To Whom It May Concern,
It has come to my attention that Dr. Stu Rosan, a family practitioner with a large ADD practice, has come under fire for his use of stimulants and stimulants + SSRIs in the treatment of attention deficit disorder (AD/HD). In my experience, there are too few physicians who properly treat this disorder, especially when there are co-morbidities such as depression, anxiety, etc., which occur in over 50% of adults with AD/HD. Unfortunately, many patients are not given the benefit of higher dosing when needed (or polypharmacological treatment) due to the fears of physicians who are uncomfortable when dosing higher than the FDA recommendations.
Since the treatment of adult AD/HD is still a fairly new field, it is my opinion that many patients are treated less than adequate medically, because of many physician’s discomfort in prescribing stimulants, let alone stimulants with other meds to address the co-morbidity.
However, those who are well established and experienced in treating AD/HD often realize that such treatments are necessary for their patients to find relief.
It is my perception that AD/HD is still under-diagnosed and under-treated. For example, one survey in four different communities found that only about twelve percent of diagnosed ADHD children received adequate stimulant treatment (Jensen, et al., 1999).
Furthermore, it is well known that the dose of stimulant prescribed is not related to the patient’s body weight, but to how rapidly it is metabolized. For example, a 200 pound adult male may derive substantial benefit from five mg of Ritalin given three times a day, while a sixty-five pound child may need three times as much. Additionally, higher total daily doses may be needed because adults need more doses to cover a longer day, compared to that of a child.
Unfortunately, there are not enough physicians in this country who have the expertise to adequately treat AD/HD. Family physicians are typically the first medical professional a patient turns to when seeking relief for AD/HD symptoms. I hope that this trend changes in that more family physicians are trained to treat their AD/HD patients adequately, which in many cases, means using higher doses of psychostimulants if indicated, and using polypharm approaches when the patient presents with co-morbidities.
Terry Matlen, MSW, ACSW
Director, ADD Consults.com
Past board member, Attention Deficit Disorder Association
Author, “Survival Tips for Women with AD/HD”