I routinely evaluate and treat adults whose chief complaint includes symptoms of poor concentration, distractability/inattention, procrastination, and difficulty completing tasks. All new patients receive a comprehensive psychiatric evaluation to rule out co-morbid mood disorders, and other psychiatric, neurologic, endocrinologic and other medical conditions that could possibly be causing, or exacerbating, these symptoms.
A childhood history of hyperactivity, impulsivity, behavioral and/or academic problems, or a prior formal diagnosis, with or without treatment, and/or documentation of psychometric testing to confirm the diagnosis are not required: I perform my own, independent and comprehensive review of an individual's history, including academic and occupational, to determine if pharmacologic treatment of these symptoms is warranted.
Inasmuch as ADD/ADHD--particularly Adult ADD--is overdiagnosed in the United States, I find that many of the adults in my practice who benefit from treatment with ADD medications are treated off-label; that is to say, while adults often request or require treatment for these symptoms, they are not always necessarily attributable to the syndrome of Attention-Deficit Disorder. Even ADD, like all psychiatric conditions, is syndromal, meaning that that diagnostic label actually refers to a spectrum of possible disorders, with an array of probable etiologies, from genetic illnesses to problems that occur in utero.
What I have found in my clinical practice is that many, if not most, of the adults I see who are seeking treatment for ADD-like symptoms do not meet stringent diagnostic criteria for that particular syndrome, or else their personal academic and occupational histories suggest otherwise. However, treatment of bonafide target symptoms, regardless of their etiology, can be warranted even in the absence of a formal diagnosis of "ADD," so long as the patient is a good candidate for such treatment (which is very effective, both for individuals with an unequivocal history of ADD/ADHD, as well as those individuals who do not appear to suffer from that particular condition), and so long as there are no medical contraindications to treatment with ADD medications. These absolute contraindications include, but are not necessarily limited to:
Stimulant Use Disorders, especially Amphetamine, Methamphetamine and Cocaine Use Disorders
Primary Psychotic Disorders, including Schizophrenia and Schizoaffective Disorders, Delusional Disorders and related psychoses
Poorly-Controlled Epilepsy (Seizure Disorders)
Bipolar I Disorder, and other Bipolar-Spectrum Disorders (See here for a note regarding the widespread problem of misdiagnosing children and adolescents with both "ADD" and "Bipolar Disorder")
Poorly-Controlled Hypertension, or patients with a history of Malignant Hypertension
Impulse Control Disorders, including Intermittent Explosive Disorder, other severe anger management problems, and certain addictions, including Hypersexual Disorder and Gambling Disorder
Other health problems represent relative contraindications to the use of ADD medications; the viability of treatment with stimulant medications must be determined on a case-by-case basis, and when justified, must proceed cautiously. Conditions which are relative contraindications to this type of treatment include:
Chemical Dependency which does not include the abuse of stimulants, including Alcohol and other Sedative-Hypnotic Use Disorders, particularly if those conditions are not in remission
I also routinely prescribe stimulant medications in the treatment of Binge Eating Disorder, Bulemia, Chronic Fatigue Syndrome, Hypoactive Sexual Desire Disorder, as adjunctive therapy in refractory Major Depressive Disorder, and other clinical depressive syndromes, or as add-on therapy to address chronic, intractable side effects of treatment with antidepressants, including lethargy, hypersomnolence, amotivation/apathy, sexual dysfunction and weight gain, when reducing the dosage of the offending agent or switching medications and other mitigation strategies fail, and in a few other, uncommon, conditions characterized by mild cognitive deficits.
For a more in-depth discussion regarding the proper methodology for appropriately diagnosing ADD/ADHD, and why Americans are over-diagnosed with these conditions, please see my Treatment Philosophy archives.
**Please note: patients taking Schedule II controlled substances, including ADD medications, must initially return to see me once a month for approximately the first three months of treatment, followed by maintenance-phase visits of at least once every 3 months, or whenever medically necessary or requested by the patient. For more information, please seeFrequency of Visits.