The title says it all. Access this great blog post in the Huffington Post by Dr. Diane McIntosh, psychiatrist and assistant clinical professor at the University of British Columbia Here.
At the beginning of March CADDAC received a reply letter from Health Canada.View this letter Here.The letter reiterated what we have been told previously.Health Canada requires official reporting of a decrease in effectiveness of a generic when compared to the brand medication to scientifically validate this information. Health Canada states,"Consumers are encouraged to complete reports in conjunction with their health professional, so that additional information about their medical history can be included in order to make the reports more detailed and scientifically valid."
If you have had an issue with an ADHD or other mental health generic medication not being as effective or lasting as long as the brand name, we strongly encourage you to access our Adverse Reaction Form and Guide to assist you with submitting an online report. Also please encourage your physician to do so as well. If this reporting does not occur issues with generic medication substitution proving inferior will not be solved.
Ontario now requires that a trial on a generic or two generics, if two are available, with an adverse event (AE) report completed for each before a pharmacist will honor a "do not substitute" request from a physician for any medication supplied by the OPDP (Ontario Public Drug Plan). The physician will need to supply the patient with copies of both AE reports with the prescription in order to get full coverage of the brand medication. You can access complete details Here.
Please note: This only applies if the government pays the full price for the brand name medication. If the patient has a patient benefit card, which can be accessed through Innovicares the price of a brand product is covered and trials on generic medications are not required. For more information on which medications are covered please access Innovicares Here (https://www.innovicares.ca/)
A recent study will be of interest to parents of children with ADHD who have a history of severe mental illness. The study looked at 141 children and young adults in Nova Scotia, taking stimulant medication, who have a parent with a history of serious mental illness such as a major depressive disorder, bipolar disorder, or schizophrenia. The study found that nearly two thirds of the study’s participants experienced a psychotic side effect such as hallucinations, delusions, hearing voices, and/or perceptual disturbances. Past research has shown that the same type of psychotic effects were found in one-quarter of children and young adults, with this family history, who had not taken these medications. While these side effects have been known for some time the quantity seen in this research was surprising.
Dr. Rudolf Uher at Dalhousie University in Halifax, the lead author of the study noted that this study by no means indicated that stimulant medication treatment, which can be very helpful for these children should be stopped, however it should alert physicians that they need to actively ask children and young adults about any unusual experiences. Dr. Uher noted that children rarely tell people about these experiences unless asked.
The study was not designed to prove cause and effect only that there was an association with taking these medications and psychotic effects.
Access additional information Here
Two large case-control studies from three Massachusetts health care systems has found no evidence that prenatal exposure to antidepressants increases the risk for autism or attention-deficit hyperactivity disorder (ADHD). Any increase of Autism or ADHD found in previous studies is thought to be due to the severity of the mother’s depression, which is a known risk factor, rather than the use of antidepressant medication.
These new finding should bring some reassurance to expectant mothers’ faced with a decision about taking antidepressant medication throughout their pregnancy.
The study looked at data form more than 1200 children with an autism related diagnosis and 1700 children with ADHD to control large groups of children with no neuropsychiatric diagnosis. The fact that both autism and ADHD incidence rates increased in children of women who were taking antidepressant medication or experiencing psychotherapy prior to becoming pregnant, indicates that the risk factor is actually the severity of the depression rather than use of antidepressants during pregnancy.
Dr. Perlis senior author of the report stated "While taking any medicine during pregnancy can be a difficult decision, we hope the results of our two papers - which now cover more than 2,500 children with autism and almost 4,000 with ADHD - will provide some reassurance to women concerned about getting treatment for depression or anxiety during pregnancy. While there are depression treatments that don't involve medication, for some patients they are not effective, available or preferred. We want women and the clinicians working with them to be as informed as possible when making this decision."
Access more information Here
This morning CADDAC and CADDRA sent out a Media Release on the issue of lack of adequate ADHD medication coverage under BC Pharmacare.
Since British Columbia is behind other provinces in providing a full range of medication treatment options for ADHD CADDAC, CADDRA and BC physicians have begun an advocacy campaign to let the BC government know that the current situation is seriously limiting treatment options for those accessing BC Pharmacare. Currently Ritalin and Dexadrine are the only medications for the treatment of individuals with ADHD fully covered by BC Pharmacare. Concerta is the only long-acting medication and it is restricted to Special Authority Request (only for the paediatric population after failing on Ritalin and Dexedrine).
Physicians with an interest in the treatment of ADHD are being asked to write letters expressing their concern. Please access BC Pharmacare Medication Coverage for more detailed information on the current situation, a copy of the latest letter sent to Minister Lake, and the BC Letter Writing Guide to assist physicians in writing and sending a letter to the BC government.
If you live in BC and this issue is of importance to you, we ask that you bring this advocacy campaign to your physician’s attention.
The topic of sleep issues frequently comes up during discussions with families impacted by ADHD; lack of total hours slept, difficulty falling asleep and staying asleep, resulting in difficulty getting up in the morning. These problems are reported in both children and adults. When children with ADHD have sleep problems, parents, whether they have ADHD or not, often complain about getting less sleep because their children are awake. This makes for a cranky and exhausted family all around. Less sleep also results in increased attention problems.
Therefore I was interested in finding this article summing up some of the most current research on what has been found to be helpful.
Apparently, a certain aspect of sleep disturbance is common in people with ADHD, delayed circadian preference, which means that one’s body clock is delayed or not in sync with the normal day/night cycle. An example would be the common delay in falling asleep that many adults and children with ADHD complain about. It is definitely a concern for parents of these children.
There are two interventions that have shown some promise: bright light therapy and Melatonin. In an adult study the use of bright light therapy was shown to reduce attentional problems, improve mood and result in subjects going to sleep earlier.
A long term study on Melatonin use in children indicated that even three to four years after Melatonin was continuously used, 90% of parents felt that it still assisted with earlier sleep onset and two thirds reported improved mood and behaviour.
Another study which paired the use of Ritalin and Melatonin as a treatment found increased growth and weight in these children despite no difference in caloric intake. The researchers hypothesised that this might be due to the increase in growth hormone which is released during deep sleep. This is an interesting finding especially for parents concerned about the potential of delayed growth for some children taking stimulants.
To view the entire article visit https://www.psychologytoday.com/blog/mental-wealth/201304/resyncing-the-bodyclock-treat-adhd
Health Canada has just released an information update stating that clearer warnings about risk of suicidal thoughts and behaviours will be included in the prescribing information for all ADHD medications:
http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2015/52759a-eng.php
Previously this warning was only included on Strattera (Atomoxetine). It is very important to read the updated information thoroughly and pay attention to the specific language used by Health Canada. Health Canada states that there is little evidence that ADHD medications cause suicidal thoughts and behaviours, but that they may possibly contribute to the risk. Health Canada has not shared what triggered the update at this time other than saying there have been some reports. Since ADHD in itself increases the risk of suicidal ideation and behaviours physicians treating patients with ADHD are already aware that monitoring for these symptoms is important. Additionally, ADHD can commonly occur along with other disorders such as depression and bipolar, so physicians are aware that additional disorders such as these need to be screened for during the assessment process. However, an added reminder to physicians, caregivers and adults taking the medication to monitor for changes in mood, thoughts, feelings of depression and suicidal behaviour especially when medication is started, increased or even stopped seems to be a sensible suggestion.
Awareness of potential side effects, even when the risk is minimal is important, but should not lead to panic or stopping the medication. Health Canada has also stated very clearly that the benefits of medications for ADHD still continue to outweigh the risks. Parents of children taking medication for ADHD and adults taking the medication should not be alarmed by this warning and they should not take their children off the medication especially without first speaking with their physician. If any of these symptoms are present caregivers and adults should be reporting these to their physician immediately. Treating any medical disorder with medication is always a matter of assessing the risk benefit ratio. Physicians follow this practice when prescribing medications. Every medication has a risk of side effects, but not treating ADHD also has significant side effects. If you have concerns speak to your physician.
An interesting survey was recently conducted by Harris Poll for the newly-created Coalition to Prevent Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Misuse (CPAMM), a network of organizations with the shared goal of developing and educational strategy for college students focusing on reducing misuse amongst college students.
The study found that while students generally felt that they are aware of the risks of misusing ADHD medication, further investigation found that this was incorrect. Most expressed understanding why some students decide to use the medication, especially when taking into account the pressure to succeed in today’s post-secondary environments. The majority of students believed that misusing stimulant medication (75%), was unethical and a form of cheating similar to athletes using performance-enhancing drugs. However, almost half of these students also felt that those who do take these medications without the presence of ADHD were doing what was necessary to keep up with extreme pressure. Most felt that the main reasons students were misusing these medications was to get better grades and to succeed.
CPAMM hopes to create peer-to-peer interventions to assist with the common misconceptions that misusing ADHD medications leads to better grades, is not harmful and that “everyone is doing it”, and to provide information of better ways to cope with educational stress.
This certainly looks like a step in the right direction.
For further information on this survey access www.uloop.com/news/view.php/144465/College-Students-Split-On-ADHD-Prescript.
I recently came across an article that nicely summed up things parents should consider when deciding on ADHD medication treatment: linked here.
The article listed five things to parents should consider when making the decision, the first being a thorough medical evaluation by a trusted expert in the field of ADHD. For a description of what is involved in a thorough ADHD assessment access Diagnosing ADHD on the CADDAC Website. For further reading, access Assessment and Diagnosis for Children and Adolescents.
Once you are assured that your child has ADHD, your next step would be to ask yourself what is your desired outcome. How will it benefit your child? I would add that your expectations of medication treatment should be realistic. The symptoms that you would like to target should actually be something that medication will assist.
You will then need to consider all side effects; not just those of medication treatment, but also symptoms of untreated ADHD. Also consider that the decision to try medication as a treatment is not a permanent decision. Most ADHD medication may be started and stopped quickly or used only when required.
Finally, remember that this is not a decision that must be made quickly or under pressure. Other treatments, such as school accommodations and parenting strategies, should be tried initially. Medication treatment can always be added at a later date if necessary.
On the other hand, it may become evident very quickly that many things have been tried unsuccessfully in the past and the child is in significant distress. In this case, a medication trial may be initiated immediately. Also you should be aware that it may actually take some time to find the right medication and the right dose.
Medical professionals make a treatment decision by assessing benefit /risk ratio and so should you. What are the potential benefits to your child and what are the potential risks? While assessing these, make sure that you are relying on proper medical research that has been peer-reviewed and duplicated on a large scale, not anecdotal stories on the Internet.
Although we have not received any significant feedback from parents or patients reporting distress regarding this shortage it is something that we CADDAC has been made aware of. Should you have any concerns please contact us and we would be happy to speak with you about this. For information on what to do if you are caught short please access http://addadhdblog.com/methylphenidate-shortage-in-canada/?inf_contact_key=f6f12e39fac0ce24a27dc692404b39f579083aeb0d6v
Sincerely,
CADDAC
