Adult ADHD support is crucial for living well with ADHD. This disorder can be overwhelming. It can be infuriating when, try as you might to be organized, things get lost or misplaced, or important deadlines and dates get missed. Trying to figure out social skills to navigate the world of people can bring heartache. To add insult to injury, it frequently feels like you’re the only one who “doesn’t have it together” and you feel like a failure. It’s not you. It’s the ADHD. And it’s why ADHD support is crucial.

Benefits of Adult ADHD Support

Support comes in many forms and has multiple purposes. Some of the benefits for seeking support for adult ADHD include:

• Help with staying on task
• Assistance with eliminating clutter and getting organized
• Increased accountability and reliability
• Higher levels of motivation
• Receiving positive help rather than criticism (How to Talk to Your Parents about ADHD)
• Exchanging ideas, strategies, and tips
• Development of ADHD self-help strategies
• Networking to connect with others who are dealing with ADHD, too
• Decreased feelings of loneliness and being misunderstood
• Giving and receiving understanding and empathy
• Gaining hope, a sense that there is a light at the end of this ADHD tunnel that can be long and dark

If you live with ADHD, finding or creating support will help you work with your symptoms rather than against them. When you have help accomplishing things, such as organization, that ADHD makes difficult, you will no longer be held back by those symptoms. You can then concentrate your energy on all of the wonderful people and things in your life.

Types of ADHD Support

Support comes in different forms. What is supportive for one person might be irritating for the next. As you search for support, keep and enhance what works for you, and discard what doesn’t. It more than okay to embrace your uniqueness when you’re finding support. Let’s explore three effective sources of ADHD support.

• Friends and family. Some people find the majority of their support among close friends and family. People close to you know you better than anyone else does, and they are often (not always) good at providing you feedback lovingly rather than offensively.

If you have an open, positive relationship with people in your life, consider enlisting their support on a regular basis. They could provide feedback on how you’re acting in social situations, and they could even role play with you to help you practice new skills.

No matter what support someone close to you provides, make sure to agree up front that the feedback is both given and received positively. This is about support rather than criticism, and done right it can deepen the connection you have with each other.

• ADHD coaches. ADHD coaches are professionals who help people living with ADHD improve challenges inherent in this disorder: inattention, hyperactivity, and impulsivity. An ADHD coach helps people with things like planning, organization, time management, and problem-solving. Coaches and clients work together to determine goals, and the coach provides information and support as well as make sure the client is accountable and taking action toward goals.

ADHD coaching can be done in person or online. The National Resource Center on ADHD (CHADD, or Children with Adults with ADHD) has information on ADHD coaching, and the ADHD Coaches Organization has a helpful coach finder on their website.

Because they know how to target the ADHD symptoms that are interfering in someone’s life, and because they understand how people with ADHD operate, coaches can provide the support you need in the way you need it.

• Adult ADHD Support groups. Sometimes, you don’t want help building skills. Sometimes, you don’t want someone to help you set goals and create strategies for achieving them. Sometimes, you just need someone to listen. ADHD support groups provide support for adult ADHD and they also provide support directly for the person.

In support groups, people come together around a common theme, in this case living with ADHD. Gathering with others who share similar experiences helps you feel less alone. Exchanging tips and frustrations can be a great way to vent to people who are going through very similar things. Adult ADHD support groups are also great places to learn tips and strategies from people who use them.

To find adult ADHD support groups in your area, check with your doctor or therapist, as these professionals often have resource lists. Also, check with your county mental health association or agency. If you have mental health organizations in your community, such as the National Alliance on Mental Illness (NAMI), calling their offices can help you connect with support groups. Look at community centers, too, as they often host support groups and keep a directory or list of what groups meet at their facilities.

Taking time to find the type of adult ADHD support that is right for you can yield satisfying results. Having support helps you manage ADHD symptoms, and it helps your sense of belonging.

ADHD medication withdrawal can be an uncomfortable, even dangerous process. ADHD medications work directly on the brain to increase levels of the neurochemicals dopamine and norepinephrine. These brain chemicals are low in people with ADHD, and when ADHD medication is used to increase them, many people with ADHD notice increased ability to concentrate and focus as well as be still. The medications work by stimulating certain processes in the brain, which is why they’re called stimulants. Stimulants, such as Concerta, have many unpleasant side effects that cause some people to want to stop taking them.

Like all stimulants, ADHD medications can create dependence, even when you’re using them the correct way. Over time, your brain becomes accustomed to the levels of medication it’s receiving. The dose, or amount, of medication you’re using becomes less effective as your brain adjusts to its presence. Eventually, you find yourself needing more medication just to maintain the same level of effectiveness.

The higher the amount of a stimulant in your system, the more difficult it is to stop taking the ADHD medication. That doesn’t mean, though, that you are stuck with taking strong stimulants for the rest of your life. You can quit taking them. The following information is here to help you know what to expect so you can cope with and handle withdrawal from ADHD medications.

Stopping ADHD Medications Safely

Because the brain becomes dependent on stimulant drugs, it is very important to taper off your medication gradually rather than quitting cold turkey with medications such as Adderall. Stopping ADHD medications (or any medications, for that matter) should always be done with the assistance of a doctor.

Your doctor will create a schedule for you so that your medication is slowly reduced over a period of time. Your dose needs to taper in small increments to avoid the sudden disappearance of a substance that the brain has come to depend on (tapering is helpful when you're getting off Vyvanse, for example).

What to Expect During Withdrawal from ADHD Medications

For some, the withdrawal period is short and relatively easy with just a few days of mild symptoms. Others can experience a much longer and more intense period of withdrawal, with strong and numerous symptoms lasting a few months. Most fall somewhere in between.

The duration and intensity of your withdrawal period from ADHD medications will largely depend on how long you’ve been taking the medication and how high the dosage has been. It’s also impacted by how you quit taking the medication. Tapering takes a bit longer, but the symptoms are fewer and milder while quitting cold turkey is much more intense and unpleasant.

Some common ADHD medication withdrawal symptoms include:

• Insomnia
• Headache
• Shaking
• Sweating
• Appetite changes (loss of appetite or extreme hunger)
• Nausea and/or vomiting
• Muscle aches/soreness
• Increased heart rate
• Fatigue
• Sluggishness
• Medication cravings
• Restlessness
• Depression
• Anxiety
• Mood changes
• Irritability
• Return of ADHD symptoms

Unfortunately, there is no medication available that effectively eases the symptoms of ADHD medication withdrawal. That doesn’t mean, however, that you have to sit powerlessly and just experience misery. You can do things to cope with the withdrawal.

How to Cope with, Handle ADHD Medication Withdrawal

Consider these tips for handling ADHD medication withdrawal:

• Continue, resume, or start therapy to help you deal with the effects of withdrawal as well as the ADHD symptoms that will intensify as the medication leaves your system
• Treat symptoms of anxiety and depression
• Be active, as physical activity is good for brain and body
• Engage in hobbies and interests to distract yourself
• Eat healthy and drink plenty of water
• Practice good sleep hygiene so you get a better night's sleep with ADHD
• Maintain a regular routine to keep a steady rhythm for your brain

Stopping ADHD medications can be challenging. With a doctor’s guidance, a knowledge of what to expect, and an arsenal of ADHD coping strategies, you can safely taper off your ADHD medication.

When you stop taking Concerta, many different things, both good and bad, can happen. Concerta is one of the medications that can be used to treat ADHD. It’s a long-acting central nervous system stimulant that creates changes in the brain to help reduce many of the problematic symptoms of adult ADHD. Specifically, Concerta increases levels of the neurotransmitters dopamine and norepinephrine, thus increasing focus, concentration, alertness, and general attention. Concerta also decreases hyperactivity and impulsivity.

Despite the fact that Concerta can minimize ADHD symptoms and thus greatly improve people’s ability to function, people sometimes want to stop taking Concerta. Concerta can indeed be helpful, but Concerta can cause problems in the form of side effects, too.

Side Effects of Concerta

Concerta is designed to work on neurotransmitters in the brain, which it does, but it is in your system and can affect your entire body. Concerta can cause problems in the nervous system, cardiovascular system, circulatory system, digestive, and, in males, the reproductive system (Pietrangelo, 2015).

Specifically, Concerta’s effects include such things as

• The Concerta crash every afternoon or evening as the amount in your bloodstream drops
• Depression
• Anxiety
• Blurred vision
• Eyesight changes
• Sleep problems
• Irritability
• Loss of appetite
• Stomachaches
• Nausea
• Vomiting
• Cough
• Dizziness

High doses of Concerta could cause, in addition to the above effects,

• Psychotic symptoms like hallucinations
• Thought disorders
• Mania

Quitting Concerta brings numerous benefits to both mental and physical health because these unpleasant side effects stop.

What Happens When You Stop Taking Concerta?

Getting off Concerta will cause different things to happen depending on how you stop. One thing that will happen no matter how you quit is the Concerta crash.

The Concerta crash is a daily side effect that happens as the amounts of the medication in your bloodstream decrease throughout the day. This regular experience is like a mini Concerta withdrawal period in which you start to experience withdrawal symptoms. Once the medication is taken again, as prescribed, the medication levels increase and the crash ends.

During Concerta withdrawal, the amount of stimulants in your system drops but isn’t replenished fully. Concerta withdrawal symptoms include:

• Anxiety
• Depression
• Suicidal thoughts
• Decreased ability to focus
• Irritability
• Lack of energy
• Nausea
• Vomiting
• Increased heart rate

Quitting Concerta cold turkey intensifies these effects. The crash is severe, creating more withdrawal symptoms as well as symptoms that are harder to manage. Abruptly stopping this stimulant medication causes intense cravings and increases the risk of resuming Concerta.

A cold-turkey approach to quitting Concerta also significantly increases the risk of depression and suicide. (Tackett, 2016).

To avoid these extreme Concerta withdrawal symptoms, misery, and risk of harm, it’s imperative to taper off this medication under medical supervision rather than just stopping on your own.

How to Properly Taper Off Concerta

It’s okay to want to stop taking Concerta. Each person’s response to Concerta is different. If you think that this medication is doing you more harm than good, talk to your doctor. Have a list with you of the effects, positive and negative, that you are experiencing with Concerta. This way, the two of you can determine the best course of action.

When quitting Concerta, you’ll go through a period of gradual tapering according to the schedule your doctor has made for you. Tapering has to be done systematically to control the amount of medication in your body as well as to let your brain adjust to the decreased levels of dopamine and norepinephrine.

Getting off Concerta is a process that takes time. Once you start to wean off the drug, withdrawal symptoms will set in anywhere from within the first day to a few days after your dose decreases. The entire process can take anywhere from two weeks to several months, depending on the length of time you were taking it as well as the strength of the dose.

Under a doctor’s supervision and with gradual tapering, the Concerta crash won’t be as severe. And throughout the process, your withdrawal symptoms will be much milder and more manageable.

Properly tapering off Concerta also can include therapy. Therapy is especially important if you are experiencing anxiety, depression, and/or suicidal thoughts. Again, these can be strong during Concerta withdrawal, so it’s important to have support.

Quitting Concerta can be desirable if you are experiencing more harmful side effects than benefits from the medication. Be sure to taper off this medication under the supervision of your doctor, and the process should be very manageable. Then, you can plan new ways to manage your ADHD.

Hands up if you suffer from a lack of self-confidence. Well, that pretty much covers everyone. So what can you do about it? Quite a lot, says life coach Judith Verity.

If you aren't happy with your life at the moment, don't worry, because you have the power to change it. It might not feel like it right now, but even small changes can make a very big difference.

f you don't think you can manage all ten of these confidence-boosting ideas straight away, just choose one and, when you've got the hang of it, do another one. In fact, you could even set yourself a two-week change program and take one of the options each day.

1. De-bug your system
If you work on a computer, you probably save your valuable, creative files, delete all the rubbish and check for bugs. Our brains are the most sophisticated computers we'll ever own, but we don't look after them as well as we look after our PCs. However, did you know you can program your brain to boost your self-esteem?

• Use the right programming language and be positive when you talk to yourself. Instead of saying 'I shouldn't eat so much', 'I mustn't be so lazy', 'I can't cope under pressure', use phrases such as 'I can eat healthy food', 'I will take regular exercise', 'I am getting more confident'.
• Congratulate yourself when things go right - even little things like getting to work on time or remembering to call a friend on their birthday.
• If something is bothering you, whether it's a person, an incident, or something you did or didn't do, acknowledge it, learn from it and then delete it. It's taking up valuable mind space and undermining your self-esteem.
• Before you go to sleep, think of six things that made you happy during the day. It could be a smile, a piece of music, sunshine on your back or a cuddle.
• Use your sleeping time positively. If something's bothering you, ask yourself some questions about it before you go to sleep. Make sure you phrase those questions positively - don't ask yourself 'why am I such a failure?' before you close your eyes. Ask 'how can I be more successful/confident/happy?'

2. Start the day right
Mornings seem to be a bad time for most people, and if you start off sluggishly, this negative mood can hang around until lunchtime. Put yourself in a positive frame of mind before you even get out of bed by asking yourself these questions:

• If I went to sleep last night with a question in mind, am I any closer to an answer now? (If you don't have that answer yet, don't chase it. Wait until it comes.)
• What am I happy about in my life? (It doesn't have to be large or wonderful. Small happinesses count.)
• What am I excited about?
• What am I proud of?
• What am I grateful for?
• What am I committed to?
• Who do I love?
• Who loves me?

3. Cultivate your social life
People with high self-esteem are generally quite sociable. But this is a chicken and egg situation and the less you interact with other people, the more negative you'll feel about yourself and the less likely you'll be to put yourself in social situations.

Break the negative circle by starting to include other people in your life. If this seems difficult, think of it as giving as well as taking. Join a voluntary organization or club and offer to help. This is not only a distraction from your problems, but also generates feelings of self worth.

4. Get some exercise
Include more exercise in your life. Working out, particularly outdoors, is a great way to generate your own 'feel-good' chemicals and will give you body confidence as well as energize you. People who exercise regularly tend to look good, they have better skin tone, better muscle tone and their movements are easier and more balanced. If you have physical poise and strength, it's much easier to feel confident inside as well.

5. Relax
Do you spend a lot of time feeling anxious and stressed? Learning to breathe like a relaxed and confident person will help you cope with daily stresses, and it's the simplest habit you could ever learn.

There are lots of books and classes about this and, if you like the idea, you could take up meditation or yoga and become a master of poise and positive energy.

6. Make your own choices
Take time out to assess a) your career and b) your relationships. Ask yourself:

• Is this job/person giving me positive feedback?
• Do I enjoy this job/person?
• Does this job/person acknowledge and reflect my creativity and my strengths?
• Am I sticking with this job/person simply out of habit?
• Could I do better?

If it's not working for you, whatever it is, change it.

7. Review your situation
Include time for reflection in your daily schedule - praying if you're religions, meditating or writing a diary of your thoughts and feelings. We often don't give ourselves enough time to process all the things that are going on in our lives.

If you decide on a diary, instead of writing a list of what went wrong today, write down these headings first, and fill them in.

• Goals: set yourself a daily outcome and build up to larger goals.
• Achievements: what did you achieve today?
• Gifts: what happened, out of the blue, to cheer you?
• Insights: you may not get one every day - but when you suddenly spot a key to some piece of your behavior, write it down.

8. Change your environment
Chances are, your environment reflects the way you feel, but, whether it's dull, cluttered or messy, you can change it. Any positive changes you make are going to have a positive effect on your mood too. Look at your desk, your home or even your wardrobe and see what you can do to make it more inspiring.

• Clear up the clutter (a good Feng Shui practice that will make you feel more energetic) and throw out stuff you don't use.
• Give yourself a sound track - add some inspiring music.
• Introduce new bold colours that you love.

9. Give yourself the VIP treatment
Start treating yourself the way you'd treat your best friend. It comes as a shock to most people how nasty and neglectful we can be to ourselves. If you aren't sure you can keep this up for long, take it a day at a time. Give yourself encouragement and support. Take yourself out for a hairdo, a massage, an aromatherapy session - or even a clothes-shopping trip.

10. Find a role model
If you're having difficulty taking this new version of yourself seriously, why not pretend to be someone else? Think of someone you admire - it could be someone you know, or someone famous - and live your day as they would. How would they react to others? Would they be assertive? Relaxed? Confident? Fun and energetic?

And yes, you do know how to do this. Even if you have to think back to when you were a child, you'll be able to come up with a time when you were happy with yourself and in control of your situation. In fact, if you can remember that time very well, why not be your own role model?

Parenting a special needs child is a challenge, but you can do it. Here are some tips for parents of ADHD children from a mother who's been through it.

I'm not a medical doctor, psychologist, lawyer or another expert - I'm a mom who struggles to help my ADHD/ADD child. In this regard, I've spent a considerable amount of time searching for answers. It's my hope that by sharing this information, it will raise public awareness as well as be instrumental in lending a helping hand toward finding "a place to start." There's something here for everybody.

Perhaps you've just learned your child has ADHD, and you are on an emotional rollercoaster ride. Perhaps you've scanned this page and felt an overwhelming sense of fear, frustration, or what next? -- Maybe you felt, "I can't do this." Consider yourself normal. Parenting a special needs child is a challenge, but you can do it.

• On the upside, it is easier to deal with a problem if you know what you are dealing with. Now you can begin to sort things out and make a plan.

Helpful Tips for Parenting Your ADHD Child

Listed below are some tips I've learned along the way:

• Accept that there is a problem, whether or not you accept the diagnosis. Denial will not help you or your child.
• Do not expend energy grieving that your child is "labeled." No, it's not fair but grieving will not make things better. Take some time to pull yourself together -- then get on with parenting your child.
• Be prepared to feel guilty about the time you spend parenting your ADHD child compared to the time you spend with other family members. Be prepared for backlash you may get caught up in as a result of other family members feeling neglected.
• You will have to look deep within yourself to find patience -- Patience dealing with your child, patience waiting for appointments, patience waiting for test results, patience when working with the school district, patience, patience, patience.
• In general, all children need structure. ADHD children require more structure, routine, and consistency.
• Behavior management plans do not work overnight -- many times it takes two to three months to see results -- sometimes longer. Many times the "plan" ends up being a little from this one and a little from that one. Make clear, age and developmentally appropriate rules and consequences for infraction of those rules. Your child must know your expectations.
• It is critical that all caregivers in the household be on the same page when it comes to disciplining your child. If one parent perceives his/her spouse to be very lenient and the other has the opposite perspective, it's time for the parents to compromise. If it requires that you have a family meeting and put rules and consequences on paper -- so be it. Behavioral expectations and consequences for violations should be as consistent as possible between caregivers. Remember "structure, consistency." And yes, this is easier said than done.

• In my opinion, Attention Deficit Hyperactivity Disorder is somewhat of a misnomer. It's not that ADHD children do not pay attention, it's that they are bombarded with information. Their filtering system does not work correctly.
• It's not unusual for an ADHD child to do well one day, and not so well the next. If you think your child can perform well in school today because s/he did yesterday, you are mistaken.
• ADHD children are very sensitive to their environment. The more noise, color, people, clutter, movement, the higher the difficulty level staying focused. Guard against over-stimulus.
• ADHD children generally do not transition well. I've found it helpful to give my child "lead time." For example, rather than saying "8:00 p.m. -- bedtime," it works better if I give some lead time by saying, "bedtime in 15 minutes...bedtime in 10 minutes...bedtime in 5 minutes."
• Many people you meet will think they know a lot about ADHD, but actually, they know very little. Some people do not believe there is such a thing as ADHD. It is these people that inadvertently add to our burden. They have no concept of the disorder, choose to have no more than a cursory knowledge of ADHD, yet tend to shout the loudest and have the strongest opinion that "it's the parenting. I could straighten him out in a week." It would be so wonderful if that was the case, but it is not. If your efforts to educate them fall on deaf ears, print a copy of this letter and give it to them. If that doesn't work "maverickmom" has some excellent advice in my opinion: Tell them to blow it out their socks.
• It is our job as parents to teach our children to function in this world to the best of their ability. In this respect, do not let the ADHD "label" cripple them. Keep your expectations high and teach them to adapt the best they can. As a parent, it's difficult to walk the centerline of teaching responsibility while addressing potential limitations.
• This day in time, everyday living is a challenge. Throw in an ADHD child, the extra time required to parent a special needs child, problems with health insurance, the extra financial strain, perhaps an uncooperative school district, the additional stress within the family unit and you have a formula for a full-blown crisis. Do not forget to take care of you. You can't adequately care for your child(ren) if you're mentally and physically falling apart. Do something special for yourself from time to time. Join a support group, call a crisis hotline when necessary, go see a movie, go shopping, and/or see a counselor.
• There is a reason to believe that ADHD treatment will improve as research advances. There is still much that is unknown about ADHD, but treatment has come a long way compared to 10 years ago.
• Unfortunately, ADHD/ADD rarely travels alone -- it appears to be the norm rather than the exception when there are no accompanying disorders such as an auditory processing disorder, learning disorder, bipolar, non-verbal learning disorder, sensory integration disorder, etc. And just because your child makes good grades in school doesn't mean the child does not have a co-existing disorder.
• Trust your instincts. No one knows your child better than you.

About the author: Alisha Leigh is not a medical doctor, psychologist, lawyer or another expert - she is a mom who struggles to help her ADHD/ADD child. In this regard, she has spent a considerable amount of time searching for answers.

A dad of two sons with ADHD shares an inspirational story and insights into raising children with ADHD.

What Works For Us

ADHD (Attention Deficit Hyperactivity Disorder) has been a blessing to our family. We are better parents, all our children are successful in their own way, and we are able to be a therapeutic foster family.

I sometimes wonder --if we didn't have ADHD, would we be so fortunate?

There were years of guilt, frustration, hopelessness, and many other emotions. My son, Ray, was difficult, moody (including drastic mood swings), very unhappy and by age six wanted to "make himself dead." We sought help with different professionals, agencies, playgroups - you name it.

Then one day we found the guidance our family needed from a therapist. For three years we saw him and he educated us in many ways.

Ray was improving but was continuing to concern all of us. He was referred to a psychiatrist who we continue to see today.

We had rules and consequences in our home but didn't have consistency or structure. This didn't mean we were bad parents, but our children were receiving mixed messages. Behavior modification has changed that and continues to be our foundation.

The first thing we did was to make a rules and consequence list for the entire family. Age appropriate rules were designed for the individual child(ren). Consequences included time outs, lost privileges, and so on. Making this as a family and posting it in clear view made the child responsible for his choices. As parents, we made sure the rules were followed, but the child was in control of his choices.

Goal charts were set up. We would pick five goals to work on. Four were for problem areas and one was a happy one, whose purpose was to help with self-esteem. Rewards for reaching goals were simple and creative. The rewards were incentives, but my children felt a sense of pride when they totaled up the check marks, stickers or happy faces. A little self-esteem began to grow.

We believe that a parent should never disagree with another adult about a consequence in front of the child. Wait until the child is not in hearing distance. If a change in consequences occurs, the person who decided on the initial consequence should be the one giving the new one. Seeing adults working together builds the support system; it creates a sense of security for the children. The child - seeing all working as one - will slowly start seeing the effect his choices have on him.

Using medications for ADHD was a very difficult decision for us. We agreed to Ritalin for one month only. Seeing the positive results, we continue to use it. Prior to this, we had tried many alternatives. Ritalin is not a cure-all. It is only the seasoning on top of the main ingredients: Behavior modification, consistency, and structure.

Two of my biological children are ADHD. The youngest has the additional "H" for "hyperactivity". Watching them together at times can be interesting. They appear to feed off of each other. Rainy days have definitely put a few gray hairs on my head. As they grow, they have taught us so much. Being very aware of their diagnosis, they are able to share their views with us.

People tell me I'm lucky because my children are not affected like other ADHD children. It's not luck, it was following through with behavior modification, consistency and structure. It took many years to get here, but the rewards show daily in their faces.

I will never forget the pain of hearing my son say, "Make myself dead." However, it was that day that made a difference in our life. In sharing this with you, maybe I can give you a little piece of hope to hold on to.

Don't ever let go, your child's bright future is on the other end.

Info on anti-dementia drugs, antipsychotics, antidepressants and other medications for treating symptoms of Alzheimer's Disease.

Four cholinesterase inhibitors, tacrine(brand name Cognex), donepezil (brand name Aricept), rivastigmine (brand name Exelon) and galantamine (brand name Reminyl) have been approved by the FDA for use in treating Alzheimer's disease. All produce some limited improvement in the cognitive symptoms associated with Alzheimer's disease, though they do not slow or halt the progression of the disease. The beneficial effects are typically modest and temporary.

This new generation of anticholinesterase drugs was originally developed to improve memory and the ability to carry out day-to-day living activities in people with Alzheimer's disease. Evidence suggests that these drugs also have beneficial effects on behavioral symptoms, particularly apathy (lack of drive), mood and confidence, delusions and hallucinations. Taking anti-dementia drugs may, therefore, reduce the need for other forms of medication. However, in higher doses, these anti-dementia drugs may occasionally increase agitation and produce insomnia with nightmares.

Memantine (Namenda) is the most recent anti-dementia drug to be developed. It works in a different way than the anticholinesterase drugs and is the first drug suitable for those in the middle to later stages of Alzheimer's disease. It is thought to slow the rate of disease progression rather than to have immediate effects on behavioral symptoms.

Commonly prescribed drugs for Alzheimer's Disease

This list includes the names of many (but not all) of the different medications available. New drugs are appearing all the time and you may need to ask your doctor what type of medication is being prescribed. The generic name is given first, followed by some of the common proprietary (trade) names.

Sources:

• Memory Loss and the Brain newsletter, winter 2006. Alzheimer's Society - UK

Overview of using medications to treat Alzheimer's patients with sleep problems.

Drugs for treating sleep disturbance

Sleep problems, especially persistent wakefulness and night-time restlessness, can be distressing for the person with dementia or Alzheimer's Disease and disturbing for caregivers. Many of the drugs commonly prescribed for people with dementia can cause excessive sedation during the day, leading to an inability to sleep at night.

Increased stimulation during the day can reduce the need for sleep-inducing medications (hypnotics) at night. Avoiding stimulants like caffeine, being exposed to the sun during the daytime to regulate circadian rhythms, limiting daytime naps and establishing a bedtime routine are other suggestions to improve sleep offered by the Mayo Clinic.

Hypnotics are generally more helpful in getting people off to sleep at bedtime than they are at keeping people asleep throughout the whole of the night. They are usually taken 30 minutes to one hour before going to bed.

Chlormethiazole is generally well tolerated by elderly people, although some cannot take it because it produces an unpleasant itching sensation in the nose. Benzodiazepines (see section on drugs for treating anxiety) such as temazepam are frequently prescribed.

Antipsychotics, used to control the agitated and combative behaviors often associated with Alzheimer's disease, also have sedative properties that help people sleep.

Side-effects

• If excessive sedation is given at bedtime, the person may be unable to wake to go to the toilet and incontinence may occur, sometimes for the first time. If the person does wake up during the night despite sedation, increased confusion and unsteadiness may occur.
• Hypnotics are often best used intermittently, rather than regularly, when the caregiver and person with dementia feel that a good night's sleep is necessary for either or both of them. The use of such drugs should be regularly reviewed by the doctor.

Sources:

Alzheimer's: Managing sleep problems, Mayo Clinic, Oct. 19, 2007.

Alzheimer's Society - UK, Carers' advice sheet 408, March 2004.

Overview of using medications to treat anxiety in Alzheimer's patients.

Medications for treating anxiety

Anxiety symptoms are fairly common among patients with Alzheimer's Disease (AD). Such symptoms are likely to make patient care more problematic and, therefore, increase the risk of nursing home placement.

Anxiety states, accompanied by panic attacks and fearfulness, may lead to demands for constant company and reassurance.

Short-lived periods of anxiety, for example in response to a stressful event, may be helped by a group of drugs known as benzodiazepines. Continuous treatment in excess of two to four weeks is not advisable because dependency can occur, making it difficult to stop the medication without withdrawal symptoms.

One important thing to remember, benzodiazepines (like Xanax) can reduce anxiety, but they can also create more memory problems and increase the risk of falls since they slow reaction times and disrupt balance. SSRI antidepressant medications (Prozac, Lexapro), though, may help to reduce anxiety for some patients.

Side-effects of anti-anxiety medications

• There are many different benzodiazepines, some with a short duration of action, such as lorazepam and oxazepam, and some with longer action, such as chlordiazepoxide. All of these drugs may cause excessive sedation, unsteadiness and a tendency to fall, and they may accentuate any confusion and memory deficits that are already present.
• Major tranquilizers (antipsychotics) are often used for severe or persistent anxiety. If taken for long periods these drugs can produce a side-effect called tardive dyskinesia, which is recognized by persistent involuntary chewing movements and facial grimacing. This may be irreversible but is more likely to disappear if it is recognized early and the medication causing the problem stopped.

Sources:

• Anxiety Symptoms as Predictors of Nursing Home Placement in Patients with Alzheimer's Disease, Journal of Clinical Geropsychology, Volume 8, Number 4, October 2002.
• Haupt M, Karger A, Janner M. Improvement of agitation and anxiety in demented patients after psychoeducative group intervention with their caregivers. Int J Geriatr Psychiatry 2000;15:1125-9.
• Treatment of agitation in older persons with dementia. The Expert Consensus Panel for Agitation in Dementia. Postgrad Med 1998 Apr; Spec No:1-88.
• Alzheimer's Society - UK - Carers' advice sheet 408, March 2004

Neuroleptics - antipsychotics are used to treat behavioral symptoms in Alzheimer's patients, but their effectiveness is in question and there are some side-effects to be aware of.

Major tranquilizers (also known as neuroleptics or antipsychotics) are drugs that were originally developed to treat people with schizophrenia.

The use of major tranquilizers in people with dementia remains controversial and clinical trials are in progress to better determine their effectiveness. At the moment, none of these treatments are specifically licensed to treat people with dementia, although they are frequently prescribed to treat symptoms including agitation, delusions (disturbed thoughts and false beliefs), hallucinations (seeing and hearing things that are not there), sleep disturbance and aggression.

Effectiveness of Antipsychotics in Treating Alzheimer's Behavioral Symptoms

The extent to which these medications benefit patients is unclear, and opinions vary as to whether they are safe for this population. The results of phase 1 of the CATIE-AD NIMH (National Institute of Mental Health) study provide a first set of real-world effectiveness data where little existed before. Overall, data from this trial suggest:

• Although some atypical antipsychotic medications are modestly helpful for some patients, they are not effective for the majority of Alzheimer's patients with psychotic symptoms.
• Good clinical practice requires that medical or environmental causes for Alzheimer's-related agitation and aggression be ruled out and that behavioral interventions be considered before turning to antipsychotic medications.
• If an antipsychotic medication then is warranted, clinicians should closely monitor their Alzheimer's patients for intolerable side effects and potential safety concerns.
• Clinicians should be mindful of the limitations of these medications and weigh the risks against potential benefits.

Side-effects of neuroleptics and antipsychotics

• Side-effects include excessive sedation, dizziness, unsteadiness and symptoms that resemble those of Parkinson's disease (shakiness, slowness and stiffness of the limbs).
• Major tranquilizers may be particularly dangerous for people with dementia with Lewy bodies, possibly causing sudden death. If a person with dementia with Lewy bodies must be prescribed a major tranquilizer, it should be done with the utmost care, under constant supervision, and should be monitored regularly.
• A new generation of major tranquilizers may be less prone to produce troublesome side-effects, although some of these drugs (risperidone and olanzapine) have been determined to be unsuitable for use in people with dementia because of the high risk of stroke. So far, there is very little information about the possible risk of stroke with other drugs in this class, such as quetiapine; therefore, their use is not recommended at the moment.
• Whichever drug is used, treatment with major tranquilizers should be regularly reviewed and the dose reduced or the drug withdrawn if side-effects become unacceptable.
• Excessive sedation with major tranquilizers may reduce symptoms such as restlessness and aggression at the expense of reducing mobility and worsening confusion.
• Evidence is also beginning to accumulate to suggest that major tranquilizers may accelerate the rate of decline and disease progression in people with Alzheimer's, so there are particular concerns about the long term use of these drugs.

Anticonvulsant drugs, such as sodium valproate (Depakote) and carbamazepine, are sometimes also used to reduce aggression and agitation, as is the antidepressant drug trazodone.

Sources:

• Devanand DP, Jacobs DM, Tang MX, et al. The course of psychopathologic features in mild to moderate Alzheimer disease. Archives of General Psychiatry 1997;54:257-63.
• The Quality of Antipsychotic Drug Prescribing in Nursing Homes, Becky A. Briesacher; M. Rhona Limcangco; Linda Simoni-Wastila; Jalpa A. Doshi; Suzi R. Levens; Dennis G. Shea; Bruce Stuart, Arch Intern Med. 2005;165:1280-12.
• NIMH: NIMH Perspective on Treating Alzheimer's Patients with Antipsychotic Medications, October 12, 2006.