BY NATAN SCHLEIDER, M.D. / WRITTEN JANUARY 10TH, 2021 / 6 MINUTE READ
Attention Deficit Disorder (ADD) / Attention Deficit Hyperactivity Disorder (ADHD) impairs job or academic performance causing anxiety in NYC patients. Anxiety, depression, and other mood disorders negatively effect concentration and focus painting an ADD like picture. Stimulants (IE Adderall or Ritalin used to treat ADHD) can make New York patients jittery, hyperactive, and anxious
‘I cannot focus. Laundry and cleaning my toilet are welcome distractions. My mind races and stomach churns nightly despite TUMS, lucky to get a few hours sleep. Do you think I should try Adderall, it helped in college? A friend gave me something to relax and it helped but left me groggy, can’t remember the name.’ –TYPICAL CHIEF COMPLAINT OF MY NEW NYC PATIENTS IN 2021.
My NYC medical practice comprised 50% primary care and 50% mental health care until early 2020. Now 80 to 90% of my practice is based on keeping the mind healthy. This the key to ensuring a healthy body and spirit.
ADHD / ADD OR anxiety OR adverse effects of medicines (ie Adderall or Xanax)? That is the questions.
Three Step Approach to Making a Diagnosis of ADHD/ADD OR Anxiety OR Adverse effect of Medicine used in my NYC Practice.
- The treatment of choice is a stimulant (whereas child ADHD has more therapeutic options). While caffeine may help keep you awake it is NOT helpful for treating ADHD. Stimulants kick in right away and last a few short hours. Suspect a diagnosis of ADHD or anxiety (they can have both of course). Try a few short acting Adderall or Ritalin tablets. Call the patient after they try the stimulant. If they have ADHD works gets done. Anxiety dissipates. The patient is happy. When stimulant medication does NOT help ADHD symptoms, it is out of the patients system in 2-4 hours. I tell them not to take it again.
- Now that ADHD has been excluded, my working diagnosis is an Anxiety Disorder. These are more complicated to treat. Many medicines are FDA approved for treatment of anxiety. Finding the right medicine may take weeks. Trial a short acting anti-anxiety medicine. Alleviating anxiety confirms the Anxiety Disorder caused ADHD symptoms.
- Stimulants like Adderall or Ritalin or Vyvanse may be feel speedy. ‘I think the ADHD medicine is helping me. But my hands tremor, it takes hours to fall asleep, and I chew my nails or tug my hair. Should I stop taking the medication?’ All ADHD medicines including non-stimulants buproprion (Wellbutin) and atomoxetine (Strattera) can exacerbate anxiety; Just because the first and second and third ADHD medicine’s adverse effects were not tolerable does not mean give up. Sometimes it is a matter of trial and error. Just as some of us New Yorkers swear by Pepsi and others Coca Cola, same with prescription medicines.
The 21st century buzzes: smart phones vibrate and chime as text messages and over zealous employers contact us at all hour. Working 9 to 5 in NYC is a distant memory. Commuting and using phones attached to a wire attached to a wall…so last decade! Media blasts ‘crisis,’ and ‘new viral strain’ ad nauseum. No wonder adults who may have displayed no ADHD in childhood now display Adult ADHD symptoms. Check emails, return texts, discard snail mail, and try assimilating piles of digital data all before the opening and closing of the New York Stock Exchange–good luck!
Makes sense that even the most punctilios New Yorkers worry.