Grandma’s Little Helper

05.08.14

Take ADHD Drugs to Treat Menopause?

Along with hot flashes and mood swings, up to two-thirds of menopausal women report suffering from “brain fog,” a frustrating condition marked by forgetfulness and an inability to concentrate. Now, a new therapy might have these women filling up the same prescriptions as their hyperactive grandchildren.

Stimulants traditionally used to treat ADHD in children could also be used to treat several cognitive and mood complaints in menopausal women, according to new research from the University of Pennsylvania. Dr. C. Neil Epperson, director of the Penn Center for Women’s Behavioral Wellness, presented the findings of an unpublished study during the American Psychiatric Association’s annual meeting. The research shows that the drug lisdexamfetamine (PDF) (LDX)—the third-most popular ADHD medication, similar to Adderall but with a lower potential for abuse—can aid post-menopausal women by improving attention and concentration, organization, and memory.

Epperson, a clinician, tells The Daily Beast that she began her research after noticing that more women were coming to her practice with worries about the early onset of dementia. As it turned out, their problems with memory, concentration and ability to focus at work usually weren’t actual dementia, but side effects of low estrogen levels associated with menopause.

Most menopausal women are treated with hormones but they aren’t effective for all women and aren’t even an option for those with certain medical conditions. That’s where Epperson says stimulants might be able to step in.

“[Estrogen’s] decline during the menopausal years, we believe, can play a role in the simultaneous decline in executive function that many women experience during the menopause transition. More specifically, estrogen plays a role in dopamine levels and the brain’s normal dopaminergic tone. We theorize that this process can result in symptoms similar to those experienced by people with attention deficit hyperactivity disorder,” Epperson said in statement released before the presentation.

Stimulants have historically been used to treat those women who failed to meet certain societal expectations.

Epperson conducted the double-blind crossover study of 32 “successful” women (participants had an average of 16 years of education and an IQ of 113) between the ages of 48 and 60 with no history of ADHD, who reported diminished ability to focus and multi-task in their early post-menopausal years. Over four weeks, half of the women were given LDX and the other half a placebo, then measured on self-reports of functioning in five areas: organization and motivation for work; concentration and attention; alertness, effort and processing speed; managing affective interference (letting emotions inhibit performance); and working memory and recall. The women who received LDX treatment, the preliminary evidence shows, had a significant reduction in the severity of all symptoms but one (the over-attention to emotion, which wasn’t a major complaint to begin with), but especially in the domain of organization and motivation for work. The women with the most severe symptoms experienced the most striking improvement; still others showed no improvement al all.

Though Epperson says this is the first study to link ADHD treatment for the ADHD-like symptoms of menopause, stimulants have historically been used to treat those women who failed to meet certain societal expectations, and despite their initial effectiveness, some experts warn against a return to potential overprescription.

“When I hear about this type of approach—taking common life changes where one might feel a little more distractible, or having trouble with memory when one gets older—and applying amphetamines, it makes me have a flashback,” Pieter Cohen, an assistant professor of medicine at Harvard Medical School, tells The Daily Beast.

“When amphetamines were introduced, it was to help stay-at-home women who were feeling down about themselves and their lives,” Cohen says.

As Cohen recounts and Nicolas Rasmussen details in his book On Speed: The Many Lives of Amphetamine, since their initial release in 1937, amphetamines have been used to improve the performance of American soldiers in WWII, stave off depression and weight gain in 1950s housewives, and eventually to treat narcolepsy and Hyperkinetic Reaction of Childhood (or ADHD as we now know it).

Pharmaceutical companies pushed these drugs—promising to put the pep back in your step—but prescriptions fell after the addictive potential of the stimulants became clear, and they were added to the Drug Enforcement Administration’s list of “controlled substances” as a Schedule II, meaning they have a high potential for abuse and dependence.

“Once you stop taking it you feel like something’s missing,” Cohen says.“It might not be an addiction where you’re racing around trying to find your next hit, but it can cause dependence, and in some cases, addiction.”

As for the UPenn study, though it hasn’t been released yet, Cohen is dubious.

“It’s absurd to draw any conclusions from a few dozen women who self-report being more productive after taking speed. That’s what this drug does, it makes people feel better, so of course your self-assessment of your capabilities would increase,” he says.

Epperson also suggested caution in her presentation: “This is with only four weeks of treatment. We don’t know what would happen if they took this for a longer period of time,” she said.

The prescription of stimulants would also be inappropriate for women with hypertension (stimulants can increase blood pressure, heart rate, and body temperature) or a history of addiction, Epperson told The Daily Beast. She also noted that LDX maker, Shire—a company that has provided grant and/or research support, according to her disclosure—said the study wasn’t large enough to say the drug is a suitable treatment for all menopausal women, just these menopausal women in the study.