I am an advocate who works with students who have attention deficit disorder. One of my new students is 16 y/o. After starting a stimulant for the ADD, he started having chest pain and was subsequently diagnosed with LQT. Of course, stimulants were stopped immediately and a beta-blocker started. One of our current problems that I don't see addressed on the internet is the impact beta-blockers have on "learning." He is already struggling with the ability to pay attention, but with the addition of the beta-blocker, he is having trouble staying awake during the school-day. He is now failing nearly all his classes. I want to help the student, his teachers and his parents find ways to keep him alert without causing added stressors. What do school-age children/teens do when the meds cause such severe drowsiness that it interfers with learning? To my knowledge, other than the chest pain after starting stimulant meds, he has had no other symptoms. AND, as a teen striving to fit in with his peers, he is "sneaking" drinks such as "Red Bull." Clearly this behavior can be lethal, but his teenage brain is saying something like, "at least i'm not drinking alcohol...it's just caffeine." Nothing I've said, or his parents seems to break through this wall of denial. Does anyone have any advise that has worked with teens before so that they can see the danger of their ways?
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Dealing with side effects of beta-blockers
11 replies
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- By DrD11
- Posted November 9, 2008 at 8:31 am
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Hello Laylabug
Having read you commentary,I share your ideas and
feelings.
Being a retired physician,post C.A.B(Courtesy of my profession),I know the feeling in taking B-Blockers.
First and most crucial approach in handling a disease
is lifestyle modification.I can not empasize more the
importance of "No Bull"(no red bull-no caffein).
This is for you nearly:"mission impossible",in the
current lifestyle of the 21st. century of the American
society. The less medication you take,the better.
Still we must take medications to save lives.
We need to find a medication with least side effects.
In the class of B-Blockers,find the one that has the
minimal or no "Blood Brain Barrier"crossing properties.
Watching you dear one and preventing future tragic events is our daily duty.
Tools have been developed for this purpose and are available.Check with you doctor about the recent deveopments.
As for myself,I am developing such a tool,trying academia to get involved.
- By dmwillden
- Posted November 10, 2008 at 11:09 am
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Dear Ladybug,
I understand completely what you are struggling with. My oldest (16 year old girl) has servere ADD and my next oldest (14 year old boy) has LQT. We have been struggling for years to find a suitable treatment for my 16 year old only to give up on the popular medication(Stratera and Retalin) because of the side affects. Incidentally, she's also been into the "Monster" drinks and coffee which we don't have it in the house, but she gets it at school! For the LQT, my son has been on Atteral (which is supposed to have the leaste side affects/ resistant to crossing the blood brain barrier), however, it still caused depression and agression. We switched to Nadal, which initially seemed to have no side effects, but the longer he was on it, the more he changed. It was almost imperceptable because it was so gradual. He was always a straight A student, but he started to fall behind in school and almost failed one of his classes. He said it was very hard to pay attention. He also became very depressed. He stopped taking it without us knowing because he was so miserable, and we realized we couldn't make him keep taking it. (luckily, Nadal leaves your system so gradually that it didn't put him in danger). We could see the old him start to return soon after he stopped. We are currently pursuing (with our doctors approval) some research-based alternative interventions that I can share with you if you are interested in details.
As far as the ADD--we have also found some alternatives that may at leaste help that part of the problem, and may even help the LQT a bit as well. A vitamin supplement called "Reliv", and an amino acid supplement called "Attend" made a difference. She didn't like the taste of the reliv, though, so it was hard to be consistant (there's also other vitimin products that may be as effective). Also, there's a homeopathic products by Univera called "ageless" that she said gave her the "caffein-like" attention, without the negative side-affects. I don't know if it would be a good choice for a LQT person, but you could check it out.
Our latest discovery for ADD is someting we are currently in the middle of and it's very exciting to see the progress. It's a neuro-feedback training program that helps the brain build it's neuro-networks. It also decreases anxiety which is important for LQT. It's called "Brain State Conditioning". You can look it up on the web.
Good luck!
- By Laylabug
- Posted November 10, 2008 at 7:11 pm
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Hello DrD11,
Thank you so much for replying to my inquiries. By way of profession, I am a RN and specialize in the field of ADD/ADHD.
I appreciate the reinforcement of the need for lifestyle changes and the no caffeine, NO "RED BULL" warning. Also, I will do some research on beta blockers that do not cross the blood brain barrier. All good advice. Thank you.
I'd be interested in learning more about tools used to help patients understand how to live with LQTS, esp. with a co-existing condition, such as ADD/ADHD.
- By Laylabug
- Posted November 10, 2008 at 7:35 pm
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Hello dmwillden,
Thank you for your reply. So Strattera didn't work either? Did it also increase heart rate? I am surprised that you did not metion Adderall increasing the heart rate, as well. Interesting.
Often, alternative treatments are supported by anticdotal information. I am an advocate for scientific research-based treatment and always interested in learning more about the potential for furture treatment options. I am very interested in learning more about what you have learned in your effort to pursue alternative treatment. I am familiar with amino acid supplements and neuro-feedback, but I am not familiar with Univera. I will do some research. Thank you very much for taking the time to respond and for the suggestions!
BTW, my client's parents do not keep caffeine in the house, either. His grandmother has been providing the Red Bull for him after school because, "a little won't hurt anything."
- By dmwillden
- Posted November 11, 2008 at 11:43 am
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Hello laylabug,
To answer your questions: Strattera caused significant depression after only a week on it. We haven't tried Adderall because she has addictive tendencies and it is a highly addictive substance. It's a form of amphetamine I believe, and does effect your heart. We had her genetically tested for LQT and she was negative, however, so that is still a possibility we are looking at if the Brain State Conditioning (BSC) doesn't work. I have been very impressed with the results of the BSC training so far, by the way. It's improved her sleep and her anxiety, impulsivity and mood in general already in only 6 sessions. I was drawn to the research on bio-feedback when we first discovered her ADD. They describe BSC as specifically "neuro-feedback" and call it a "quantum leap forward" from regular bio-feedback. However it is expensive! We just finally took the plunge because we were finally desperate enough (she's failing 3 classes, may not graduate on time, and is becoming increasingly defiant).
About the alternative LQT treatments:
I've been looking up research in specific areas and actually contacting the researchers themselves (all over the world) to ask questions and learn more. Here's what I have found for LQT type 2 (our type)--
There are two main components that increase risk for a heart episode--the QT interval, and the bodies adrenal response to his/her circumstances. The beta blockers address the addrenal response by blocking the bodies adrenal signal to the heart. With LQT type 2, however, that also increases the QT interval so the beta blocker's effectiveness is controversial and could actually increase risk. That's one reason we felt justified in taking our son off of them.
QT interval is effected by the following:
1. In LQT2 specifically-- low potassium levels increase the interval (electrolytes in general are key--magnesium is especially important as it helps in absorbing the potasium.)
2. DHA from Omega-3 (Also Vit B is necessary for the body to break down Omega-3 into the DHA)
3. In the early morning hours (4:00-ish) the QT interval is the longest (for LQT2)
4. Immediately after excercise it's longest (for LQT2)
5. Insulin/glucose levels may also affect it
Factors that increase the body's adrenal response include (Which seem to be inherent with ADD)
1. Lack of sleep
2. Anxiety/Stress
3. Low blood sugar
4. Adrenaline evoking activities (depends on person's individual "excitement level")
5. Swimming (water temp shock)
I have also found some research that indicates that moderate, regular endurance-type training seems to decrease the QT interval (specifically in type 1 LQT). This could be due to greater efficiency in the polorization of the heart because of it's increased "vagal tone". I'm still trying to find out more to see if it could apply to LQT2 as well.
I hope some of this helps!
- By DrD11
- Posted November 11, 2008 at 12:39 pm
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Hello.
Your provided information is interesting and challenging.
Like you,I got interested in this subject,for personal reasons.I find it far more complicated than what I thought initialy.
Realizing that you are involved in this subject,I am
interested in colaboration.
In the past 2 years,I found some ideas,of value.
My attempts to get collaboration from academia,
resulted in certain frustration.(Retired,remember?)
This did not bring me to "give up".
I already published an article.I invented a tool.
I submitted articles(Rejected).
As for your querry,about the tool,I can not detail you at this stage.I can advise you about existance of tools
in the medical field under Telemedicine.One of them is in Germany,named:"Vita Phone".(Check with your
Cardiologist).
As for your research on the metabolic aspects of this
disorder,I urge you to look at Vitamin B3(The orpahn
medicine to so many non orphan disease).
Today when all celebrate the L.D.L.,only very few
remember the H.D.L.(They do not even remember that this is the Good colesterol ,and why?)
- By dmwillden
- Posted November 11, 2008 at 1:19 pm
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DrD11
Were you responding to my post?
- By Laylabug
- Posted November 12, 2008 at 10:58 am
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Hello dmwillden,
Thank you for clarifying the ADD medication issue.
I have heard good things about the neuro-feedback. But I also know it is expensive and, from what I understand, the benefits often do not last after stopping the treatments. This is a major block to many who seek alternative treatment. There could be new research to support otherwise...I look forward to the day.
The additional information you have provided is very helpful. I really appreciate your insight.
Thank you!
- By dmwillden
- Posted November 12, 2008 at 1:04 pm
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Laylabug,
I understand that with this particular technology, some of the benefits can wear off over time, but others remain indefinately. They boast of an 85% success rate in general (all disorders), but I'm not sure about the ADD success rate specifically. As far as the price, it is costing us $150 per session, but insurance may help cover for some. They recomend 10-30 sessions, depending on your progress. If you weigh that cost with the 85% chance of success without any harmful side effects, (and with some unexpected side benefits) it's worth looking into. Here's their web site if you are interested in looking at the research: brainstatetech.com. Be sure to watch the videos Amazing stuff!
I'm glad I could be of help! Good luck and God bless you for your amazing dedication and concern for this special student.
- By Laylabug
- Posted November 12, 2008 at 6:46 pm
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DrD11,
Oh my gosh. You cannot imagine how often I am asking clients to take a step back and look at their daily nutrition and sleep patterns. It is something in the health profession that we KNOW is important, but after reading your message...I think I'm the last one who should be giving advice about nutrition.
I did as you suggested and looked into vit. B3. It is amazing to me that we can get caught in the wave of life and get so far away from taking care of ourselves.
I am going to do a bit more research so that I am able to offer better advice.
I was not familiar with Telemedicine, however, it sounds similar to the way I often must work with families who do not have access to local professionals with experience in the field of ADD/ADHD. It is definitely better than no assistance at all.
Thank you for communicating and advising. I appreciate it.
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