Role of Integrative Treatment in Adult ADHD

Theresa R. Cerulli, MD: Rakesh, can you give us some specifics with regard to integrative treatment, talking more specifically about the nonpharmacologic approaches?

Rakesh Jain, MD, MPH: Yes. I’m delighted that you brought up that particular issue because while clearly pharmacology is important, pharmacology that is absent of heart is a problem. And when I say heart, I’m speaking metaphorically to the great importance of psychoeducation. We’ll certainly talk about therapy, but most people who have adult ADHD [attention-deficit/hyperactivity disorder], if they were unaware of it previously, are actually quite confused.

Theresa R. Cerulli, MD: It’s what is ADHD and what isn’t ADHD. A lot of education I think is still needed, not just with our patients but a lot of clinicians. It can be a very confusing topic, which is why we’re all here today.

Rakesh Jain, MD, MPH: Very well said. Therefore, psychoeducation and support is so incredibly important, Theresa. But then to follow through with the integrative aspects, many of our adults with ADHD have very poor sleep habits. Really poor sleep habits that negatively impact almost any medication treatment we can offer. So in my hands, once I’ve diagnosed someone with adult ADHD, for example, I’m doing a pretty thorough review of other things: what are their exercise habits, what are their sleep habits, what are the nutritional habits? Many of us have commented on how ADHD can leave a person hollow in terms of self-esteem and self-confidence. That has to be addressed as well, and then as you heard Birgit talk about earlier, depression and anxiety are so common. Very often adding CBT [cognitive behavioral therapy] for direct intervention on anxiety and depression, but also to be truthful, the evidence does support that CBT as a supportive intervention to medications in adult ADHD can be helpful. We often think of lifestyle as a homeopathic side issue, but with adult ADHD, I think giving it prominence makes it more palatable to the patient and the patient’s support system. And the outcomes with all the medications that we can offer them are further enhanced and augmented.

Theresa R. Cerulli, MD: Excellent points.

Transcript Edited for Clarity