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Change Your Brain, Change Your Life
The Breakthrough Program for Conquering Anxiety, Depression,
Obsessiveness, Anger, and Impulsiveness
Daniel G Amen
Three Rivers Press
In my opinion these are the first-line medications for treating ADD, especially ADHD
and ADD without hyperactivity, when ADD is the primary problem. They are also used totreat narcolepsy, help in some postconcussive syndromes, and are used in resistant depression.
Our current understanding of these medications is that they increase dopamine output fromthe basal ganglia and increase activity in the prefrontal cortex and temporal lobes.
- Contrary to popular belief, these are considered very safe medications when taken
as prescribed under a doctor's supervision.
- The PDR lists 60 milligrams as the top dosage for Ritalin and 40 milligrams as the
top dosage for Adderall, Dexedrine, and Desoxyn. Many clinicians, like myself, feel the rangeof effectiveness may be much higher for some individuals.
- With Cylert it is very important to monitor liver function tests, as 2 to 3 percent of
people taking this medication may develop chemical hepatitis.
- Do not take stimulants with citrus juices (orange, grapefruit, lemon). They lessen the
- Decrease caffeine intake when taking a stimulant. Caffeine and these stimulants
together tend to overstimulate the nervous system.
- The common side effects of stimulants tend to be decreased appetite, sleep problems
(if taken too late in the day), and transient headaches or stomachaches.
2. Tricyclic Antidepressants (TCAs) and Bupropion (Wellbutrin)
These medications are effective antidepressants. They tend to decrease overactive
norepinephrine (imipramine, desipramine, doxepin), dopamine (bupropion), serotonin(clomipramine), or a combination of these (amitriptyline, nortriptyline). They tend to be morestimulating than the others listed. Many of these are now considered second-line medicationsfor depression because they tend to have more side effects than the SSRIs (next section). Yetsome of them also have significant advantages. When depression is mixed with anxiety,imipramine and desipramine may be a better choice. When depression is mixed with ADD,desipramine, imipramine, bupropion, and venlafaxine (see next section) seem to be the mosteffective. Bed-wetting and depression or anxiety may best respond to imipramine. A skilledpsychopharmacologist can help you sort through these medications.
sleep problems, headaches,fibromyalgia, and painsyndromes
- These medications need to be monitored more closely than stimulants, especially
- Many adults respond to very low doses of these medications for ADD symptoms.
This is important because the low doses often produce far fewer side effects than the higher"antidepressant" doses.
- Unlike stimulants, these may take several weeks to a month to become effective.
- When Wellbutrin was first released in the USA, a number of people developed
seizures while taking it. It was pulled from the market in the early 1980s. The manufacturer
figured out the dosage pattern was wrong, and the FDA allowed it to release it with adifferent dosage regimen. Do not take more than 150 milligrams at a time.
- These medications are usually not first-line treatments for ADD. I use these
medications to treat depression, anxiety disorders, bed-wetting, and the limbic subtype ofADD, often in conjunction with one of the stimulants.
3. Antiobsessive or "Antistuck" Medications
These medications increase the availability of serotonin in the brain, and they are often
helpful to calm down cingulate hyperactivity. They are typically marketed as antidepressants.
They also tend to calm down limbic hyperactivity. Except for Effexor, these medications arenot first-line treatments for ADD and, in fact, they may make ADD worse. These serotonin-enhancing medications are also used to treat eating disorders, obsessive-compulsive disorder,
oppositional defiant disorder, PMS (over-focused type), excessive worrying, temper problemsassociated with things not going a person's way, and other cingulate problems listed in thisbook.
5. Blood Pressure Medications
- Contrary to the negative media attention, Prozac is generally a very safe medication.
In our experience, however, people who have temporal lobe problems may experience anintensification of angry and aggressive feelings on Prozac or other serotonin-enhancingmedications. Therefore, we are careful to screen for these before placing someone on thesemedications. If you have side effects on any medication, it is important to contact your doctorand discuss them.
- Unlike stimulants, these may take several weeks to several months in order to be
effective and even three to four months to become optimally effective.
- The most common side effect of these medications is sexual dysfunction. Sometimes
adding gingko biloba or bupropion counteracts these problems.
4. Anticonvulsant or Antiseizure Medications
These medications are used to treat temporal lobe dysfunction, seizures, aggression,
emotional instability, headaches, resistant depression, and bipolar disorder. They are oftenvery effective in resistant psychiatric conditions where all else has failed.
5. Blood Pressure Medications
The following blood pressure medications have been used to help with tic disorders,
hyperactivity, aggressiveness, and impulsivity. They are not usually helpful with theattentional symptoms, and they are often mixed with a stimulant medication when ADD ispresent.
- Clonidine and guanfacine are also used as primary treatments for tic disorders such
- When I use clonidine in addition to a stimulant medication, I order a screening EKG.
There have been several reports that this combination may cause problems, even though Ihave found it to be effective and safe.
- These medications are also used to treat insomnia, which is very common in ADD.
6. Combination Medications
People can have more than one problem or more than one brain system involved in
their symptoms. Sometimes one medication seems to be able to treat a number of problems,as mentioned above, and sometimes a combination of medications is needed to obtain fulltherapeutic benefit.
Here are four common combinations of medications I use in my practice.
- A stimulant plus an antiobsessive antidepressant (such as Adderall plus Effexor) for
patients with ADD plus depression, obsessiveness, or severe oppositional behavior. In myclinical experience I have seen many people who are children or grandchildren of alcoholicsbenefit from this combination. Frequently, this population presents with cingulate (overfocussymptoms) and prefrontal cortex problems (attentional symptoms).
- An anticonvulsant plus an antiobsessive antidepressant (such as Depakote plus
Zoloft) for patients with temper problems and excessive worrying or depression.
- A blood pressure medication, plus a stimulant and an antiobsessive antidepressant
(such as Catapres, Adderall, plus Effexor) for patients with Tourette's syndrome, ADD, andOCD.
- A tricyclic antidepressant plus a blood pressure medication (such as Tofranil plus
Inderal) for patients with depression, anxiety, and hand tremors in social situations.
The Visit Telephone Transmitter Art. no. BE1430 Introduction The Visit system consists of a number of radio transmitters and receivers. The transmitters detect different events in the surrounding area and transmit a radio signal to the receivers. The receivers pick up this signal and provide indications using light, sound and/or vibration. The transmitter determines what type of light,
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