Safe Medicine Patch Disposal Some medicines come in patches that you attach to your skin. Examples include: NicoDerm CQ (nicotine), used to quit smoking; Climara (estradiol), used to treat symptoms of menopause; Duragesic (fentanyl), used to relieve serious, long-term pain.Patches are designed to give a constant amount of medicine over a. He had more of an ADD type issue. He said it may be worthwhile to slap a lowest dose Nicotine patch on him over a weekend and see how he responds. Just wondering if anyone has tried Nicotine patches and if so, what was the response for tics and or attention/focusing. Were you able to continue it long term? Thanks for any replies:).
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Sir: Focusing and memory ability are dysfunctional in attention-deficit/hyperactivity disorder (ADHD), which commonly co-occurs with depression and anxiety. Treatment with methyl-phenidate or amphetamine frequently corrects inattentiveness and memory impairment, but is less reliable in the alleviation of the accompanying depression and anxiety. These medicines have depression and anxiety as reported side effects. In addition to the involvement of dopaminergic and noradrenergic neurons, there is evidence to suggest that cholinergic neurons are involved in the biobehavior associated with ADHD.Nicotine-dependent individuals experience more inattentiveness, forgetfulness, depression, and anxiety during withdrawal, and nicotine replacement is thought to reverse withdrawal-induced focusing and memory impairment, depression, and anxiety. Changes in focus and memory ability, associated with nicotine dependence and replacement treatment, are directly mediated by nicotinic-cholinergic neurons, and depression and anxiety are thought to be indirectly mediated by pathways between nicotinic-cholinergic receptors and dopaminergic, nor-adrenergic, serotonergic, and gabaminergic neurons.The following report illustrates a case of adult ADHD associated with depression and anxiety that responded to transdermal nicotine patches. Case reportMr.
A, a 43-year-old white man, was self-referred in June 2006 for an ADHD evaluation. Although he had symptoms of depression and anxiety, he only fulfilled DSM-IV-TR criteria for ADHD. A had been taking metoprolol (50 mg daily) for mild hypertension for several years, and after evaluation in our facility in 2006, he began medication trials with amphetamine mixed salts (10 mg 3 times daily), methyl-phenidate (36 mg), and bupropion (150 mg). He experienced marked irritability; each stimulant needed to be discontinued within a couple of days, and the bupropion was stopped within 3 weeks of starting. A then began a trial using the 7 mg trans-dermal nicotine patch from 7 a.m. On Monday through Friday, and on weekends as needed. He developed mild chest discomfort at around noon of the first treatment day.
A was instructed to remove the patch and begin again the following morning using the equivalent of a 3.5 mg transdermal patch. This was crafted by partially peeling the foil backing and cutting the foil in half with scissors, being certain not to cut or disturb the patch's delivery system in any way. (Caution: the manufacturer does not endorse this technique, and dosing may be inconsistent from day-to-day.) In this way, Mr. A applied a half-exposed 7 mg patch—about 3.5 mg—from 7 a.m.
On alternate mornings. A fully exposed patch was to be applied on the following day. A's ADHD symptoms, which mainly consisted of inattentiveness and poor reading comprehension, completely resolved within an hour of starting approximately 3.5 mg of nicotine from the transdermal patch, as did his depressive and anxious symptoms.
Problems with inattentiveness, reading comprehension, depression, and anxiety partially returned (about 30%) after the patch was removed each day. He continued to respond for about 1 year as long as the patch was applied, without the need to increase the transdermal dose. His blood pressure remained stable throughout, and although Mr. A is a recovering cigarette smoker with over 10 years clean, use of the transdermal patch has not led to cigarette relapse. He continues to report fewer thoughts and cravings to pick up “just one” cigarette as compared to his prepatch thought and craving frequency.This case report neither rules out the placebo effect, nor does it prove that transdermal nicotine is useful in managing adult ADHD with depression and anxiety.
However, it does suggest that the beneficial effect of transdermal nicotine may be attributed to biobehavioral pathways common to chronic nicotine withdrawal and ADHD with depression and anxiety. Nicotine agonists and delivery systems may be new treatments for adult ADHD.
Larger well-designed studies are warranted to evaluate the therapeutic potential of nicotine delivery systems in otherwise medically stable adults with ADHD accompanied by depression and anxiety. Further exploration of the nicotinic-cholinergic system may also expand our understanding of the neuropsychiatry underlying ADHD. Hervey AS, Epstein JN, Curry JF. Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review.
2004 Jul; 18(3):485–503. Kunwar A, Dewan M, Faraone SV. Treating common psychiatric disorders associated with attention-deficit/hyperactivity disorder. Expert Opin Pharmacother. 2007 Apr; 8(5):555–562. Rowe DL, Hermens DF.
Attention-deficit/hyperactivity disorder: neurophysiology, information processing, arousal and drug development. Expert Rev Neurother. 2006 Nov; 6(11):1721–1734. Heishman SJ. Behavioral and cognitive effects of smoking: relationship to nicotine addiction. Nicotine Tob Res. 1999 1suppl 2.
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S143–S147.discussion S165–S166. Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Syst Rev. 2007 Jan; 1:CD000031. Balbani AP, Montovani JC.
Methods for smoking cessation and treatment of nicotine dependence. Rev Bras Otorrinolaringol (Engl Ed) 2005 Nov–Dec; 71(6):820–827.
Rosecrans JA. The biobehavioral effects of nicotine: interaction with brain neurochemical systems. In: Cocores JA, ed. The Clinical Management of Nicotine Dependence. New York, NY: Springer-Verlag.
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