Looking for Novelty

We all like new things. New is interesting. New is exciting. New is stimulating, sexy, captivating and scintillating. New holds our attention… for a while. Then new is old, boring, passé and dull. There is usually a bit of time between new and old, that transitional period during which an object, relationship or idea is still fresh enough to taste before being ripe enough to throw out.

For some of us, everything gets old quickly. We start to recognize the pattern, but feel powerless to change it. Infatuation with a new love inevitably slides into sameness. Intellectual acrobatics involved in getting up to speed at a new job, once negotiated, turn into tedium and repetition. New teachers teaching new subject matter are engaging and inspiring until, a few weeks into the term, reviewing and building upon knowledge becomes drudgery.

The examples are endless. New cars, friends, foods, pets, hobbies, surroundings, homes, technologies, furniture and luggage are all fun at first. We approach them, try them on, feel some satisfaction, spend some time with them, and eventually take them for granted.

There are those who speak of “keeping it new.” I would suggest that is not possible. I would, however, suggest that “keeping it from getting old” is possible. Maintaining interest in someone or something over time is challenging, especially for stimulation-seeking individuals with ADHD. For them, interest is everything because it allows focus. When a task, relationship or object gets repetitive, paying attention to it feels impossible.

One way to remain engaged is to continue finding new challenges within the same endeavor. It’s impossible to know everything there is to know about anyone or anything. Seek out different aspects, facts and nuances that can more fully describe your subject. Find mystery within what you think you know. Our tendency is to use pattern recognition in order to label our experience, rather than operating under the assumption that each new experience is unique.

If you find stimulation seeking behavior detrimental to your pursuit of love, education or amazing achievement, practice being in the moment. Look around you. Listen, feel and use all of your senses. Stimulation is everywhere. It’s in the person with whom you are having a conversation. It’s in a tree, the snow, a hot shower, driving your car, taking a walk, your body and your mind. Pay attention to each moment, and you might discover that you’ve been missing out on endless newness.

-Thor Bergersen M.D.

Who Benefits from Adderall (generic) Shortage?

The shortage of generic Adderall (amphetamine-dextroamphetamine), one of the most commonly prescribed medications for ADHD, has caused a lot of stress and suffering for people with ADHD. As a prescriber, I spend an extra hour or two each day searching for pharmacies that have it in stock, communicating with patients unable to obtain the medication that works for them, and prescribing alternative meds which often don’t work as well for many people.

The shortage, which has gone on for several months, has many causes. One of the generic manufacturers had production problems, which could not be corrected by other generic companies because of limitations on production imposed by the FDA and DEA. The Controlled Substances Act of 1970, a 53 year old reaction to the 1960s drug culture, lumped ADHD medications like Ritalin and Adderall into the same category as opiates, making them “schedule 2 substances,” which are defined by their potential for addiction and abuse.

It seems that nobody in the FDA or DEA has done a simple search for incidence of overdose, abuse and addiction of these meds, which turns up results for methamphetamine and cocaine, but not the ADHD meds in question. Both government entities have made it clear that they do not care about the shortage, will not change the quota system, and blame prescribers and people with ADHD for the problem.

Because people can’t get generic ADHD meds, many have to switch to brand names like Vyvanse and Mydayis, as well as brand name Adderall. Who makes all 3 of these? Takeda Pharmaceuticals, one of the largest global pharma companies. Takeda stock is up almost 15% in the last 6 months.

I wonder how many bureaucrats and lawmakers own Takeda stock?

-Thor Bergersen M.D.

ADHD: Diagnosis or Description?

ADHD stands for Attention Deficit/Hyperactivity Disorder. It would be reasonable to assume from the name that everyone with ADHD has difficulty paying attention and staying still for any length of time. The label, however, is not accurate in this case.

Most people who have what is called ADHD can pay attention to what interests them, or to matters requiring their urgent attention, sometimes for extended periods of time. Not everyone with this "label" is hyperactive or restless, which makes the diagnostic category somewhat confusing. 

The terms "deficit" and "disorder" appear frequently in the diagnostic manual for psychiatrists and other mental health professionals, known as the DSM, currently in its fifth revision, to lend credibility to diagnostic categories through the "disease model," which is necessary for research and billing purposes. These terms do not, however, help real people to understand what they or someone close to them are dealing with. The DSM attempts to compensate for it's own deficiencies by offering three subtypes of ADHD: 1) primarily inattentive, 2) primarily hyperactive/impulsive, and 3) combined type.

A more accurate label for what most of the people with whom I meet struggle with is "Attention Regulation or Control Disorder (ARD/ACD)", which is sometimes accompanied by hyperactivity or restlessness. This name, which is my invention and not an officially recognized category, acknowledges the fact that, while it may be difficult for those with this set of traits to focus on demand, it is not impossible to do so when certain conditions (interest or urgency) exist. The presence of physical restlessness or hyperactivity is a "problem" depending upon environmental expectations. Typically difficult situations include classrooms, work meetings and cubicle settings.  

So, while our center is called ADHD Boston, we recognize the limitations of this diagnostic category. ARD or ACD Boston wouldn't get nearly as many Google hits. -Thor Bergersen MD