Conclusion: How I Treat Adult ADHD With Dr Birgit Amann

Watch Dr Birgit Amann discuss how she would treat JD, a patient with adult ADHD who is receptive to getting a new opinion on his diagnosis and a different type of treatment approach after years of little to no symptom relief.

Transcript:

Hello. My name is Dr Birgit Amann. I'm a child, adolescent, and adult psychiatrist in a private practice setting in Troy, Michigan. Today, we're going to talk about how I treat ADHD with an adult focus. Thank you for spending time with me.

We'll start by talking about a case. I'm going to introduce JD to you, who is a 44 year old Caucasian male who presents to me for his initial evaluation. JD's chief complaints, or top concerns, are that he's really struggled for many, many years feeling very overwhelmed. He's not performing adequately in his job. He's not got good performance reviews. He's been passed up on promotions. It's causing strain within his marriage, mostly financial. JD feels depression related to these issues. You can look at him and see that he's discouraged, and has almost a defeated look on his face.

JD gives a history of having been on many different antidepressants over the years. He's never been treated for ADHD. He says, "Dr Amann, I've been on all of them, and either they don't work at all, or they just help me a little bit. I get little to no relief." He's had some therapy, some individual, and he and his wife have done some marital, but they really didn't follow through within the marital therapy or his individual counseling. He reflects back and says, "I never really have worked up to my full potential. I know it in my adult life. I can reflect on it as a child and adolescent. I remember my report cards where teachers would say it. I recall my parents commenting about it." And all of these things from way back into adulthood have really caused JD to have very negative self-esteem.

I asked JD about a family history of psychiatric illness, and JD says, "I don't know specific details, but I do recall that there's a niece or a nephew that has been treated for ADHD." We know that this condition is highly heritable. When JD came to me he was on no medications, but he's really hesitant to try something different. He says, "No, it's just going to be the same thing. It's not going to help me." But what JD is receptive to is a new set of eyes. He wants to have somebody look again and give a new opinion on his diagnosis and maybe a different type of treatment approach.

So, let's take a look at the polling question. With the information that we talked about related to JD's presentation. What would be your next step in evaluating him?

Would you maybe prescribe another antidepressant or another anti-anxiety agent? Would you refer JD for psychotherapy again to look at depression and anxiety? Or would you consider reevaluating him? Would you perhaps kind of go back to baseline and look at doing not only mood disorder rating scales but ADHD scales as well to get a sense of where he is at this time and then go from there in his treatment strategy and approach? Would you start a medication for adult ADHD? Or would you refer him for adult ADHD coaching?

I decided to do the third option. I took it back to baseline.

We did some fresh rating scales on JD, but we made sure to include not only the mood disorder questionnaires but also the adult ADHD scales. JD did meet the criteria for adult ADHD, and he did have mild depression and anxiety, but really, it was very clear that the undiagnosed, untreated ADHD was driving a lot of his depression and his anxiety. It really wasn't surprising based on knowing the family history of ADHD, as well as his own recollections way back into childhood and those teacher comments. J

D was encouraged by us using this step-by-step process. We talked about how we could look at medication for adult ADHD and could certainly look at adult ADHD coaching. Medications can't do it all, so it's the combination of the 2 that would likely help him to kind of optimize his overall functioning.

JD and I discussed that after he was adequately treated for adult ADHD, we would then go back and re-reflect on how is he doing from a mood standpoint. How are the depression and the anxiety? Do we still need to consider perhaps a depression or anxiety medication or refer him to counseling for the depression and anxiety?

Ultimately JD responded well to his ADHD treatment. He had another performance review, it went much better. You could tell that his confidence had improved. He held his head higher. He had better eye contact. He talked about how he and his wife were doing better because they could actually communicate better. He could actually share with her that really the biggest concern he had around his job was that he might lose it. He was the sole breadwinner at home, he was the person responsible for maintaining finances within the home.

At the end of the day seeing JD improve and respond so well was so rewarding for me as his prescriber. I hope that the case example of JD helps you with treating your adult ADHD patients. Thank you so much for spending time with me.