If you have ADHD and
executive dysfunction, like disorganization,
time management problems, and emotion dysregulation, then you probably already know that the stimulants like Adderall and Ritalin don't do a lot
to address these issues. That's where the
non-stimulants come into play, and there's a newer one that shows promise at helping executive dysfunction. I'm Dr. Tracey Marks, a psychiatrist, and I make mental health education videos. The primary first line treatment for attention deficit
hyperactivity disorder, or ADHD for short, is
stimulant medications. They fall into two classes, amphetamines like Adderall,
Vyvanse and Dexedrine, and the methylphenidate class, which are medicines like
Ritalin and Focalin. These medications work very well for attention, concentration, and distractibility, and hyperactivity, but they're not so great for directly improving
the executive functions. They may indirectly help,
like if you're better able to stay focused without distractions, you may be better organized for that day, while the medication is working. But once the medication wears off, the disorganization returns. So what exactly are we talking about with executive dysfunction? I have other videos talking
in more detail about this, and I'll have them linked to this video. But briefly, you can think
of executive dysfunction as things like planning, time management, organization, and even
controlling your emotions. But another big one is
called set shifting. Set shifting is the
ability to switch attention between tasks and then
return to where you left off. So let's say you're doing some work and you're in a groove and someone says, "Can we jump on a quick call to discuss this thing? It should only last about 15 minutes, and then I'll let you
get back to your work." Well, that sounds really benign. It's just 15 minutes, right? What's the big deal with that? For the person without a problem with set shifting, it's not a big deal. You just press pause, do the other thing, then unpress pause, and then
it's like you never stopped. But for the person with
problems with set shifting, and executive dysfunction
is not exclusive to ADHD, and not everyone with
ADHD struggles with this. But if you do, that 15 minute quick call can just ruin your productivity
for the rest of the day. And yes, that sounds really dramatic, like the rest of your day, really? Yes, really. If you have this, you know
what I'm talking about. When you return to your work, it takes so much work
to shift your mind away from what you were just doing, or away from complete free flow mode where you're just thinking about a bunch of things
that you need to do. By the time you settle down and refocus on the previous task, it may be an hour or more later, and now it's time for
another interruption. Here's why a stimulant medication may not solve this problem. If you're on a stimulant, you
may be in hyper focus mode where when you have to stop
to have that quick call, you may have trouble letting go mentally from what you were doing and
be unable to fully engage with the person to talk
about something else. It's not like you can't talk at all, but your mind may be wandering while you're talking or listening, and you're not getting the most out of it. But even with the stimulant on board, the interruption pulls
you out of hyperfocus, and that's enough to get
you mentally jumbled. It's like being on a fast
moving train that derails. The train can still move,
but it's not good movement and the friction brings it to a stop. And similarly, when you're done, you're not going to get
back to where you were, unless you take another pill, which you shouldn't do if it's not time for you to take another pill. But some people will take a little more just so they can finish their work, and this is probably what is happening when as me as the doctor,
I'll hear people tell me that the medicine seems to wear off too quickly in the afternoon. That wearing off may be because
that the dose is too low, or you're becoming tolerant,
so it's wearing off. Or it could be because interruptions have caused you to lose your focus, and you can't get it back because of trouble with set shifting. So all of this to say work productivity is more complex when you
factor in executive functions. So here's where the
non-stimulant medications can come to the rescue. Currently, there are four available non-stimulant medications, clonidine, brand name, Kapvay, guanfacine, brand name Intuniv, atomoxetine, brand name Strattera and the latest one approved in 2021, viloxazine, brand name Qelbree. Clonidine and guanfacine have been around for more than a decade. Clonidine extended release
was FDA approved in 2009, and guanfacine in 2010. They were only approved
though for children and adolescents with ADHD, and still are seen as
second choices to stimulants for children who can't
tolerate stimulants, or the doctors may use them to add to their stimulant
regimen to enhance the effect. They also may be a good
choice if you're trying to target impulsivity in
a child or adolescent. Atomoxetine, Strattera, was actually the first non-stimulant approved for ADHD in
children and adults in 2002. So it's over 20 years old. It's also been used for people who can't tolerate stimulants, or as an add-on to the stimulant. In my experience prescribing it, the results for my adult patients was just kind of so-so. The stimulants always seemed to work better and faster. Now we have viloxazine, Qelbree, and a recent 2023 study compared it directly to Strattera. The results were that
Qelbree was more effective and worked faster, within
about a week for children and two weeks for adults. Unlike stimulants, Strattera and Qelbree have to be taken daily. Strattera can take a month or more to see a good effect. Both medications are
norepinephrine reuptake inhibitors, so they increase the amount of norepinephrine in
the prefrontal cortex. This increased norepinephrine has a secondary effect
of increasing dopamine and serotonin in this region of the brain. Also, in this comparison study of Strattera versus Qelbree, of the people who had Qelbree
added to their stimulant, 85% of them tapered off the stimulant after they were stabilized on Qelbree. That's a big deal to feel like Qelbree was enough to use all by itself and they no longer needed the stimulant. Then here's the other important finding. Another study that I'll have linked in the description of this video showed that Qelbree significantly reduced executive function deficits. The caveat here is that
this study was of children, and you can't always generalize those kinds of results to adults. But the fact that the profile of the drug shows that it improves
executive dysfunction in children is promising
and worth trying to use it for this purpose in adults. Qelbree is still a brand drug, so your doctor may need to complete an insurance authorization in order for your insurance to pay for it. Some insurances will require that you try and fail Strattera before they will pay for Qelbree. Thanks to the Mental Wellness Space Store for supporting this video. I am the creator of this online store that offers products like canvas prints, wall posters, tumblers, shirts, digital workbooks, and other tools designed
to promote mental wellness. It's wellness woven into everyday life, reflecting my mission to integrate mental
wellbeing into daily living. It's about celebrating and
elevating mental health. And just as the shirt says, mental health commands
a seat at the table. Join me in pulling up a chair and bringing mental health
into everyday conversation. Thanks for watching today. See you next time.
