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Attention Deficit Hyperactivity Disorder

Identifying ADD in Adults

09/10/1998

Question:

Dear Sir

I recently consulted a neurologist as I thought I may have developed a form of epilepsy. My symptoms are inability to remain focused or concentrate on one thing for any length of time, frequently entering a "day-dream-like state",extreme forgetfulness,unable to cope, have over time progressively become slower at doing tasks, my brain "switches off" at times (especially when something "complex" is being explained to me) and I also experience a ringing in the ears - especially first thing in the morning. I am 37 years old and would not expect to experience this sort of degeneration for many years to come.

The physician thought I may have a "cognitive decline" and did a MRI,EEG and various other tests including blood tests. The MRI did not show any abnormalities. The EEG showed high beta activity.

Naturally the nature of my symptoms are causing me to be concerned and depressed. The physician suggested that I do physical exercise every day and he also prescribed a course of Lilly - Fluoxetine (Prozac?). I am concerned about taking this medication and would prefer to find out what is causing the problem and treat it with a natural remedy if possible. I now wonder whether I could be suffering from a ADD.

Would ADD be detected in the kind of tests my physician conducted? With the symptoms mentioned above, would a physician generally consider checking for ADD in an adult?

I would appreciate your thoughts on this.

Thanking you

Answer:

It sounds like your symptoms are truly effecting your quality of life. Since I am only familiar with a few aspects of your case, and have not met you nor done a history and physical, I can only give you some general information that may help to take the next steps in dealing with your problem. 1) ADD does not happen suddenly in one's 30's. ADD-like syndromes can begin late (such as those caused by extensive cocaine abuse), but not true ADD. ADD could go unrecognized before age 30, but a look at the history should give strong clues. 2) A few medical problems can cause the symptoms you describe including diabetes and thyroid disease. Your doctor may have tested your blood for those, or may have decided against that because your history and physical did not support the need for those tests. 3) Without question, depression can cause the symptoms you describe. Fluoxetine (Prozac) is often a good choice for someone with depression. It has been around quite a while, has well understood side effects, and has been found to be quite safe. It received bad press a few years back but for unsubstantiated reasons. Of note, we have noted in the ADD Center I work in that many persons with true ADD find that drugs like flouxetine can help depression but interfere with clarity of thinking in a way that is problematic for them because of their ADD. We tend to use antidepressants with norepinephrine (a specific brain chemical associated with ADD) activity as well as seratonin (another brain chemical) activity for persons with ADD, mostly buproprion or venlafaxine. Of course, this may not pertain to your circumstances at all. St. John's Wort is a natural remedy you may want to discuss with your doctor. At 300 mg, three times a day, it has been found to be a very helpful medication for many people with your symptoms. 4) ADD is not detectable with an EEG or MRI. Good luck with your search for help. If you try a few antidepressants for adequate trials but get no help, then a further workup may be indicated. Susan L. Montauk, M.D.

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Response by:

Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati