References for "Attention deficit hyperactivity disorder and sleep"

Barkley RA. Attention Deficit Hyperactivity Disorder in Adults: The Latest Assessment and Treatment Strategies (Jones and Bartlett Publishers, 2010). Golan N, et al. "Sleep Disorders and Daytime Sleepiness in Children with Attention-Deficit/Hyperactive Disorder," Sleep (March 15, 2004): Vol. 27, No. 2, pp. 261–66. Gruber R, et al. "Instability of Sleep Patterns in Children with Attention-Deficit/Hyperactivity Disorder," Journal of the American Academy of Child and Adolescent Psychiatry (April 2000): Vol. 39, No. 4, pp. 495–501. (Locked) More »

References for "Augmentation strategies for depression"

Coppen A, et al. "Enhancement of the Antidepressant Action of Fluoxetine by Folic Acid: A Randomised, Placebo Controlled Trial," Journal of Affective Disorders (November 2000): Vol. 60, No. 2, pp. 121–30. Freeman MP, et al. "Complementary and Alternative Medicine in Major Depressive Disorder: The American Psychiatric Association Task Force Report," Journal of Clinical Psychiatry (June 2010): Vol. 71, No. 6, pp. 669–81. Gaynes BN, et al. "The STAR*D study: Treating Depression in the Real World," Cleveland Clinic Journal of Medicine (January 2008): Vol. 75, No. 1, pp. 57–66. (Locked) More »

References for "Reconsidering the placebo response"

Beecher HK. "The Powerful Placebo," Journal of the American Medical Association (December 24, 1955): Vol. 159, No. 17, pp. 1602–06. Brinkhaus B, et al. "Acupuncture in Patients with Chronic Low Back Pain: A Randomized Controlled Trial," Archives of Internal Medicine (February 27, 2006): Vol. 166, No. 4, pp. 450–57. Cherkin DC, et al. "A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain," Archives of Internal Medicine (May 11, 2009): Vol. 169, No. 9, pp. 858–66. (Locked) More »

Augmentation strategies for depression

Only one-third of adult patients newly diagnosed with major depression achieve complete relief of symptoms after taking one antidepressant. These remission rates apply even when patients take "newer" antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). When a first drug fails, three next-step options exist: switching to a new medication, augmenting the first drug with one that acts in a different way, or augmenting drug treatment with psychotherapy. Augmentation is generally considered the best option when a first drug provides partial relief but does not completely alleviate symptoms. Disadvantages of this strategy include cost of additional treatment and (if drug augmentation is used) increased likelihood of side effects and drug interactions. One of the most relevant studies for real-world clinical practice, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, found that both psychotherapy and drugs are about equally effective as augmentation strategies. More recent clinical trials have tested dietary supplements as possible augmentation agents, adding to the options. (Locked) More »

Reconsidering the placebo response

In scientific studies, the term placebo usually refers to an inert pill or procedure that serves as a comparison to an active intervention (typically a drug or psychotherapy). Now a handful of acupuncture studies not only provides additional evidence that a placebo itself can have dramatic impact on illness, but also suggest that the context in which an intervention takes place can bolster the placebo response. The nature of the placebo response — and whether it even exists — has been the subject of scientific discussion for decades. In a 1955 paper, pioneering anesthesiologist Dr. Henry K. Beecher famously described the placebo response as powerful. Nearly a half-century later, a review published by the prestigious Cochrane Collaboration concluded instead that the placebo might be powerless. More recently, the Cochrane reviewers conducted another analysis and reached a middle ground, concluding that for some clinical conditions — particularly pain and nausea — placebos may confer symptom alleviation, while in other situations they do not. This raises the obvious question: why would placebos work in some cases but not in others? The latest research has been aimed at better understanding the placebo response by studying it on its own rather than just as a comparison to a drug or psychotherapy. (Locked) More »

Attention deficit hyperactivity disorder and sleep

Parents and clinicians report that sleep problems affect 25% to 50% of children and adolescents with attention deficit hyperactivity disorder (ADHD). The most typical problems include bedtime resistance and difficulty falling asleep. Studies using objective measures of sleep quality have produced inconsistent results, however. For example, studies using an actigraph, a lightweight monitor that people can use at home, have found that sleep in youths with ADHD is similar to that of other youths when it comes to parameters such as sleep onset, duration, and quality. At the same time, actigraph studies suggest that youths with ADHD are more active during the night (assessed by frequency and duration of movements), and they show greater variability in sleep patterns from one night to the next — suggesting unstable regulation of sleep and arousal. The symptoms of ADHD and sleeping problems often overlap, making it difficult to differentiate the two. For this reason, it's important to rule out sleep problems before confirming a diagnosis of ADHD. At the same time, sleep disorders can exacerbate symptoms of ADHD — and vice versa — presenting a challenge to both parents and clinicians. (Locked) More »

Ask the doctor: What is hypomania?

Recently I've been staying up until 3 or 4 in the morning to work on my oil paintings. I know I should feel tired, but I don't. One of my friends said that I might be hypomanic. What is that? More »