Ritalin gets all the headlines as the drug for the treatment, or overtreatment, of ADHD, but it is no longer the market force it once was. Sales have fallen, from $260 million in 1998 to $54 million last year. Those sales have been more than made up for by newer ADHD drugs. The top three are powerful stimulants: Alza's Concerta, Shire's Adderall and Cephalon's Provigil. They're followed closely by Strattera, Eli Lilly's new pill that was the first nonstimulant approved for adult use by the Food & Drug Administration. Strattera has captured 13 percent of the market since its debut in January.
ADHD's causes are still being determined, but they are likely genetic. A link has been found between ADHD and faulty regulation of dopamine, a brain neurotransmitter regulating movement and emotional response. Low dopamine activity may cause undiagnosed ADHD sufferers to self-medicate, first with sugar in childhood, then with caffeine, cigarettes or cocaine — whatever helps them focus. Stimulants such as Concerta and Adderall keep dopamine in the brain synapses longer, but these pills can be addictive. Strattera takes a slightly different approach:preventing the reuptake of norepinephrine, another neurotransmitter in the brain.
Like depression or anxiety, ADHD is often a closet sickness. Deborah Hoyt told her employers only recently, after 10 years on the job. Most big companies, like Ford Motor, have tucked confidential counseling for their employees with ADHD into their employee-assistance programs.
For others, a cottage industry of some 1,000 ADHD coaches has sprung up in response. Coaches are something like long-distance pseudotherapists who understand the ADHD mind. Phone sessions cost between $50 and $400 an hour but aren't covered by insurance. No standards or guidelines yet exist for coaches to live up to, and the coaching process can last for weeks or months. David Giwerc, a former Young & Rubicam marketing director, was diagnosed with ADHD in 1994 while training as an executive coach. He tells clients to find work that gets them moving around, to guard against the tendency to reply to every last e-mail or voice mail, and, as he does, squeeze a grip ball to stop from interrupting people on the phone.
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