Add, Attention Deficit Disorder

[micave]

Hi Everybody,

Let me introduce myself first. I'm new on this forum and I'm a man living with POTS since 4 years now (I guess). A half a year ago they discovered the disease and now I'm being treated by a doctor and professor from Internal Medicine. They do a very well job so far. I'm from the Netherlands, which is a relive small country in Europe. Most foreigners know it because of our capital city, Amsterdam. I know a lot of people think everybody does drugs here (weed, pot) but that is not true. Mostly tourists do drugs here somehow. That being said (and pot related assumptions out of the way, because i neve use pot or whatsoever) we can go on.

Anyway on the advice from my doctors I needed to talk with a psychologist because I told the I had troubles with the moments I have more... POTS (the less good days). Now turned the Psychologist to be a shrink and he want's to put me on medication for ADD. According to him I'm suffering from ADD and I do recognize the symtoms very well.

My questions are:

- Does anyone have experience with POTS and ADD combined with Ritalin (or another brand). And how does the usage of the meds work out for you?

- Is there a relationship between ADD & POTS, and if how?

- can one be the cause of the other?

Thank you for your feedback.

Micave

[firewatcher]

Welcome Micave! There are several here from the Netherlands, I would suggest you "Personal Mail" each other and compare notes on doctors and such. Search the forum and you'll find several threads about ADD and what we call "brainfog" (which are not technically the same.)

Here is a recent abstract for an article from Vanderbilt University on POTS and ADD:

Psychiatric profile and attention deficits in postural tachycardia syndrome.

Raj V, Haman KL, Raj SR, Byrne D, Blakely RD, Biaggioni I, Robertson D, Shelton RC.

Department of Psychiatry, Vanderbilt University School of Medicine, 1500 21st Ave, South, Nashville, TN 37212, USA.

OBJECTIVES: Patients with postural tachycardia syndrome (POTS) often appear anxious and report inattention. Patients with POTS were formally assessed for psychiatric disorders and inattention and compared with patients with attention deficit hyperactivity disorder (ADHD) and control subjects. METHODS: Patients with POTS (n = 21), ADHD (n = 18) and normal control subjects (n = 20) were assessed for DSM-IV psychiatric disorders and completed a battery of questionnaires that assessed depression, anxiety and ADHD characteristics. RESULTS: Patients with POTS did not have an increased prevalence of major depression or anxiety disorders, including panic disorder, compared with the general population. Patients with POTS had mild depression. They scored as moderately anxious on the Beck Anxiety Inventory but did not exhibit a high level of anxiety sensitivity. Patients with POTS scored significantly higher on inattention and ADHD subscales than control subjects. These symptoms were not present during childhood. CONCLUSIONS: Patients with POTS do not have an increased lifetime prevalence of psychiatric disorders. Although they may seem anxious, they do not have excess cognitive anxiety. They do experience significant inattention which may be an important source of disability.

PMID: 18977825 [PubMed - indexed for MEDLINE]

[MelissaCrystal]

I can see the connection in a lot of people, but I have POTS and don't have any signs of ADD or ADHD, but it's probably one of the many possible causes!

[micave]

Thanks Firewatcher for the info. I do have some contact with other Dutch members already. I pm'ed a few and it is realy nice to talk with each other in our own language.

I'll try to find the whole study and see how they came up with these figures and so on. I'm not wuite sure if I had ADD since childhood or not. I do know my brother and father have symptoms from that.

If I do have ADD the possibility of rest in my head would be nice. We'll see what my physician says.

Thanks again.

[juliegee]

Welcome Micave!

The way I understand Firewatcher's abstract, it sounds like there is significant overlap with ADD and POTS. I don't think that study indicated that POTS is is "in your head"- as a matter of fact, the exact opposite appears to hold true.

We have discussed this topic several times in the past on this site. Maybe do a search and look for the old threads- good info there.

How did you arrive at the ADD DX? Do you think it fits? I'm not sure if you've done neuro-cognitive testing, but typically ADD patients have difficulty with working memory and speed processing. COINCIDENTALLY, so do dysautonomia patients. I worry that some patients with autonomic dysfunctions (like POTS) are mistakenly DXed with ADD. Dysautonomia patients are very well known to suffer with "cognitive fog." Lack of blood flow to the brain has been implicated here and can certainly result in the same symptoms manifesting as ADD sufferers.

Another coincidence, many dysautonomia patients are prescribed stimulant-type meds to treat their condition. Meds like Concerta, Ritalin, Aderall, Strattera, and Provigil are just a few. These meds act as vasoconstructors. They improve the constriction of blood vessels in peripheral circulation thereby improving the amount of blood flow that returns to the heart & ultimatelythe head. These meds are also thought to exert beneficial effects through actions on the central nervous system as well.

Let us know what you find out-

Julie

[firewatcher]

I completely agree with Julie! The point of this article is that while there is an attention/focusing deficit in POTS patients, it is NOT the same as ADD without orthostatic intolerance! This is NOT in your head and ADD will NOT cause orthostatic tachycardia. You can have one, the other or both, but what we call "brainfog" is NOT ADD.

[micave]

Thanks everybody. The Brainfog in experiencing is different than what I would consider the ADD symptoms. When i read the ADD explenation and the behaviour characteristics it suits me well.

The Brain Fog is another catagory indeed. I hate the brain fog because I'm unable to do anything (mentally especially).

I will discuss the ritalin (or Concerta, which I prefer) with my doctor.

i tried the search but could not find a good topic (I need to try better I Guess)

[Barliman]

I do know this is a late reply-- but- I think it is worth adding to the thread.

Its interesting to see this in light of recent information that suggests that many ADHD symptoms are caused by orthostatic intolerance. There is also good, but incomplete SPECT evidence of diminished cerebral perfusion in ADHD- notably when upright.
It may be that inattentive symptoms reflect lower cerebral perfusion, and hyperactive / impulsive symptoms reflect a sympathetic response in an attempt to preserve cerebral perfusion.

It is believed, however, that stimulants such as dexamphetamine and ritalin do improve cerebral perfusion.

Brain fog is common in ADHD, CFS, fibromyalgia, and dysautonomia. Having spoken to many people IMO they are similar across the board.
Secondly ADHD is thought to have a neurological basis-- it is not all in our heads.

ADHD symptoms are not restricted to the orthostatic ones though, there are others reflecting cerebellar and basal ganglia dysfunction.
Finally because ADHD is present from childhood it is a special case- imagine growing up with orthostatic intolerance and getting in trouble at school because of the instinctive urge to fidget.  We do carry some psychological baggage because of that.
It's tough- it's a condition not well understood.

This video, recently released by an American doctor is of great interest-- certainly to me - as I have ADHD, and now worsening dysautonomia.

 

[Carolyn]

I have the same question about ADD/ADHD and MSA. My husband was diagnosed with ADD about 22 years ago and with MSA in 2013. He is not on any medication for ADD; is there a correlation between ADD and MSA? Can MSA made the ADD symptoms worse?

[Barliman]

Am I right in assuming MSA is multi systems atrophy?

 

[Lily]

I have ADHD (inattentive and hyperactive) and POTS.  ADHD [and ADD (inattentive only)] is a life-long problem.  It does not develop with time like POTS can.  There is some overlap in symptoms, due to the decreased cerebral blood flow in POTS, but one can distinguish between the two.  

If you truly have ADHD/ADD your symptoms will have been evident your entire life, and they will be the same from day to day and hour to hour regardless of how you are feeling POTS-wise.  I was diagnosed with ADHD at age 16.  Thinking back, Mom and Dad could see that my behavior as a 5 yr old (maybe even earlier) was consistent with ADHD.  If you have fewer or zero "ADD" symptoms when you are lying down or having a good POTS day, you should be strongly suspicious of the ADD diagnosis.

There are some medications that are used with both conditions, but I don't know that a causal link between the conditions has been discovered.  It would be very interesting if there was a more basic physical problem that can cause both conditions, but ADD and POTS cannot cause each other.

Ritalin is a primary and very effective ADHD drug, but it is also used in POTS to help peripheral veins constrict better.  Clonidine is sometimes used in ADHD as a secondary add-on to the primary drug, and it is also used in POTS when the sympathetic nervous system is overactive.  I take Strattera and Wellbutrin for ADHD.  They boost norepinephrine and dopamine in the brain, respectively.  For POTS I am on Clonidine and Florinef.  All this works very well for me, but it took a lot of experimenting to find the right medications in the right combinations.  ADD medications can work better or worse for different people, so you will probably need to try a few before finding the right one for you.

It would probably help to bring POTS info to your psychiatrist.  Perhaps ask your POTS doctor what kind of article or other written material he would give to a fellow doctor.