Wednesday, July 1, 2015

How Can ADHD Drug Vyvanse Ease Menopause Symptoms?

A drug marketed for attention deficit hyperactivity disorder (ADHD) might improve memory and concentration problems associated with menopause, a new study suggests. Vyvanse (lisdexamfetamine), a stimulant, is usually prescribed to children and adults with ADHD. But researchers found it also may help to improve menopausal women's "executive function" -- brain activities such as memory, reasoning, multitasking, planning and problem-solving.

According to a new study, women who are experiencing difficulty with time management, attention, organization, memory, and problem solving – all the cognitive functions often referred to as executive - related to menopause may find improvement with a drug already being used to treat attention deficit hyperactivity disorder (ADHD). The study led by researchers at the Perelman School of Medicine at the University of Pennsylvania is the first to show that Vyvanse (lisdexamfetamine, or LDX) improved subjective and objective measures of cognitive decline commonly experienced in menopausal women. Results of the study are published online today in the journal Psychopharmacology.

"Reports of cognitive decline, particularly in executive functions, are widespread among menopausal women," said lead author, C. Neill Epperson, MD, professor of Psychiatry and Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania, and director of the Penn Center for Women's Behavioral Wellness. "There are approximately 90 million post-menopausal women living in the US alone, and with the average age of onset occurring at 52, the great majority of those women will live in the postmenopausal state for at least one-third of their lives. Therefore, promoting healthy cognitive aging among menopausal women should be a major public health goal."

The Penn-led team administered a once-daily dose of LDX for four weeks to 32 healthy, non-ADHD-diagnosed women between the ages of 45 and 60 experiencing difficulties with executive functions as a result of mid-life onset menopause, and as measured using the Brown Attention Deficit Disorder Scale (BADDS). All participants served as their own controls by being randomly assigned to crossover to a placebo for an additional four weeks.

The researchers found a 41 percent overall improvement in executive functions for women receiving LDX, compared to a 17 percent improvement when taking placebo medication. There were also significant improvements in four out of the five subscales for women taking LDX: organization and motivation for work; attention and concentration; alertness, effort, and processing speed; and working memory and accessing recall.

“The low estrogen levels in menopause can cause a drop in serotonin and dopamine levels, leading to severe mood and cognitive changes,” explains Sheryl Ross, MD, ob-gyn and women’s health expert at the Obstetrics, Gynecology and Women's Health Center in Santa Monica, California.

"We need more research before changing our clinical practice, but it is encouraging that we are looking at other treatments for a variety of cognitive, mood and physical symptoms that are present during perimenopause and menopause for women," said Dr. Nicole Cirino, director of women's mental health and wellness at Oregon Health & Science University. "It's especially exciting to see this research for women who cannot tolerate hormone replacement therapy," added Cirino, who was not involved in the study.

Many women use hormone replacement therapy for menopausal symptoms, but how much it can help mental functioning is controversial, said Dr. Kevin Ault, an obstetrician-gynecologist and professor at the University of Kansas Medical Center. The evidence has not clearly shown that it does or does not help.

Not every woman is comfortable taking hormone replacement therapy or cannot take it due to other medical complications, Ross noted. "Even though this is a small study, it shows that other medications can be safe and effective in treating annoying cognitive side effects of menopause," she said.

While the women in the study were taking the medication, their blood pressure and heart rate increased but stayed in the normal range overall. The study authors did not report other major side effects.

"One of the problems with having a small study like this is that you're not going to see the big picture with side effects," Ault said.

Known side effects of Vyvanse include trouble sleeping, nervousness, dizziness, skin numbness, irregular heartbeat, headaches, nausea, vomiting, weight loss and loss of appetite, said Ross.

There are also individuals who should not take Vyvanse based on their health history, Cirino said, such as those with a history of heart conditions or a history of addiction or dependence.

"It is a psychostimulant that is a controlled substance, so it has to be given to the right candidate," Cirino said. "These can be addictive substances, especially if not carefully monitored, and they can worsen certain mood conditions, such as anxiety disorder, bipolar disorder or psychotic disorder."

Ideally, she said, women would wean off the medication once past menopause.

A 30-day supply of Vyvanse is estimated to cost between $200 and $250 without insurance. It is available through major pharmacies but has not been approved by the Food and Drug Administration for use in menopausal women.

The best candidates for ADHD drugs are women whose cognitive menopausal symptoms are getting in the way of their quality of life. “Menopausal women who do not have any symptoms related to mood or cognitive function should not take ADHD drugs,” Ross says. This is because using ADHD drugs during menopause comes with some risks, including addiction and potential abuse because of their stimulating effects. Other possible side effects include trouble sleeping, nervousness, dizziness, irregular heartbeat, skin numbness, headaches, nausea, and vomiting.

If you do not find the prospect of using ADHD drugs in menopause appealing, there are other things you can do. If you do not have risk factors such as a family history of breast cancer, short-term hormone replacement therapy may help boost your attention and memory, Ross says. Other potential drug treatments include antidepressants, blood pressure medications, and anti-seizure drugs.

“There are also some non-medication treatments, including acupuncture, hypnosis, yoga, meditation, regular exercise, and dietary changes, such as limiting caffeine, alcohol, and spicy foods,” Ross says.

No matter which treatment you choose for improving mental and emotional symptoms of menopause, make sure it's a good fit. “Dealing with the symptoms of menopause is an individualized process that has to feel right for you,” Ross says.

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