ADD/ADHD and Fibromyalgia (FMS):
Where Is the Connection?
Glenda H.
Davis, MD, and Patricia Stephens, CNC
We will refer to
both ADHD and ADD as "ADD." We encourage you to:
1) forget any preconceived ideas about what ADD
is or isn’t; 2) read with an open mind; 3) seek
to learn all you can about adult ADD.
Two years ago we raised the question, "Is there
a connection [between ADD and FMS]?"(2). We
believe there is, since ADD and FMS: a) respond
to the same medications (stimulants), b) have
similar symptoms, c) run in the same families.
An ADD work-up typically evaluates emotional and
behavioral, but not physical, symptoms, whereas
an FMS work-up usually evaluates physical, but
not emotional or behavioral, symptoms. But when
ADD and FMS patients are asked the same
questions, the similarities between these two
conditions are more obvious.
NOTE:
There is no advantage for an ADD patient to seek
a FMS diagnosis, and there may be disadvantages.
Stimulants cannot legally be used to treat the
FMS. However, if a FMS patient meets ADD
criteria and obtains treatment for ADD, the FMS
symptoms improve as well.
The Connecting Link: Autonomic Nervous System
Dysfunction
ADD and FMS may actually be different
manifestations, at different ages, of a common
underlying
autonomic nervous system dysfunction.
ADD is usually
diagnosed in childhood; FMS is usually diagnosed
in adulthood. But many FMS adults struggle with
concentration all their lives, compensating,
often using lists and other reminders to help
them remember important things. Secretaries
often organize for executives with ADD. Some who
memorize easily perhaps excelled in school, but
never really learned the material. Others
performed at an above average level, but still
below their ability.
Thousands of letters responding to
www.add-fibromyalgia.com support our hypothesis
that ADD and FMS frequently coexist.
Compensating for ADD throughout life can be
stressful. Chronic stress eventually takes a
physical toll --peptic ulcers, irritable bowel
syndrome, headaches, muscle aches, fatigue, and
other commonly associated FMS symptoms. Dr.
Daniel Amen expresses the same view in his book
Healing ADD.
"Fibromyalgia and
ADD commonly coexist. I think the chronic stress
associated with ADD is in part responsible for
the muscle pain"(1).
Autonomic Dysfunction Disorder = the real ADD?
The common denominator for ADD and FMS may be
autonomic nervous system (ANS)
dysfunction. The
ANS is composed of the sympathetic ("fight or
flight"), parasympathetic ("rest and digest"),
endocrine (hormones), and enteric (gut) nervous
systems. When these systems are balanced, the
body is healthy. When they are unbalanced, the
body is not. Since the ANS affects every organ
system in the body, it is not surprising that
the symptoms associated with ADD and FMS are so
varied. It may show up in several members of one
family, in several different presentations.
In general, with increased sympathetic nervous
system tone, the person is geared up --"hyper"--
and has difficulty relaxing; with increased
parasympathetic nervous system tone, the person
appears "lazy" or "sluggish." But the systems
are interrelated in complex ways, with
innumerable possible variations. An excellent
book on the many presentations of adult ADD is
DRIVEN TO DISTRACTION
by Drs. Hallowell
and Ratey.
Symptoms common to both ADD and FMS
· Low stress tolerance
· Concentration or memory problems
· Mood swings, depression, anxiety
· Poor organizational skills
· Low energy
· Difficulty relaxing
· Sleep disturbances
· Poor regulation of body temperature
· Skin rashes, itching
· Urinary frequency
· Reflux, gastritis, ulcers, constipation or
diarrhea
· Aches and pains
· Low or high blood pressure
· Yeast or fungal infections
· Allergies, asthma, bronchitis, sinusitis
· Sexual over- or under-arousal
· Numbness and tingling (carpal tunnel symptoms,
legs "going to sleep," etc.)
· Heart-related symptoms (chest tightness,
palpitations, etc )
· Poor coordination, other gross motor skills
· Poor handwriting, other fine motor skills
· Impulsive eating or spending
How Do the Stimulants Work?
Stimulants seem to act by increasing levels of
dopamine and norepinephrine
at neuronal
synapses. Based on our observations, they also
stimulate the adrenal glands to produce more
cortisol.
When on a stimulant for ADD, a person’s immune
system works better--less asthma, allergies,
infections, and skin rashes.
The right dose of the right medication
(stimulant) for ADD/FMS (ADD with FMS) is the
least amount that produces maximal benefits with
NO side effects.
See
www.add-fibromyalgia.com for specifics on
regulating medications.
When a woman with ADD/FMS is on
the right dose of the right medication,
it is like turning
on the light in a previously dark room. The
difference is amazing! But if a person has
always lived with what we call "ADD" (with the
attention deficit being only a small part of the
picture), she thinks nothing is wrong. She has
always been that way. And since he is like other
family members, problems are minimized, because
"it runs in the family." We gauge "normal" in
relation to ourself and our family. That is why
it is sometimes a challenge to convince an
individual with ADD to consider treatment, even
when problems are obvious to others. If the
person could ever experience "normal" (whatever
that is), then he could make a better-informed
decision as to whether he prefers to be treated
or not.
No problem with addiction
to stimulants has
been observed, even in people with a history of
drug abuse. If an individual has a history of
drug abuse, we monitor them closely, but no
habituation has been noted. That is, once we
find the optimal dose, it continues to work
indefinitely without any need to increase
dosage. If a patient takes other medicines,
especially pain medicine, they are often able to
reduce the dosage of these other medicines.
The stimulant dose needed sometimes varies with
hormonal fluctuations
and with
increased or decreased stress
levels. During
those times, we recommend adjusting the dose
slightly as needed (with the doctor’s
permission), up or down, depending on how your
system works. If your maintenance dose begins
causing side effects, it may mean you need to
cut back. At times of major hormonal upheavals,
such as puberty, pregnancy, childbirth, and
menopause, permanent adjustments may have to be
made, either up or down. They should be made
slowly, based on response. Some women need
hormone replacement for the stimulant to be most
effective. Other women do not need hormonal
supplementation and do well in menopause taking
only the stimulant.
Herbal Supplements and Treatment of ADD/FMS
Herbal supplementation is valid in the treatment
of ADD/FMS. But the stimulants are much easier
to regulate initially if there are
no supplements
on board. The more supplements on board,
the more difficult it is to regulate the
stimulant. If you anticipate getting an ADD
work-up, stop all the supplements you can before
going to the doctor. If you must take
supplements while beginning a stimulant, take
the supplements faithfully, not intermittently.
If you change what you take from day to day, it
becomes nearly impossible to know which
medication or supplement is causing a particular
effect.
Once you have attained better clarity of mind,
better physical well-being, and better
organizational ability, you may want to tackle
the herbal route. But initially the stimulants
are much easier to use to attain quality of
life. If you cannot find a physician, or prefer
to use herbals, or stimulants do not agree with
you, herbals are an option. See our web site (www.add-fibromyalgia.com)
for details.
Important points to remember:
Be patient.
It takes some detective work to find the right
dose, but it is worth the effort. The stimulant
may have to be used with an antidepressant or
another medication. What works for one woman
will not necessarily work for another. You were
created as a unique human being.
Be perceptive.
If you have side
effects with the stimulant, notice what they
are, what time they occur, and when you took
your last dose. It may be a side effect of the
medication, or it may be time for another dose.
Report all this information to your physician or
coach, so they can help you adjust the dose or
the timing.
Be persistent.
Never give up! You
may not feel significantly better until you are
near the right dose. We start with small doses
to minimize side effects, so it may take a while
to titrate to your right dose. But there is a
better life available. Keep studying and
pursuing answers until you have them.
Be pro-active.
Share your
successes with others. Once you find your right
combination, help others find theirs. Talk with
people who can change laws to allow freedom in
prescribing stimulants for those who need them.
Encourage others to seek treatment if needed. Be
willing to tell them your experience.
References:
1. Amen, D (2001).Healing ADD. Putman's Sons
Publishing Co., pp. 261-262.
2. Davis,
GH. (2000). "ADD/ADHD and Fibromyalgia: Is
There a Connection?" ADDvance Magazine, Jan/Feb,
pp. 13-16.
3. Krause KH, Krause J, Magyarosy I, et
al.(1998). "Fibromyalgia Syndrome and Attention
Deficit Hyperactivity Disorder: Is there a
comorbidity and are there consequences for the
therapy of Fibromyalgia Syndrome?" The Journal
of Muscoloskeletal Pain, 6, pp.111-116.
4. Stephens, P. (Jan/Feb, 2000). "Fibromyalgia
Responds to Attention Deficit Disorder
Medications," ADDvance Magazine, p. 17.
(The following article was published in ADDvance
On-Line Magazine August 2002.)
