​​The wholistic approach to treating ADULT ADHD
​The first thing to know about ADHD treatment is that it is not only treated with medications. Yes, ADHD medications are very effective but their use alone will only take you so far, as a comprehensive treatment plan involves a wholistic, multimodal approach.

Did you know that over 80% of adults with ADHD also have another mental health condition such as anxiety, depression or substance addiction? Your treatment plan should take into consideration all of your mental health conditions, not just the ADHD.

​Let’s start by describing the various “non-medication” strategies to consider as part of your treatment plan.
​1. Meet with your primary healthcare provider to Review the consultation report
​​If you have been diagnosed with ADHD, the first step in your treatment plan is to arrange to meet with your primary healthcare provider (the person who referred you to me) to review the consultation report. This is best done immediately after our treatment planning meeting. A physical examination and certain laboratory investigations are often required to rule out contributing factors for your symptoms. It is vital that we know the cause of your symptoms before we begin treating these symptoms. Bottom line, make an appointment as soon as possible with your primary healthcare provider to review the treatment recommendations in the consultation report.
2. Lifestyle Recommentations for Adult adhd
​There is a wealth of scientific research endorsing regular exercise, healthy diet and sleep routine, as well as only consuming drugs and/or alcohol in moderation as the foundation for your treatment plan. Here is more information from the ADDitude Magazine, a free and abundant resource, for your consideration.
 
3. Self-help Resources
4. Psychotherapy (talk-therapy) Services
Psychotherapy (talk-therapy) is a key component of your treatment plan. It is typically offered in two formats; group and individual therapy - using various strategies, depending on the nature of the mental health condition. Here is a list of the different services available online and in the greater Victoria/Vancouver area.

 ADHD-Specific Psychotherapy Resources
Other Psychotherapy Resources
5. HOw to find a specific adhd therapist
Talk therapy is a collaborative process, and it is important to find the correct match for your individual needs. A few questions to ask yourself are; Why do I want to work with a therapist and what am I hoping to achieve with this form of treatment? Am I looking for help with practical daily living issues as well as forming healthy habits (ADHD Coaching) or am I more interested in focusing on issues of emotional regulation and direct treatment of co-morbid conditions such as anxiety, depression, and substance abuse (Traditional Psychotherapy)? Regardless of your needs, the process to finding a specific therapist is;
  1. Identify what you are trying to achieve with this form of treatment.
  2. Compile a list of potential therapists. Consider utilizing the specific links already provided.
  3. Visit their websites, and interview them about them about their training, experience, and services.
  4. Take notes on each potential therapist, including your reactions (“gut feelings”).
  5. Select the therapist that best meets your needs. ​
​See this downloadable resource to aid in your process;  ADHD Coaching 
6. Neurofeedback For ADHD
​Neurofeedback is an effective treatment intervention, especially when combined with medications. It is also a helpful intervention when medications are not tolerated or recommended (such as during pregnancy and breastfeeding). Existing research does suggest that neurofeedback can result in improved attention, diminished hyperactivity, and enhanced executive functions, including working memory, for some patients.  However, some of the most important researchers in the ADHD field would argue that the efficacy of neurofeedback for ADHD has not been conclusively established.  The bottom line is that research support for both stimulant medication therapy and behavior therapy is stronger than it is for neurofeedback at the moment.

Here is a link to a useful review article: Can Neurofeedback Effectively Treat ADHD?

​Should you wish to explore this option, here is a link to a recommended local resource: Neurofeedback Victoria
7. Academic accommodations & Financial Support for BC Postsecondary Students
​Most postsecondary institutions in British Columbia have a "Centre for Accessible Learning" to assist with resources for adults diagnosed with ADHD. Here are a few local resource centres: UBC, SFU, Capilano University, BCIT, VIU, Royal Roads University, Camosun College and University of Victoria. In general, these centres help with the process of obtaining academic accommodations and financial support. Theses services first require that you provide their office with "documentation of disability" using the following forms;
​
1. Academic accommodations: Verification of Mental Health Disorder
2. Financial support through Student Aid BC: Appendix 8

Together we can complete these forms, If you have received a diagnosis of ADHD from my office. The cost of this service is covered under the BC Medical Services Plan, so patients do not have to pay any additional fees. Email me at [email protected] if you are interested in any of these services.
8. Medications for adult adhd
First Choice Treatments
Long-acting psychostimulants are the first choice of medications used to treat ADHD. These medications have the best evidence base, risk-benefit profile, effectiveness, and duration of effect. There are two types of psychostimulants; methylphenidate and amphetamine. Long-acting methylphenidate is available as three different products with varying duration of action: Biphentin (6-8 hours), Concerta (10-12 hours), and Foquest (14-16 hours). Long-acting amphetamine is available as two different products with varying duration of action: Adderall XR (8-10 hours) and Vyvanse (12-13 hours).

Second Choice Treatments
Non-stimulants including Strattera (atomoxetine) and Intuniv XR (guanfacine XR) as well as short/intermediate acting psychostimulants are the second-choice treatment options because they are either not as effective, have sub-optimal duration of action, or have more side effects compared with the long-acting psychostimulants. The short and intermediate acting methylphenidate products are Ritalin (4 hours) and Ritalin SR (6 hours). The short and intermediate acting amphetamine products are Dexedrine (4 hours) and Dexedrine Spansules (6 hours).
 
Third Choice Treatments
These are medications whose use is “off-label” to treat ADHD, meaning that they are useful in certain situations but that they are not officially indicated for the treatment of ADHD. Generally speaking, they are less effective and/or have more side effects than either the first or second choices. These medications include Wellbutrin XL (bupropion XL), Catapres (clonidine), Alertec (modafinil), Norpamin (desipramine) and a few other infrequently used options.
9. Cost saving programmes for adhd medications
​Here is a list of links to the various resources available;
1. Public Formulary Overview - A review of ADHD medication coverage available in British Columbia (BC).
2. Special Authority Medication Coverage for ADHD - For coverage of Long-Acting Stimulant medications and Atomoxetine in BC. The application is completed and submitted by the prescribing prescriber.
3. Psychiatric Medications Plan (Plan G) - For coverage of Short-Acting Stimulant medications in BC. The application is completed and submitted by the prescribing prescriber.
​4. innoviCares Card - A free prescription savings card, funded by participating pharmaceutical manufacturers. Present you innoviCares card and ask for the brand-name medication. Your card will automatically cover a portion of the cost of the original brand.
5. First Nations Health Authority - Medication and other health benefits for First Nation Citizens
6. Vyvanse Assistance Program- Takeda developed the VYVANSE Patient Assistance Program for Canadian patients requiring reimbursement support. The program is available to all eligible Canadians.
7. Concerta Access Program- The Janssen BioAdvance® network provides access and affordability support for patients who have been prescribed Janssen medications.
10. Difference between name-brand and generic ADHD medications
​Both patient experience and research studies confirm significant differences between certain brand name and generic products. In general, certain generic ADHD medications are less effective and have a more side effects compared with the brand name equivalent. Here is an excellent review on this subject, for your information: Generic ADHD Medications vs. Name-Brand Drugs
11. How adhd medications are initally prescribed
​The ADHD medications are most often taken at the start of your day, beginning with the lowest treating dose. The dose is then increased every 7 to 14 days until you reach the desired outcome, intolerable side effects, or the maximum daily dose. The choice of your medication is based on many factors, including; duration of action, cost, drug interactions, and your other health conditions.
12. How to know if the adhd medication is working
The goal with medications is to improve your concentration, focus, and make you less restless and impulsive. Improving these symptoms often results in an improvement of your functioning… but not always. Remember these medications help you focus, but they don’t tell you what to focus on! Addressing your other mental health issues and setting priorities for how you spend your time are equally important if you want to improve your overall level of functioning. Here is a useful tool to monitor your medication response and side effects: Medication Monitoring Form You might also consider filling out and bring this form to your meetings with your prescribing practitioner.
13. Common Side Effects of ADHD Medications
The most common side effects of ADHD medications reported at my office include; mild increase in blood pressure and heart rate, appetite suppression, upset stomach, dry mouth, and headache. Most of these side effects improve or resolve over a several-day period when the medication is taken at a steady daily dose. Minimizing caffeine sometimes eliminates or reduces side effects. The adverse effects of medications are reversible. Regular monitoring of pulse and blood pressure is recommended. For more information about medication side effects, see the links in the previous section.
14. Importance of taking medication "daily" rather than "as needed"
​Psychostimulants only work on the day that you take them. For most adults, the difficulties they experience from ADHD effect them during weekdays, evenings, and on weekends. For example, adults with ADHD are 2 to 4 times more likely to be involved in a motor vehicle accident… when they are not on medications. Their risk of motor vehicle accidents returns to “normal” when properly medicated. Children often stop their psychostimulant medication during holidays and summer to help mitigate the side effects of stunted growth and decrease in weight. These are rarely an issue for adults.
15. Developing "Tolerance" to psychostimulant Medication
​Some people experience a “rejuvenating” effect when restarting psychostimulants after taking a break. A pattern of stopping and starting or escalating doses over time may reflect “tolerance” to the mood enhancing or energising side effects of the psychostimulants. Sometimes people confuse these side effects from the attention and behavioural control clinical effects. While the energetic side effects tend to be reduced over time, the improvement of sustained concentration is usually still there.
16. How to stop the adhd medication
​If you do have to stop your medications, please do so carefully. Some individuals experience withdrawal from psychostimulants when they are suddenly stopped, particularly if the dosages are high. Tapering the medication over 7 to 10 days will minimize or avoid withdrawal. Guanfacine XR and clonidine should not be abruptly stopped due to the risk of rapid increase in blood pressure.
17. addiction safety issues with psychostimulant medications
​Compared to typically developing individuals, people with ADHD have a two-fold risk for substance addiction. Although people commonly report subjective calming with cannabis and other improved symptoms, there is no evidence that cannabis is an effective treatment for ADHD or that it improves attention and productivity. In fact, there is evidence that cannabis can impair cognition and worsen motivation issues. Individuals with ADHD and a substance addiction are at highest risk for misusing their psychostimulant medication. Long acting psychostimulants and non-stimulants have the lowest abuse potential.
18. Using recreational substances while taking adhd medications
​The key here is “everything in moderation.” Alcohol, cocaine, crystal methamphetamine, and psychostimulants all increase heart rate and blood pressure. Psychostimulants are less effective when they are competing with other substances which interfere with their function. There are many reasons to curtail your substance use, such as addiction potential and worsening of mental and physical health, but if you do use these substances, it is best to only safely consume them later in the day, when the psychostimulant medication is less active.
BC Adult ADHD Diagnosis
Dr. Craig Emes, Psychiatrist
Office hours: 9am–4pm, Monday, Tuesday, Thursday, & Friday
Location: Online Virtually Across British Columbia
​Mailing address: #352 - 2223A Oak Bay Avenue, Victoria, BC, V8R 0A4
Phone: 250-381-6030  Fax: 250-381-6033
Email: [email protected]