, increased alertness and reduced sleepiness. However, they also caused headaches, nausea and a rise in blood pressure in a substantial number of people. Due to the limited benefits and frequent side effects, neither of these drugs is approved for shift workers in Europe.

"For lots of people who do shift work, it would be really useful if they could take a pill that would help them go to sleep or stay awake at the right time," said lead author of the review, Juha Liira, who is based at the Finnish Institute of Occupational Health in Helsinki, Finland. "But from what we have seen in our review, there isn't good evidence that these drugs can be considered for more than temporary use and some may have quite serious side effects."

Most of the data reported in the review was from small, low quality trials. In addition, trials tended to be carried out in specific settings, such as health care or oil rigs, so their results may be less relevant for workers in other types of roles.

"It's curious that there's such a clear gap in the research," said Liira. "It may well be that studying the effects of these drugs or others drugs in properly designed trials would be seen as unethical because workers should not need drugs to get along with their work. So the studies just haven't been done or if they have, our review has not been able to identify relevant data."

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ADHD diagnosis by involuntary eye movements

A study shows that ADHD can accurately be diagnosed by a person's involuntary eye movements.

Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed -- and misdiagnosed -- behavioral disorder in children in America, according to the Centers for Disease Control and Prevention. Unfortunately, there are currently no reliable physiological markers to diagnose ADHD. Doctors generally diagnose the disorder by recording a medical and social history of the patient and the family, discussing possible symptoms and observing the patient's behavior. But an incorrect evaluation can lead to overmedication with Ritalin (methylphenidate), which has parents everywhere concerned.

Now a new study from Tel Aviv University researchers may provide the objective tool medical professionals need to accurately diagnose ADHD. According to the research, published in Vision Research, involuntary eye movements accurately reflect the presence of ADHD, as well as the benefits of medical stimulants that are used to treat the disorder.

Keeping an eye on the eyes

Dr. Moshe Fried, Dr. Anna Sterkin, and Prof. Uri Polat of TAU's Sackler Faculty of Medicine, Dr. Tamara Wygnanski-Jaffe, Dr. Eteri Tsitsiashvili, Dr. Tamir Epstein of the Goldschleger Eye Research Institute at Sheba Medical Center, Tel Hashomer, and Dr. Yoram S. Bonneh of the University of Haifa used an eye-tracking system to monitor the involuntary eye movements of two groups of 22 adults taking an ADHD diagnostic computer test called the Test of Variables of Attention (TOVA). The exercise, which lasted 22 minutes, was repeated twice by each participant. The first group of participants, diagnosed with ADHD, initially took the test un-medicated and then took it again under the influence of methylphenidate. A second group, not diagnosed with ADHD, constituted the control group.

"We had two objectives going into this research," said Dr. Fried, who as an adult was himself diagnosed with ADHD. "The first was to provide a new diagnostic tool for ADHD, and the second was to test whether ADHD medication really works -- and we found that it does. There was a significant difference between the two groups, and between the two sets of tests taken by ADHD participants un-medicated and later medicated."

Foolproof, affordable, and accessible diagnosis

The researchers found a direct correlation between ADHD and the inability to suppress eye movement in the anticipation of visual stimuli. The research also reflected improved performance by participants taking methylphenidate, which normalized the suppression of involuntary eye movements to the average level of the control group.

"This test is affordable and accessible, rendering it a practical and foolproof tool for medical professionals," said Dr. Fried. "With other tests, you can slip up, make 'mistakes' -- intentionally or not. But our test cannot be fooled. Eye movements tracked in this test are involuntary, so they constitute a sound physiological marker of ADHD.

"Our study also reflected that methylphenidate does work. It is certainly not a placebo, as some have suggested."

The researchers are currently conducting more extensive trials on larger control groups to further explore applications of the test.

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Study claims that ADHD medication can increase risk of heart issues

A study claims that medication used to treat ADHD might increase the risk of heart complications in children.

Whether drugs used to treat attention deficit hyperactivity disorder boost the risk of heart conditions in children remains a subject of concern. Now, research from Denmark suggests medications such as Ritalin and Concerta make rare cardiac problems twice as likely, although still uncommon.

"The risk of adverse cardiac effects of ADHD medication is real and should not be forgotten," said study lead author Dr. Soren Dalsgaard, an associate professor at Aarhus University.

However, doctors and parents should not be alarmed and take kids off stimulant medication if they have benefits from it and no cardiac symptoms, he said. "But we should continue to monitor cardiovascular status," he added.

The findings aren't definitive because they don't prove cause-and-effect and they seem to conflict with some previous research that looked at fewer heart conditions over shorter periods of time.

The inattention, hyperactivity and impulsivity associated with ADHD can make it hard for children with the disorder to learn and socialize. Stimulant drugs taken on a daily basis can help control these behaviors.

Worldwide, the number of children and teens with ADHD who take stimulant medications is increasing, according to background research in the study. Experts say these drugs can boost heart rate and blood pressure.

"The most common cardiac effects are benign -- very small, clinically insignificant increases in heart rate or blood pressure," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York in New Hyde Park.

Alarms sounded because of reports of sudden deaths, heart attack and stroke related to ADHD drugs, which has led some physicians to assess heart health before starting young people on the drugs.

But a 2011 study of U.S. children and young adults published in the New England Journal of Medicine found no link between ADHD drugs and heart attacks, sudden death and stroke. And in 2012, a study in the Journal of the American Medical Association found no sign of a link in young and middle-aged adults either.

The new study, published online recently in the Journal of Child and Adolescent Psychopharmacology, followed 714,000 children in Denmark, born from 1990 to 1999, for an average of 9.5 years. Of those, 8,300 were diagnosed with ADHD after age 5.

Of the total with ADHD, 111 kids -- or a little more than 1 percent -- had a heart problem such as high blood pressure, cardiac arrest, irregular heartbeat or general cardiovascular disease.

When the researchers adjusted their statistics to take into account certain differences, they found those who took methylphenidates such as Ritalin or Concerta -- whether diagnosed with ADHD or not -- were about twice as likely to suffer from heart problems.

The researchers didn't examine whether ADHD itself could be linked to heart problems.

In a news release, journal editor Dr. Harold Koplewicz said the study "confirms the small but real risk we have understood for some time through prior reports and clinical experience." Koplewicz is president of the Child Mind Institute in New York City.

The findings raise the question of whether the benefits of the drugs outweigh the possible harms. In the big picture, few children who took the drugs actually developed heart problems, study lead author Dalsgaard said.

"Indeed, the benefits from ADHD medication can be worth the risk of adverse effects, but we should not underestimate the risk of cardiac effects," he said.

Adesman emphasized the rarity of heart problems in ADHD patients. Parents may wish to talk to a pediatric cardiologist if their child has an existing heart problem and they wish to put them on a stimulant for ADHD, he said.

"In my experience, most cardiologists will support treatment with stimulant medication for most children with congenital heart disease -- even for kids who have had open heart surgery to repair a malformed heart," he said.

More research is planned, Dalsgaard said, especially to unravel an unusual finding in the study. Children seemed at higher risk of heart problems if their doctors had lowered their drug dosage. It's not clear if the change in dose contributed to the heart issues or whether there's another explanation.

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What can I do about my migraines?

This article discusses what someone who suffers from migraines can do about their headaches.

If you are one of the roughly 30 million Americans who suffer from the intense, throbbing misery of migraines, you'd probably try anything to ease the pain. Here are some options to consider and discuss with your doctor:

Pain-relieving medications.

Over-the-counter aspirin, ibuprofen or acetaminophen, as well as formulations marketed specifically for migraines, may help relieve mild to moderate pain. Take at the first sign of a headache. Prescription drugs may be needed for more severe attacks. Preventive therapies may also be an option if you suffer from frequent attacks, if they last a long time or if pain-relievers aren't helping.

Biofeedback.

This alternative therapy uses electrical sensors on your body to detect and monitor physical responses related to stress, such as muscle tension. Having that information helps you learn to make subtle changes — such as relaxing those specific muscles — to relieve headaches. A form of this therapy called neurofeedback, or EEG biofeedback, focuses on helping people alter brain waves, which some research suggests may ease migraine pain. Other alternative treatments include acupuncture and massage therapy.

Avoid your triggers.

Whether it's a type of food or smell, a specific medication, or even disrupted sleep or missed meal – many factors can set off an attack. Do your best to steer clear of them and maintain a consistent routine.

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Study: Century-old anti-parasitic medication may reverse symptoms of autism... in mice...temporarily

A study looks into a century-old sleep medication and found that it reversed the symptoms of autism in mice.

In a further test of a novel theory that suggests autism is the consequence of abnormal cell communication, researchers at the University of California, San Diego School of Medicine report that an almost century-old drug approved for treating sleeping sickness also restores normal cellular signaling in a mouse model of autism, reversing symptoms of the neurological disorder in animals that were the human biological age equivalent of 30 years old.

The findings, published in the June 17, 2014 online issue of Translational Psychiatry, follow up on similar research published last year by senior author Robert K. Naviaux, MD, PhD, professor of medicine, pediatrics and pathology, and colleagues.

Naviaux said the findings fit neatly with the idea that autism is caused by a multitude of interconnected factors: "Twenty percent of the known factors associated with autism are genetic, but most are not. It's wrong to think of genes and the environment as separate and independent factors. Genes and environmental factors interact. The net result of this interaction is metabolism."

Naviaux, who is co-director of the Mitochondrial and Metabolic Disease Center at UC San Diego, said one of the universal symptoms of autism is metabolic disturbances. "Cells have a halo of metabolites (small molecules involved in metabolism, the set of chemical processes that maintain life) and nucleotides surrounding them. These create a sort of chemical glow that broadcasts the state of health of the cell."

Cells threatened or damaged by microbes, such as viruses or bacteria, or by physical forces or by chemicals, such as pollutants, react defensively, a part of the normal immune response, Naviaux said. Their membranes stiffen. Internal metabolic processes are altered, most notably mitochondria -- the cells' critical "power plants." And communications between cells are dramatically reduced. This is the "cell danger response," said Naviaux, and if it persists, the result can be lasting, diverse impairment. If it occurs during childhood, for example, neurodevelopment is delayed.

"Cells behave like countries at war," said Naviaux. "When a threat begins, they harden their borders. They don't trust their neighbors. But without constant communication with the outside, cells begin to function differently. In the case of neurons, it might be by making fewer or too many connections. One way to look at this related to autism is this: When cells stop talking to each other, children stop talking."

Naviaux and colleagues have focused on a cellular signaling system linked to both mitochondrial function and to the cell's innate immune function. Specifically, they have zeroed in on the role of nucleotides like adenosine triphosphate (ATP) and other signaling mitokines -- molecules generated by distressed mitochondria. These mitokines have separate metabolic functions outside of the cell where they bind to and regulate receptors present on every cell of the body. Nineteen types of so-called purinergic receptors are known to be stimulated by these extracellular nucleotides, and the receptors are known to control a broad range of biological characteristics with relevance to autism, such as impaired language and social skills.

In their latest work, Naviaux again tested the effect of suramin, a well-known inhibitor of purinergic signaling that was first synthesized in 1916 and is used to treat trypanosomiasis or African sleeping sickness, a parasitic disease. They found that suramin blocked the extracellular signaling pathway used by ATP and other mitokines in a mouse model of autism spectrum disorder (ASD), ending the cell danger response and related inflammation. Cells subsequently began behaving normally and autism-like behaviors and metabolism in the mice were corrected.

However, the biological and behavioral benefits of suramin were not permanent, nor preventive. A single dose remained effective in the mice for about five weeks, and then washed out. Moreover, suramin cannot be taken long-term since it can result in anemia and adrenal gland dysfunction.

Still, Naviaux said these and earlier findings are sufficiently encouraging to soon launch a small phase 1 clinical trial with children who have ASD. He expects the trial to begin later this year.

"Obviously correcting abnormalities in a mouse is a long way from a cure in humans, but we think this approach -- antipurinergic therapy -- is a new and fresh way to think about and address the challenge of autism.

"Our work doesn't contradict what others have discovered or done. It's another perspective. Our idea is that this kind of treatment -- eliminating a basic, underlying metabolic dysfunction -- removes a hurdle that might make other non-drug behavioral and developmental therapies of autism more effective. The discovery that a single dose of medicine can fundamentally reset metabolism for weeks means that newer and safer drugs might not need to be given chronically. Members of this new class of medicines might need to be given only intermittently during sensitive developmental windows to unblock metabolism and permit improved development in response to many kinds of behavioral and occupational therapies, and to natural play."

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Obesity and diabetes may be helped by migraine medication

A migraine medication that blocks specific pain receptors may also treat obesity and diabetes.

By blocking a key pain receptor in mice models, a team of researchers has discovered a potential new method for treating obesity and diabetes. 

In a study published in the May 22, 2014, issue of Cell, Andrew Dillin, PhD, and researchers at the University of California, Berkeley found genetically modified mice that lacked a certain pain receptor called TRPV1 lived 14% longer than mice that had it. 

“In long-lived TRPV1 knockout mice, the nuclear exclusion of the transcriptional coactivator CRTC1 within pain sensory neurons originating from the spinal cord … decreases production of the neuropeptide CGRP from sensory endings innervating the pancreatic islets, subsequently promoting insulin secretion and metabolic health,” the authors wrote. “In contrast, CGRP homeostasis is disrupted with age in wild-type mice, resulting in metabolic decline.”  

Furthermore, the researchers found TRPV1-deficient mice had lower levels of the CGRP proteins that are responsible for blocking insulin release and increasing blood glucose levels, which ultimately affect the development of type 2 diabetes and obesity. As a result, treated mice were able to quickly remove sugar from their systems, regardless of exercise frequency or aging. 

“We think that blocking this pain receptor and pathway could be very, very useful — not only for relieving pain, but (also) for improving lifespan and metabolic health, and, in particular, for treating diabetes and obesity in humans,” Dillin said in a press release. 

The investigators noted an anti-migraine medication produces similar results, since it inhibits a CGRP protein that triggers TRPV1. In fact, older mice treated with the drug in the study had increased longevity compared to untreated older mice, and they were also metabolically similar to younger mice. 

Moving forward, Dillin said he plans to further examine the influence of TRPV1 and CGRP in both mice and humans. 

“Our findings suggest that pharmacological manipulation of TRPV1 and CGRP may improve metabolic health and longevity,” Dillin noted. “Alternatively, chronic ingestion of compounds that affect TRPV1 might help prevent metabolic decline with age and lead to increased longevity in humans.”

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Breastfeeding while taking epilepsy medication does not harm infant

Brain development of breastfed infants is not harmed by the mother taking epilepsy medications.

Taking epilepsy drugs while breast-feeding does not appear to harm the developing brains of young children, a new study finds.

There have been concerns that using epilepsy drugs while breast-feeding could pose a threat to youngsters because it's been shown that some epilepsy drugs can cause cell death in young animals' brains.

And in spite of the fact that epilepsy experts recommend breast-feeding, "it is still a sensitive topic among women with epilepsy," noted one expert, Dr. Patricia Dugan, assistant professor of neurology at the Comprehensive Epilepsy Center at NYU Langone Medical Center, New York City.

"Despite reassuring published data, such as this article, patients frequently tell us that they receive contradictory advice from their obstetricians and pediatricians, resulting in a significant amount of distress for the mother," said Dugan, who was not connected to the new research. "Hopefully, papers such as these will encourage everyone involved in the care of women with epilepsy to promote breast-feeding," she said.

The new study included 181 children of mothers who had epilepsy and took drugs to control the condition. Nearly 43 percent of the children were breast-fed for an average of seven months.

IQ tests conducted on the children when they were 6 years old found no differences between those who were breast-fed and those who were not, according to the study published online June 16 in JAMA Pediatrics.

"Our study does not provide a final answer, but we recommend breast-feeding to mothers with epilepsy, informing them of the strength of evidence for risks and benefits," wrote a team led by Dr. Kimford Meador, of Stanford University in California

Another expert said the study offers valuable information.

"The authors controlled for many of the factors that might influence the intellectual outcome of this large number of children," noted Dr. Ian Holzman, chief of the division of newborn medicine at the Kravis Children's Hospital at Mount Sinai in New York City.

"By following these children through age 6, they were able to present information relevant to the important issue of school performance," he said. "This study allows us to counsel mothers who are planning to breast-feed that there doesn't seem to be any harm [in taking epilepsy medications]."

Dugan said the study also hinted at other benefits for breast-fed children.

"It also showed that testing of breast-fed children at 6 years old -- an age when more meticulous testing can be performed -- reflected beneficial effects of breast-feeding, with higher IQ and better verbal abilities than nonbreast-fed children," she said.

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Study shows that ADHD treatment does not increase suicide risk

A study shows that drug therapy for ADHD does not increase suicide risk.

A new register-based study from Karolinska Institutet in Sweden shows that drug therapy for ADHD does not entail an increased risk of suicide attempts or suicide, as was previously feared. The results are published in the British Medical Journal (BMJ).

"Our work in several ways shows that most likely there is no link between treatment with ADHD drugs and an increased risk of suicide attempts or suicide. The results rather indicate that ADHD drugs may have a protective effect," says Henrik Larsson, researcher at the Department of Medical Epidemiology and Biostatistics, who headed the study.

Earlier research has indicated that ADHD drug treatment would increase the occurrence of suicidal thoughts. However, these studies have been small scale and/or the methods used have been limited, which make the results uncertain. To gain clarity in this matter, researchers at Karolinska Institutet have now used national patient registers to identify all patients in Sweden diagnosed with ADHD between 1960 and 1996; a total of 37,936 individuals. These people were then followed over the period 2006-2009, in terms of drug treatment and events that could be linked to suicide attempts and suicide.

Among other things, the study compared the rate of suicidal behaviors while the patients were receiving ADHD medication, as compared with the rate for the same patients while not receiving medication. Using this design the researchers were able to determine that there was no evidence to support that ADHD drug therapy would increase the risk of suicide attempts/suicide. One strong point of the study now being published is that all the individuals were compared to themselves, as this allowed the researchers to take into account the differences between those taking the drugs and those who do not.

"Many epidemiological studies on the risks related to drugs fail to adjust for the differences between individuals who take the drugs and those who do not. This is a critical limitation given that the individuals on medication are usually more severely ill than the others," says Henrik Larsson.

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