The overall incidence of eating disorders among teenage girls is low, but those who develop them are at high risk for other emotional problems that linger into early adulthood.

That is the conclusion of a new study by the Oregon Research Institute in Eugene and published in the Journal of the American Academy of Adolescent Psychiatry. It finds a much higher percentage of those with symptoms of bulimia, symptoms of anorexia, and partial versions of those diseases also suffer with more depression, anxiety disorders, and substance abuse problems than the general teen population.

"The whole study is based on a large cohort of high school students we recruited in the 1980s, and we've been following them ever since," says study author Peter M. Lewinsohn, PhD, senior research scientist and professor emeritus in psychology at the University of Oregon in Eugene.

For this study, the students were examined twice during adolescence and once in their 24th year. Lewinsohn says that the number of males with eating disorders in this study was so small that the researchers only looked at the problem in girls.

The study found that kids with eating disorders were twice as likely to have a psychological problem as a group of "no-eating-disorder" kids -- and that rate was approaching 90%. And among the kids with eating disorders, more than 70% of them continued to have psychological problems at age 24.

"I think an eating disorder needs to be understood in the context of a lot of other problems," Lewinsohn says. "It doesn't seem it occurs by itself. We would like to have looked at "pure" eating disorder people, but there weren't enough of them."

Lewinsohn suggests adolescent girls be routinely screened for eating disorders during physical examination -- especially if they are known to have a psychological disorder. Conversely, those kids with known eating disorders ought to be cross-checked for psychological problems, he says. "I think the pediatricians are the gatekeepers here, because they see everybody. They are in a very important position to identify these problems."

One eating disorders expert says it's hard to say whether all eating disorder patients have mental problems, as well. "I know with bulimia, many of the girls, if they develop it later, they view it as 'trying it' because their friends are doing it -- and are less likely to be psychologically impaired," says Elizabeth Carll, PhD, who has a private practice in Long Island, N.Y. "The earlier ones have a poorer prognosis."

As for screening teenage girls for eating disorders: "I think it's great," Carll says. "But most girls will not admit it. With anorexia, it's pretty obvious. But with bulimia, many of the girls are quite secretive. They may admit to being concerned with dieting -- which might be a risk factor if they're at a normal weight."

But "might" is the operative word there. Carll points out that about 75% of American women, if asked at any given time, would say they are on a diet -- when only about a third really need to be. "It's a condition both cultural and sociological," she says. "It's an obsession with thinness, and in our culture, an obsession with health and nutrition."

"It's different for every patient, but we know eating disorders have very little to do with food and eating," says Mae Sokol, MD, a child and adolescent psychiatrist with the Eating Disorders Program at the Menninger Clinic in Topeka, Kan. "It's not a coincidence that these things begin in adolescence when there's a search for identity."

She recommends pediatricians learn to ask the right questions to ferret out a possible eating disorder. If, for example, a teen shows up with an athletic injury, it would offer an opportunity to check for out-of-control exercising. Complaints of an upset stomach might reveal forced vomiting. Sokol suggests it's probably easier in the long run to catch an eating disorder during adolescence: "It is true that once they get to their 18th birthday they have more say over their fate. I'm a believer in involuntary treatment if that's all you can do. But it's easier when they're a child and their parents have a say."

As for that involuntary treatment, Sokol says she sometimes recommends parents of older teenagers (those considered by law to be adults) to ask a judge for medical guardianship -- which reduces the older teens to children in the eyes of the state.

"This behavior in severe form is very similar to suicide," she says. But with proper treatment -- including psychotherapy and nutritional monitoring -- there is hope. "I'm a firm believer there is life after an eating disorder. Some do get completely cured," she says. "Treatment is really important. It can make the difference between a chronic case and one that is cured."

next: The Five Greatest Motivators For Preschool Children to Eat Healthy Foods
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Suggestions to keep the Alzheimer's patient from wandering away.

The biggest fear that most caregivers have is how to prevent their loved one from leaving the house, unsupervised, and wandering away.

• Place locks on exit doors high or low on the door out of direct sight. Consider double locks that require a key. Keep a key for yourself and hide one near the door for emergency exit purposes.
• Use loosely fitting doorknob covers so that the cover turns instead of the actual knob. Due to the potential hazard they could cause if an emergency exit is needed, locked doors and doorknob covers should be used only when a caregiver is present.
• Install safety devices found in hardware stores to limit the distance that windows can be opened.
• If possible, secure the yard with fencing and a locked gate. Use door alarms such as loose bells above the door or devices that ring when the doorknob is touched or the door is opened. 
• Avoid medicating the person to prevent them from walking away. Doses that are sufficiently powerful to stop someone from 'wandering' can cause drowsiness, increase confusion and possibly cause incontinence.
• Some caregivers have found that placing a mirror in the hall, or fixing a bead curtain across the front door, can deter the person from leaving. However, this approach may be confusing or distressing for the person with Alzheimer's.
• Whenever possible, the patient should sleep on the lower level. Nighttime presents a variety of risks.

Limiting the Risks of Wandering Away with Alzheimer's

• Do not leave a person with Alzheimer's disease who has a history of wandering unattended.
• If the person is determined to leave, try not to confront them as this could be upsetting. Try to accompany them a little way and then divert their attention so that you both return.
• Make sure the person carries some form of identification or the name and phone number of someone who can be contacted if they get lost. You could sew this into a jacket or a handbag so that it is not easily removed. Obtain a medical identification bracelet for the person with AD with the words "memory loss" inscribed along with an emergency telephone number. Place the bracelet on the person's dominant hand to limit the possibility of removal, or solder the bracelet closed. Check with the local Alzheimer's Association about the Safe Return program.
• Tell local shopkeepers and neighbors about the person's Alzheimer's - they may offer to keep a look out.
• If the person is in day care, respite residential care or long term care, tell the staff about their walking habits and ask about the policy of the home.
• If the person does disappear, try not to panic.
• If you are unable to find them, tell the local police. Keep a recent photograph, to help the police identify them.
• When the person returns, try not to scold them or show them that you are worried. If they got lost, they may be feeling anxious themselves. Reassure them, and quickly get them back into a familiar routine.
• Once the situation is resolved, try to relax. Phone a family member or friend and talk about your feelings. Remember that this type of behavior is likely to be a phase.

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Safe Return Program

The Alzheimer's Association's Safe Return program is designed to help identify people who wander and return them to their caregiver. Caregivers who pay a $40 registration fee receive:

• An identification bracelet
• Name labels for clothing
• Identification cards for wallet or purse
• Registration in a national database with emergency contact information
• A 24-hour toll-free number to report someone who is lost

You can register someone by filling out a form online at the Alzheimer's Association's Web page or by calling (888) 572-8566.

Sources:

• National Institute on Aging, Home Safety for People with Alzheimer's Disease, Oct. 2007
• Wisconsin Bureau of Aging and Long Term Care Resources, Department of Health and Family Services, How to Succeed: Caregiving Strategies That Provide Answers for Common Behavior Themes, July 2003.

next: Helping Someone With Alzheimer's

Covers SAMe, a natural treatment of depression, Alzheimer's Disease, and fibromyalgia. Learn about the usage, dosage, side-effects of SAMe.

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

S-Adenosylmethionine (SAMe) is a naturally occurring compound that is involved in many biochemical processes in the body. SAMe plays a role in the immune system, maintains cell membranes, and helps produce and break down brain chemicals such as serotonin, melatonin, and dopamine as well as vitamin B12. SAMe also participates in the making of genetic material, known as DNA, and cartilage. Low amounts of folate (vitamin B9) in the body may lead to reduced levels of SAMe.

Numerous scientific studies indicate that SAMe may be useful in the treatment of depression, osteoarthritis, fibromyalgia, and liver disorders. Although it has been available in Europe by prescription for a number of years, SAMe was only recently introduced as a dietary supplement in the United States.

 

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SAM-e Uses

SAMe offers a variety of potential therapeutic uses, primarily in the treatment of the health conditions listed below. It is important to note that SAMe has not been tested carefully over long periods of time. For this reason, it is not yet known whether using SAMe for an extended length of time (months or years) is safe.

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SAM-e for depression
Preliminary research suggests that SAMe is more effective than placebo in treating mild to moderate depression and is just as effective as anti-depressant medications without the side affects frequently associated with the medications (headaches, sleeplessness and sexual dysfunction). Plus, antidepressants tend to take six to eight weeks to begin working, while SAMe seems to begin much more quickly than that.

More research regarding the safety and effectiveness of SAMe, especially for longer periods of time, is needed. It is not clear exactly how SAMe works to relieve depression, so it is best to avoid using SAMe together with other antidepressants. In addition, given the serious nature of this mood disorder, professional help should be sought for symptoms of depression before taking SAMe or any substance.

Osteoarthritis
Laboratory and animal studies suggest that SAMe may reduce pain and inflammation in the joints as well as promote cartilage repair, but researchers are not clear about how or why this works. Clinical trials with people (although generally small in size and of short duration) have also shown favorable results for SAMe when used to relieve osteoarthritis symptoms. In several short-term studies (ranging from 4 to 12 weeks), SAMe supplements were as effective as NSAIDs (nonsteroidal anti-inflammatory drugs) in adults with knee, hip, or spine osteoarthritis. SAMe was equivalent to the medications in diminishing morning stiffness, decreasing pain, reducing swelling, improving range of motion, and increasing walking pace. Several of the studies also suggest that SAMe has fewer side effects than NSAIDs.

Fibromyalgia
From studies comparing SAMe to placebo, this supplement seems to improve pain, fatigue, morning stiffness, and mood in those with fibromyalgia.

Liver Disease
Results of several animal studies suggest that SAMe may be beneficial in treating various liver disorders, particularly liver damage caused by excessive alcohol consumption. Animal studies also suggest that SAMe may protect the liver from damage after acetaminophen overdose (a pain-relieving medication purchased without a prescription). A study of 123 men and women with alcoholic liver cirrhosis (liver failure) found that SAMe treatment for 2 years may improve survival rates and delay the need for liver transplants more effectively than placebo. Although the results of this study are encouraging, more clinical trials are needed to determine whether SAMe is safe and effective for the prevention and/or treatment of liver disease.

SAM-e for Alzheimer's Disease
Studies suggest that people with Alzheimer's Disease (AD) have low levels of SAMe in the brain and that supplementation can actually increase those levels. While it has been reported that some individuals with AD have improved cognitive function from SAMe supplementation, well-designed research studies are needed to determine whether this supplement is truly safe and effective for people with the disease.

Other
Although it is premature to tell if these are safe or appropriate uses for SAMe, some early research has looked at the relationship between SAMe and Parkinson's disease, migraine headaches, Sjogrens disorder (which causes pain in connective tissue), attention deficit/hyperactivity disorder (ADHD) in adults, and vascular disorders such as heart disease.

SAMe levels may be low in people with Parkinson's and heart disease. However, experiments in rats have indicated that SAMe supplements may actually cause Parkinson's disease in these animals.

Given SAMe's structure, some have raised concern about the potential for SAMe to increase homocysteine levels. (Homocysteine has been shown to contribute to the development of plaques in the blood vessels). However, early information suggests that SAMe may actually lower homocysteine. Research is needed to know whether taking SAMe supplements may reduce homocysteine and reduce one's chances of getting heart disease.

A preliminary study of 124 migraine sufferers suggests that SAMe may decrease the frequency, intensity, and duration of headaches as well as lead to an improved sense of well being and use of fewer pain killers.

 

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Dietary Sources for SAM-e

SAMe is not found in food. It is produced by the body from ATP and the amino acid methionine. (ATP serves as the cell's major energy source and drives a number of biological processes including muscle contraction and the production of protein).

 

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Available Forms of SAM-e

• S-adenosylmethionine butanedisulfonate
• S-adenosylmethionine disulfate ditosylate
• S-adenosylmethionine disulfate tosylate
• S-adenosylmethionine tosylate

It is important to purchase enteric-coated tablets packaged in foil or foil blister packs. SAMe should be stored in a cool, dry place, but not refrigerated. Tablets should be kept in the blister pack until the time of ingestion.

 

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How to Take SAM-e

Starting with a low dose (for example 200 mg per day) and increasing slowly helps avoid upset to the digestive system.

It is important to note that many of the studies evaluating SAMe for the conditions mentioned have tested injectable, not oral, forms of SAMe. Therefore, the reliability and effectiveness of oral SAMe is not entirely clear. Look for enteric-coated tablets as these are more stable and may be more dependable in terms of the amount of SAMe in the pill.

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Pediatric

There are no known scientific reports on the pediatric use of SAMe. Therefore, it is not currently recommended for children.

Adult

Recommended doses of SAMe vary depending on the health condition being treated. The following list provides guidelines for the most common uses:

• depression: The majority of studies have used between 800 and 1,600 mg of SAMe per day for depression. The daily dosage is typically split between morning and afternoon.
• Osteoarthritis: A dosage of 600 mg (200 mg three times per day) for the first two weeks and then 400 mg (200 mg twice per day) for another 22 weeks has shown improvement in symptoms of osteoarthritis. Another study demonstrated improvement using 1,200 mg (400 mg three times per day) for 30 days.
• Fibromyalgia: A dosage of 800 mg per day for six weeks was shown to improve symptoms.
• Alcoholic liver disease: 800-1,200 mg per day orally in divided doses for six months enhances liver function. For liver disease, SAMe should be administered with the supervision of a qualified health care provider. This is because SAMe is administered intravenously.

 

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Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

The safety of SAMe has not been fully assessed in children or women who are pregnant or nursing. For this reason, these groups of people should avoid SAMe. Side effects may include dry mouth, nausea, flatulence, diarrhea, headache, anxiety, a feeling of elation, restlessness, and insomnia. For this reason, SAMe should not be taken at night.

People with bipolar disorder (manic-depression) should not take SAMe since it may worsen manic episodes. SAMe should not be combined with different antidepressants without first consulting a health care provider.

People taking SAMe should supplement its use with a multivitamin that contains folic acid and vitamins B12 and B6.

 

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Possible Interactions

If you are currently being treated with any of the following medications, you should not use SAMe without first talking to your healthcare provider.

SAM-e and antidepressant medications
There have been reports of SAMe interacting with antidepressant medications and increasing the potential for side effects including headache, irregular or accelerated heart rate, anxiety, and restlessness. On the other hand, because it often takes up to six or eight weeks for antidepressant medications to start working, SAMe has been used with certain drugs to relieve symptoms more quickly. Consult your healthcare provider before using SAMe if you are taking any medications for depression.

 

Supporting Research

Abittan CS, Lieber CS. Alcoholic liver disease. Curr Treat Options Gastroenterol. 1999;2(1):72-80.

Anonymous. SAMe for depression. Med Lett Drugs Ther. 1999;41(1065):107-108.

Baldessarini RJ. Neuropharmacology of S-adenosyl-L-methionine. Am J Med. 1987;83(5A):95-103.

Bell KM, et al. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand Suppl. 1994;154:15-8.

Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of S-adeno-L-methionine in speeding the onset of action of imipramine. Psychiatry Res. 1992;44(3):257-262.

Bottiglieri T. Folate, vitamin B12, and neuropsychiatric disorders. Nutr Rev. 1996;54(12):382-390.

Bottiglieri T, Godfrey P, Flynn T, Carney MWP, Toone BK, Reynolds EH. Cerebrospinal fluid S-adenosylmethionine in depression and dementia: effects of treatment with parental and oral -adenosylmethione. J Neurol Neurosurg Psychiatry. 1990;53:1096-1098.

Bottiglieri T, Hyland K, Reynolds EH. The clinical potential of ademetionine (S-adenosylmethionine) in neurological disorders. Drugs. 1994;48(2):137-152.

Bradley JD, Flusser D, Katz BP, Schumacher HR, Jr., Brandt KD, Chambers MA, et al. A randomized, double blind, placebo controlled trial of intravenous loading with S-adenosylmethionine (SAM) followed by oral SAM therapy in patients with knee osteoarthritis. J Rheumatol. 1994;21(5):905-911.

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Bray GP, Tredger JM, Williams R. S-adenosylmethionine protects against acetaminophen hepatotoxicity in two mouse models. Hepatotol. 1992;15(2):297-301.

Bressa GM. S-adenosylmethionine (SAMe) as antidepressant: meta-analysis of clinical studies. Acta Neurol Scand Suppl. 1994;154:7-14.

Carney MW, et al. The switch mechanism and the bipolar/unipolar dichotomy. Br J Psychiatry. 1989;154:48-51.

Carney MW, Toone BK, Reynolds EH. S-adenosylmethionine and affective disorder. Am J Med. 1987;83(5A):104-106.

Chavez M. SAMe: S-Adenosylmethionine. Am J Health Syst Pharm. 2000;57(2):119-123.

Cheng H, Gomes-Trolin C, Aquilonius SM, et al. Levels of L-methionine S-adenosyltransferase activity in erythrocytes and concentrations of S-adenosylmethionine and S-adenosylhomocysteine in whole blood of patients with Parkinson's disease. Exp Neurol. 1997;145(2 Pt 1):580-585.

Cohen BM, et al. S-adenosyl-L-methionine in the treatment of Alzheimer's Disease. J Clin Psychopharmacol. 1988;8:43-47.

ConsumerLab.com. Product review: SAMe. 2000. Accessed at http://www.consumerlabs.com/results/same.asp on March 20, 2002.

Cooney CA, Wise CK, Poirer LA, Ali SF Methylamphetamine treatment affects blood and liver S-adenosylmethionine (Sam) in mice. Correlation with dopamine depletion in the striatum. Ann N Y Acad Sci. 1998;844:191-200.

di Pavoda C. S-adenosylmethionine in the treatment of osteoarthritis. Review of clinical studies. Am J Med. 1987;83(suppl 5A):60-65.

Fava M, Giannelli A, Rapisarda V, Patralia A, Guaraldi GP. Rapidity of onset of the antidepressant effect of parenteral S-adenosyl-L-methionine. Psych Res. 1995;56(3):295-297.

Fava M, Rosenbaum JF, MacLaughlin R, Falk WE, Pollack MH, Cohen LS, et al. Neuroendocrine effects of S-adenosyl-L-methionine, a novel putative antidepressant. J Psychiatric Res. 1990;24(2):177-184.

Fetrow CW, Avila JR. Efficacy of the dietary supplement S-adenosyl-L-methionine. Ann Pharmacother. 2001;35(11):1414-1425.

Fugh-Berman A, Cott JM. Dietary supplements and natural products as psychotherapeutic agents. Psychosom Med. 1999;61:712-728.

Gaby AR. Natural treatments for osteoarthritis. Alt Med Rev. 1999;4(5):330-341.

Gatto G, Caleri D, Michelacci S, Sicuteri F. Analgesizing effect of a methyl donor (S-adenosylmethionine) in migraine: an open clinical trial. Int J Clin Pharmacol Res. 1986;6:15-17.

Glorioso S, et al. Double-blind multicentre study of the activity of S-adenosylmethionine in hip and knee osteoarthritis. Int J Clin Pharmacol Res. 1985;5:39-49.

Iruela LM, Minguez L, Merino J, Monedero G. Toxic interaction of S-adenosylmethionine and clomipramine. Am J Psychiatry. 1993;150:3.

Jacobsen S, Danneskiold-Samsoe B, Andersen RB. Oral S-adenosylmethionine in primary fibromyalgia. Double-blind clinical evaluation. Scand J Rheumatol. 1991;20:294-302.

Konig B. A long term (two years) clinical trial with S-adenosylmethionine for the treatment of osteoarthritis. Am J Med. 1987;83(5A):89-94.

Laudanno GM. Cytoprotective effect of S-adenosylmethionine compared with that of misoprostol against ethanol-, aspirin-, and stress-induced gastric damage. Am J Med. 1987;83(5A):43-47.

Leventhal LJ. Management of fibromyalgia. Ann Intern Med. 1999;131:850-858.

Lieber CS. Hepatic, metabolic, and nutritional disorders of alcoholism: from pathogenesis to therapy. Crit Rev Clin Lab Sci. 2000;37(6):551-584.

Lieber CS. Role of oxidative stress and antioxidant therapy in alcoholic and nonalcoholic liver diseases. [Review]. Adv Pharmacol. 1997;38:601-628.

Loehrer FMT, Angst CP, Haefeli WE, et al. Low whole blood S-adenylmethionine and correlation between 5-methyltetrahydrofolate and homocysteine in coronary artery disease. Arterioscler Thromb Vasc Biol. 1996;16:727-733.

Loguercio C, Nardi G, Argenzio F, et al. Effect of S-adenosyl-L-methionine administration on red blood cell cysteine and glutathione levels in alcoholic patients with and without liver disease. Alcohol Alcohol. 1994;29(5):597-604.

Maccagno A, di Giorio EE, Caston OL, Sagasta CL. Double-blind controlled clinical trial of oral S-adenosylmethionine versus piroxicam in knee osteoarthritis. Am J Med. 1987;83(suppl 5A):72-77.

Mato JM, Camara J, Fernandez de Paz J. S-adenosylmethionine in alcoholic liver cirrhosis: a randomized, placebo-controlled, double-blind, multicenter clinical trial. J Hepatol. 1999;30:1081-1089.

Morelli V, Zoorob RJ. Alternative therapies: Part 1. depression, diabetes, obesity. Am Fam Phys. 2000;62(5):1051-1060

Morrison LD, Smith DD, Kish SJ. Brain S-adenosylmethione levels are severely decreased in Alzheimer's Disease. J Neurochem. 1996;67:1328-1331.

Mueller-Fassbender H. Double-blind clinical trial of s-adenosylmethionine versus ibuprofen in the treatment of osteoarthritis. Am J Med. 1987;83(suppl 5A):81-83.

SAMe for depression. Med Letter. 1999;41(1065):107-108.

Shekim WO, Antun F, Hanna GL, McCracken JT, Hess EB. S-adenosyl-L-methionine (SAM) in adults with attention deficit/hyperactivity disorder (ADHD): preliminary results from an open trial. Psychopharmacol Bull. 1990;26(2):249-253.

Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease. 9th ed. Media, Pa: Williams & Wilkins; 1999.

Tavoni A, Vitali C, Bombardieri S, Pasero G. Evaluation of S-adenosylmethionine in primary fibromyalgia. A double-blind crossover study. Am J Med. 1987 Nov 20;83(5A):107-110.

Vendemiale G, et al. Effects of oral S-adenosylmethionine on hepatic glutathione in patients with liver disease. Scand J Gastroenterol. 1989;24:407-415.

Vetter G. Double-blind comparative clinical trial with S-adenosylmethionine and indomethacin in the treatment of osteoarthritis. Am J Med. 1987;83(suppl 5A):78-80.

Young SN. The use of diet and dietary components in the study of factors controlling affect in humans: a review. J Psychiatr Neurosci. 1993;18(5):235-244.

 

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The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

Comprehensive information on potassium mineral supplements. Learn about the usage, dosage, side-effects of potassium.

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Potassium is a mineral that helps the kidneys function normally. It also plays a key role in cardiac, skeletal, and smooth muscle contraction, making it an important nutrient for normal heart, digestive, and muscular function. A diet high in potassium from fruits, vegetables, and legumes is generally recommended for optimum heart health.

Having too much potassium in the blood is called hyperkalemia and having too little in the blood is known as hypokalemia. Proper balance of potassium in the body depends on sodium. Therefore, excessive use of sodium may deplete the body's stores of potassium. Other conditions that can cause potassium deficiency include diarrhea, vomiting, excessive sweating, malnutrition, and use of diuretics. In addition, coffee and alcohol can increase the amount of potassium excreted in the urine. Adequate amounts of magnesium are also needed to maintain normal levels of potassium.

For most people, a healthy diet rich in vegetables and fruits provides all of the potassium needed. The elderly are at high risk for developing hyperkalemia due to decreased kidney function that often occurs as one ages. Older people should be careful when taking medication that may further affect potassium levels in the body, such as nonsteroidal anti-inflammatories (NSAIDs) and ACE inhibitors (see section on Interactions for additional information). Taking potassium supplements, at any age, should only be done under the guidance of a healthcare provider.

 

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Uses

Hypokalemia
The most important use of potassium is to treat the symptoms of hypokalemia, which include weakness, lack of energy, muscle cramps, stomach disturbances, an irregular heartbeat, and an abnormal EKG (electrocardiogram, a test that measures heart function). Treatment of this condition takes place under the guidance and direction of a physician.

Osteoporosis
High dietary intake of potassium from fruits and vegetables throughout one's life helps to preserve bone mass thereby preventing bone loss that can lead to osteoporosis.

High Blood Pressure
Some studies have linked low dietary potassium intake with high blood pressure. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends adequate amounts of potassium in the diet, along with other measures such as dietary calcium and weight loss, to prevent the development of high blood pressure. Similarly, the Dietary Approaches to Stop Hypertension (DASH) diet emphasizes eating foods rich in fruits, vegetables, and low- or non-fat dairy products to provide high intake of potassium, as well as magnesium and calcium.

While appropriate and adequate dietary intake is necessary for preventing or improving blood pressure, potassium supplements are probably not. Some animal and early human studies did suggest that potassium supplements could help to lower blood pressure. More recent well-designed studies, however, suggest that potassium supplements do not improve blood pressure significantly. Use of potassium supplements for blood pressure, therefore, depends on the medications you are taking and the instructions of your doctor.

Stroke
In several population based studies evaluating very large groups of men and women over time, a diet rich in potassium was associated with a reduced risk of stroke. For the men, this seems to be particularly true among those with high blood pressure and/or those taking diuretics (blood pressure medications that help the kidneys eliminate sodium and water from the body). Potassium supplements, however, do not seem reduce the risk of stroke.

Inflammatory Bowel Disease (IBD)
Amongst other nutrient deficiencies, people with IBD (namely, ulcerative colitis or Crohn's disease) often have low levels of potassium. Your doctor will determine if supplementation with potassium is necessary.

Asthma
Several studies have suggested that diets low in potassium are associated with poor lung function and even asthma in children compared to those who eat normal amounts of potassium. Enhancing dietary intake of potassium through foods such as fish, fruits, and vegetables may, therefore, prove to be of value for preventing or treating asthma.

 

 

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Dietary Sources for Potassium

The best dietary sources of potassium are fresh unprocessed foods, including meats, fish, vegetables (especially potatoes), fruits (especially avocados, dried apricots, and bananas), citrus juices (such as orange juice), dairy products, and whole grains. Most potassium needs can be met by eating a varied diet with adequate intake of milk, meats, cereals, vegetables, and fruits.

 

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Available Forms of Potassium

There are several potassium supplements on the market, including potassium acetate, potassium bicarbonate, potassium citrate, potassium chloride, and potassium gluconate.

Potassium can also be found in multivitamins.

 

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How to Take Potassium

Potassium supplements, other than the small amount included in a multivitamin, should only be taken under the specific guidance and instruction of a healthcare provider. This is particularly true for children.

The recommended daily intakes of dietary potassium are listed below:

Pediatric

• Infants birth to 6 months: 500 mg or 13 mEq
• Infants 7 months to 12 months: 700 mg or 18 mEq
• Children 1 year: 1000 mg or 26 mEq
• Children 2 to 5 years: 1400 mg or 36 mEq
• Children 6 to 9 years: 1600 mg or 41 mEq
• Children over 10 years: 2000 mg or 51 mEq

Adult

• 2000 mg or 51 Meq, including for pregnant and nursing women.

 

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Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider. In the case of potassium, this is particularly important in the elderly.

Diarrhea and nausea are two common side effects from potassium supplements. Other potential adverse effects include muscle weakness, slowed heart rate, and abnormal heart rhythm.

Excessive amounts of the herb licorice (not licorice candy) and caffeine-containing herbs (such as cola nut, guarana, and possible green and black tea) can lead to loss of potassium.

Potassium must not be used by people with hyperkalemia.

 

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Possible Interactions

If you are currently being treated with any of the following medications, you should not use potassium without first talking to your healthcare provider.

Potassium levels may be increased by the following medications:

• Nonsteroidal anti-inflammatory drugs (NSAIDs; such as ibuprofen, piroxicam, and sulindac): This interaction is particularly likely to occur in people with decreased kidney function.
• ACE inhibitors (such as captopril, enalapril, and lisinopril): This interaction is particularly likely to occur in people who are taking NSAIDs, potassium-sparing diuretics (such as spironolactone, triamterene, or amiloride), or salt substitutes along with the ACE inhibitor. A rise in potassium from ACE inhibitors may also be more likely in people with decreased kidney function and diabetes.
• Heparin (used for blood clots)
• Cyclosporine (used following a transplant to suppress the immune system)
• Trimethoprim (an antibiotic)
• Beta-blockers (such as metoprolol and propranolol that are used to treat high blood pressure)

Potassium levels may be decreased by the following medications:

• Thiazide diuretics (such as hydrochlorothiazide)
• Loop diuretics (such as furosemide and bumetanide)
• Corticosteroids
• Amphotericin B
• Antacids
• Insulin
• Theophylline (used for asthma)
• Laxatives

Please refer to the depletions monographs related to these medications for additional information. A healthcare practitioner will determine whether potassium supplements are needed when individuals are taking these medications.

Other potential interactions include:

• Digoxin: Low blood levels of potassium increase the likelihood of toxic effects from digoxin, a medication used to treat abnormal heart rhythms. Normal levels of potassium should be maintained during digoxin treatment which will be measured and directed by the healthcare provider.

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Supporting Research

Alappan R, Perazella MA, Buller GK, et al. Hyperkalemia in hospitalized patients treated with trimethoprim-sulfamethoxazole. Ann Intern Med. 1996;124(3):316-320.

Appel LJ. Nonpharmacologic therapies that reduce blood pressure: a fresh perspective. Clin Cardiol. 1999;22(Suppl. III):III1-III5.

Apstein C. Glucose-Insulin-Potassium for acute myocardial infraction: remarkable results from a new prospective, randomized trial. Circ. 1998;98:2223 - 2226.

Apstein CS, Opie Lh. Glucose-insulin-potassium (GIK) for acute myocardial infarction: a negative study with a positive value. Cardiovasc Drugs Ther. 1999;13(3):185-189.

Ascherio A, Rimm EB, Hernan MA, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among U.S. men. Circ. 1998;98:1198 - 1204.

Brancati FL, Appel LJ, Seidler AJ, Whelton PK. Effect of potassium supplementation on blood pressure in African Americans on a low-potassium diet. Arch Intern Med. 1996;156:61 - 72.

Brater DC. Effects of nonsteroidal anti-inflammatory drugs on renal function: focus on cyclooxygenase-2-selective inhibition. Am J Med. 1999;107(6A):65S-70S.

Burgess E, Lewanczuk R, Bolli P, et al. Lifestyle modifications to prevent and control hypertension. 6. Recommendations on potassium, magnesium and calcium. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. CMAJ. 1999;160(9 Suppl):S35-S45.

Cappuccio EP, MacGregor GA. Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens. 1991;9:465-473.

Chiu TF, Bullard MJ, Chen JC, Liaw SJ, Ng CJ. Rapid life-threatening hyperkalemia after addition of amiloride HCL/hydrochlorothiazide to angiotensin-converting enzyme inhibitor therapy. Ann Emerg Med. 1997;30(5):612-615.

Gilliland FD, Berhane KT, Li YF, Kim DH, Margolis HG. Dietary magnesium, potassium, sodium, and children's lung funtion. Am J Epidemiol. 2002. 15;155(2):125-131.

Hermansen K. Diet, blood pressure and hypertension. Br J Nutr. 2000:83(Suppl 1):S113-119.

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Heyka R. Lifestyle management and prevention of hypertension. In: Rippe J, ed. Lifestyle Medicine. 1st ed. Malden, Mass: Blackwell Science; 1999:109-119.

Hijazi N, Abalkhail B, Seaton A. Diet and childhood asthma in a society in transition: a study in urban and rural Saudi Arabia. Thorax. 2000;55:775-779.

Howes LG. Which drugs affect potassium? Drug Saf. 1995;12(4):240-244.

Iso H, Stampfer MJ, Manson JE, et al. Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Stroke. 1999;30(9):1772-1779.

Joint National Committee. Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Arch Int Med. 1997;157:2413-2446.

Kendler BS. Recent nutritional approaches to the prevention and therapy of cardiovascular disease. Prog Cardiovasc Nurs. 1997;12(3):3-23.

Krauss RM, Eckel RH, Howard B, et al. AHA dietary guidelines. Revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000;102:2284-2299.

Matsumura M, Nakashima A, Tofuku Y. Electrolyte disorders following massive insulin overdose in a patient with type 2 diabetes. Intern Med. 2000;39(1):55-57.

Newnham DM. Asthma medications and their potential adverse effects in the elderly: recommendations for prescribing. Drug Saf. 2001;24(14):1065-1080.

Olukoga A, Donaldson D. Liquorice and its health implications. J Royal Soc Health. 2000;120(2):83-89.

Pasic S, Flannagan L, Cant AJ. Liposomal amphotericin is safe in bone marrow transplantation for primary immunodeficiency. Bone Marrow Transplant. 1997;19(12):1229-1232.

Perazella MA. Trimethoprim-induced hyperkalemia: clinical data, mechanism, prevention and management. Drug Saf. 2000;22(3):227-236.

Perazella M, Mahnensmith R. Hyperkalemia in the elderly. J Gen Intern Med. 1997;12:646 - 656.

Physicians' Desk Reference. 55th ed. Montvale, NJ: Medical Economics Co., Inc.; 2001:1418-1422, 2199-2207.

Poirier TI. Reversible renal failure associated with ibuprofen: case report and review of the literature. Drug Intel Clin Pharm. 1984;18(1):27-32.

Preston RA, Hirsh MJ MD, Oster, JR MD, et al. University of Miami Division of Clinical Pharmacology therapeutic rounds: drug-induced hyperkalemia. Am J Ther. 1998; 5(2):125-132.

Ray K, Dorman S, Watson R. Severe hyperkalemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction. J Hum Hypertens. 1999;13(10):717-720.

Reif S, Klein I, Lubin F, Farbstein M, Hallak A, Gilat T. Pre-illness dietary factors in inflammatory bowel disease. Gut. 1997;40:754-760.

Sacks FM, Willett WC, Smith A, et al. Effect on blood pressure of potassium, calcium, and magnesium in women with low habitual intake. Hypertens. 1998;31(1):131 - 138.

Shionoiri H. Pharmacokinetic drug interactions with ACE inhibitors. Clin Pharmacokinet. 1993;25(1):20-58.

Singh RB, Singh NK, Niaz MA, Sharma JP. Effect of treatment with magnesium and potassium on mortality and reinfarction rate of patients with suspected acute myocardial infarction. Int J Clin Pharmacol Thera. 1996;34:219 - 225.

Stanbury RM, Graham EM. Systemic corticosteroid therapy - side effects and their management. Br J Ophthalmol. 1998;82(6):704-708.

Suter PM. Potassium and Hypertension. Nutrition Reviews. 1998;56:151 - 133.

Tucker KL, Hannan Mt, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr. 1999;69(4):727-736.

Whang R, Oei TO, Watanabe A. Frequency of hypomagnesia in hospitalized patients receiving digitalis. Arch Intern Med. 1985;145(4):655-656.

Whelton, A, Stout RL, Spilman PS, Klassen DK. Renal effects of ibuprofen, piroxicam, and sulindac in patients with asymptomatic renal failure. A prospective, randomized, crossover comparison. Ann Intern Med. 1990;112(8):568-576.

Young DB, Lin H, McCabe RD. Potassium's cardiovascular protective mechanisms. Am J Physiology. 1995;268(part 2):R825 - R837.

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Discover what causes premature ejaculation and techniques to treat premature ejaculation. Along with comments on having an orgasm.

Rarely a physiological problem, premature ejaculation can result from over-excitement, positioning or rate of intercourse. "The roots of it go back to the way men learn to orgasm, which is typically through masturbation," suggests Kaminetsky. "A lot of young boys masturbate quickly, because they don't want their mom to walk in on them. It becomes a trained behavior." To treat premature ejaculation, experts suggest changing positions, breathing deeply, thinking about something other than sex or simply stopping for a moment. Here, Kaminetsky offers two additional techniques for delaying orgasm:

• Practice this before reaching "ejaculatory inevitability," the point when ejaculation cannot be stopped; most men recognize it as a sensation of deep warmth or pleasure: Squeeze the head of the penis for about four seconds or until the sensation subsides, then resume.
• During intercourse, the man should press his pelvic bone against the woman's and rock rather than thrust his body. "It won't be as stimulating for him so he'll last longer, and it may be more stimulating for the woman."

HIS BENEFITS

• Long life: Men who have two or more orgasms a week tend to live significantly longer than do those who have only one or none, according to research at Cardiff University in Wales.
• Less cancer: Breast cancer is rare in men, but once developed, the mortality rate is high. Fortunately, a study published in the British Journal of Cancer found that men who have more than six orgasms a month are significantly less likely to develop breast cancer than are those who have less frequent sex.
• Healthy hearts: A study of 2,500 men at the University of Bristol and Queens University of Belfast found that men who have at least three or more orgasms a week are 50 percent less likely to die from heart failure or coronary heart disease.
• Good health: Having sex once or twice a week also fights off the flu and other viruses by strengthening the immune system, psychologists at the University of Pennsylvania recently found.
• Youthful looks: A study of 3,500 aging people at the Royal Edinburgh Hospital in Scotland found that those who looked the youngest also had the most vigorous sex life. The effects were even greater if the subjects were emotionally satisfied as well.

READ MORE ABOUT IT: The Good Girl's Guide to Bad Girl Sex Barbara Keesling, Ph.D. (M. Evan and Co., 2001)

Sexual Fitness: 7 Essential Elements of Optimizing Your Sensuality, Satisfaction and Well-Being Hank C.K. Wuh, M.D. (G.P. Putnam's Sons, 2001)

Personal Comments

Bee, 25, Copywriter

Masturbating is the easiest way for women to learn how to have an orgasm. Women who masturbate will be a lot more likely to have an orgasm during sex. I think it helps you learn the actual mechanics of what turns you on, where things need to happen.

Because the guy isn't going to know that; there's no reason he would. Every woman is different. Also, the bonding that goes on during sex seems most extreme with an orgasm. It's kind of like one or both people have gone completely over the edge; they're suspended in the other person's grasp, and they're completely surrendered to it. That intensifies any connection.

Gabriel, 25, Musician

There are guys who don't get a rise out of giving a woman an orgasm and would just prefer not to have someone else there. I've even heard some guys say they have better orgasms during masturbation than sex. The mere thought of it astounds me, but it makes sense if a guy has a fear of intimacy or, even more, a fear of performing (performance anxiety). It probably takes away from his own orgasm if he's overly concerned with his sexual performance or whether or not she's having one. It's ironic because an orgasm during sex is enhanced when it's with someone you truly care about.

Kamara, 27, Musician

I'm amazed when I talk to anyone who claims to have never had an orgasm, probably because I just can't imagine not having them or not being able to have them. At the same time, it doesn't surprise me: I was raised in a very conservative religious atmosphere that actually called masturbation "self-abuse," and all sexuality -- not to mention orgasms -- was beautiful and good only if it happened in a marriage bed. It takes a while to expel the load of guilt that piles up around your sexuality if you're raised in that kind of culture, and I'm sure some people never do. But there was no way I wasn't going to aim for the prize once I knew what it felt like. Maybe it depends on your sexual drive -- for me, the drive was strong enough that I could never feel guilty about an orgasm for long.

Steven, 28, Veterinarian

Some guys think sex has to include an orgasm. Orgasms are great, but there's so much more to sex. An orgasm is more of a physical experience; I guess there is an emotional aspect, but it's over in a second. I think anybody can give you an orgasm, but it's the person there after the orgasm that matters. But I think I'm the exception.

Does Orgasm Equal Sex

Our ever-changing definition of sex may hinge more on the climax than on the act itself; Psychologist L.M. Bogart, Ph.D., gave Kent State students a list of scenarios in which "Jim" and "Susie" engaged in vaginal, anal or oral intercourse and either did or did not achieve orgasm. Vaginal intercourse was considered sex 97 percent of the time, followed by anal intercourse (93 percent) and oral sex (44 percent). Researchers were surprised to find that orgasm occurrence dictated whether or not the activity was considered sex. Although the woman was more likely to label vaginal intercourse sex if neither partner climaxed, when it came to oral sex, the recipient was more likely to consider it sex than the partner performing the act, especially if the recipient achieved orgasm -- because the stimulator was unlikely to achieve orgasm. For anal sex, it was more likely to be called sex if Jim had the orgasm, but it was sex to Susie regardless of whether she achieved orgasm. In general, the lack of orgasm for women was less likely to affect her labeling the act sex. Although most sex therapists argue against using orgasm as an end-all definition of sex, Bogart's study indicates that orgasm is still an important gauge by which we measure sexual activity.

Source: Psychology Today

MUST HAVES for people with an eating disorder like anorexia, bulimia, compulsive overeating

Recommended for sufferers, friends and family

buy the book $15

"Eating with Your Anorexic: How My Child Recovered Through Family-Based Treatment and Yours Can Too"By: Laura Collins Read Laura's blog Eating Disorder Recovery: The Power of Parents, right here at HealthyPlace.

 

Beating Ana: How to Outsmart Your Eating Disorder and Take Your Life Back
By: Shannon Cutts
buy the book 

 

Life Without Ed: How One Woman Declared Independence from Her Eating Disorder and How You Can Too
By: Jenni Schaefer and Thom Rutledge
buy the book 

Reader Comment: 'Life Without Ed truly guides the reader into the separation of self from ED.'

Intuitive Eating: A Revolutionary Program That Works
By: Evelyn Tribole, Elyse Resch
buy the book 

Reader Comment: 'This book is the only "plan" you'll ever need to get off the dieting roller coaster and become a healthy eater.'

The Secret Language of Eating Disorders: How You Can Understand and Work to Cure Anorexia and Bulimia
By: Peggy Claude-Pierre
buy the book 

Reader Comment: "In her book, Peggy describes anorexia as a very slow attempted suicide, a descent toward nothingness---I agree. Anorexia is not a diet, it is not a shallow attempt to be "model thin", and it is definitely not just about food."

Help Your Teenager Beat an Eating Disorder
By: James Lock, Daniel le Grange
buy the book 

Reader Comment: "This book was not written as a self-help manual, but it was written for parents and contains loads of practical advice garnered from years of working directly with sufferers and their parents."

The Eating Disorders Sourcebook
By: Carolyn Costin
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Reader Comment: "This book provides an excellent overview of many aspects of eating disorders and their treatment. Carolyn Costin is extremely insightful and knowledgeable about the subject and she writes in a clear, accessible way."

Eating in the Light of the Moon: How Women Can Transform Their Relationship with Food Through Myths, Metaphors, and Storytelling By: Anita A. Johnston PhD.
buy the book 

Reader Comment: "This is a deeply insightful book that speaks to women with disordered eating of all types and severities."

The End of Overeating: Taking Control of the Insatiable American Appetite
By: David Kessler MD
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Reader Comment: "The book is a fascinating read, full of documentation and testimonials on the growing obesity problem and our apparent inability to control our food intake as a culture."

The Adonis Complex: How to Identify, Treat and Prevent Body Obsession in Men and Boys
By: Harrison G. Pope, Katharine A. Phillips, Roberto Olivardia
buy the book 

Reader Comment: "The chapter notes contain at least 50 research papers that they have published in various scientific journals. Some of their findings are pretty stunning."

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Serious depression and conduct disorder raise a teen's risk of suicide. Substance abuse problems also increase suicidal thinking and behavior in teens.

In addition to depression, there are other emotional conditions that can put teens at greater risk for suicide - for example, girls and guys with conduct disorder are at higher risk. This may be partly because teens with conduct disorder have problems with aggression and may be more likely than other teens to act in aggressive or impulsive ways to hurt themselves when they are depressed or under great stress. The fact that many teens with conduct disorder also have depression may partly explain this, too. Having both serious depression and conduct disorder increases a teen's risk of suicide. Substance abuse problems also put teens at risk for suicidal thinking and behavior. Alcohol and some drugs have depressive effects on the brain. Misuse of these substances can bring on serious depression, especially in teens prone to depression because of their biology, family history, or other life stressors.

Besides depressive effects, alcohol and drugs alter a person's judgment. They interfere with the ability to assess risk, make good choices, and think of solutions to problems. Many suicide attempts occur when a teen is under the influence of alcohol or drugs. Teens with substance abuse problems often have serious depression or intense life stresses, too, further increasing their risk.

Life Stress and Suicidal Behavior

Let's face it - being a teen is not easy for anyone. There are many new social, academic, and personal pressures. And for teens who have additional problems to deal with, life can feel even more difficult. Some teens have been physically or sexually abused, have witnessed one parent abusing another at home, or live with lots of arguing and conflict at home. Others witness violence in their neighborhoods. Many teens have parents who divorce, and others may have a parent with a drug or alcohol addiction.

Some teens are struggling with concerns about sexuality and relationships, wondering if their feelings and attractions are normal, if they will be loved and accepted, or if their changing bodies are developing normally. Others struggle with body image and eating problems, finding it impossible to reach a perfect ideal, and therefore having trouble feeling good about themselves. Some teens have learning problems or attention problems that make it hard for them to succeed in school. They may feel disappointed in themselves or feel they are a disappointment to others.

All these things can affect mood and cause some people to feel depressed or to turn to alcohol or drugs for a false sense of soothing. Without the necessary coping skills or support, these social stresses can increase the risk of serious depression and, therefore, of suicidal ideas and behavior. Teens who have had a recent loss or crisis or who had a family member who committed suicide may be especially vulnerable to suicidal thinking and behavior themselves.

Guns and Suicide Risk

Finally, having access to guns is extremely risky for any teen who has any of the other risk factors. Depression, anger, impulsivity, life stress, substance abuse, feelings of alienation or loneliness - all these factors can place a teen at major risk for suicidal thoughts and behavior. Availability of guns along with one or more of these risk factors is a deadly equation. Many teen lives could be saved by making sure those who are at risk don't have access to guns.

Different Types of Suicidal Behaviors

Teen girls attempt suicide far more often (about nine times more often) than teen guys, but guys are about four times more likely to succeed when they try to kill themselves. This is because teen guys tend to use more deadly methods, like guns or hanging. Girls who try to hurt or kill themselves tend to use overdoses of medications or cutting. More than 60% of teen suicide deaths happen with a gun. But suicide deaths can and do occur with pills and other harmful substances and methods.

Sometimes a depressed person plans a suicide in advance. Many times, though, suicide attempts are not planned in advance, but happen impulsively, in a moment of feeling desperately upset. Sometimes a situation like a breakup, a big fight with a parent, an unintended pregnancy, being harmed by abuse or rape, being outed by someone else, or being victimized in any way can cause a teen to feel desperately upset. In situations such as these, teens may fear humiliation, rejection, social isolation, or some terrible consequence they think they can't handle. If a terrible situation feels too overwhelming, a teen may feel that there is no way out of the bad feeling or the consequences of the situation. Suicide attempts can occur under conditions like this because, in desperation, some teens - at least for the moment - see no other way out and they impulsively act against themselves.

Sometimes teens who feel or act suicidal mean to die and sometimes they don't. Sometimes a suicide attempt is a way to express the deep emotional pain they're feeling in hopes that someone will get the message they are trying to communicate.

Even though a teen who makes a suicide attempt may not actually want or intend to die, it is impossible to know whether an overdose or other harmful action they may take will actually result in death or cause a serious and lasting illness that was never intended. Using a suicide attempt to get someone's attention or love or to punish someone for hurt they've caused is never a good idea. People usually don't really get the message, and it often backfires on the teen. It's better to learn other ways to get what you need and deserve from people. There are always people who will value, respect, and love you - sure, sometimes it takes time to find them - but it is important to value, respect, and love yourself, too.

Unfortunately, teens who attempt suicide as an answer to problems tend to try it more than once. Though some depressed teens may first attempt suicide around age 13 or 14, suicide attempts are highest during middle adolescence. Then by about age 17 or 18, the rate of teen suicide attempts lowers dramatically. This may be because, with maturity, teens have learned to tolerate sad or upset moods, have learned how to get support they need and deserve, and have developed better coping skills to deal with disappointment or other difficulties.

next: Depressed Veterans and Suicide
~ depression library articles
~ all articles on depression

Detailed information on mood stabilizers and atypical antipsychotics for treatment of bipolar disorder in children and adolescents.

Children and adolescents with bipolar disorder are treated with medications, although none of these medications, with the sole exception of lithium (in patients as young as 12 years old), have received Food and Drug Administration (FDA) approval for this application. Despite the paucity of data, pediatric treatment guidelines have evolved based on empirically derived plans. The Child Psychiatric Workgroup on Bipolar Disorder established guidelines based on the most up-to-date evidence (Kowatch, 2005). In general, these guidelines involve algorithm-based use of mood stabilizers and atypical antipsychotic agents alone or in various combinations.

Use of mood-stabilizing agents in children and adolescents has some unique considerations. Specifically, adolescents and children generally metabolize more rapidly than adults because of more efficient hepatic functions. Also, adolescents and children have faster renal clearance rates than adults. For example, lithium carbonate has an elimination half-life of 30-36 hours in an elderly patient, 24 hours in an adult, 18 hours in an adolescent, and less than 18 hours in children. Steady states also are achieved earlier in children than in adolescents and earlier in adolescents than in adults. Thus, plasma levels may be drawn and assessed earlier in children and adolescents than in adults.

Some consequences of the efficient metabolizing and clearance systems of young individuals are as follows: (1) peak drug levels may show higher plasma concentrations than anticipated in adults, and (2) trough levels may show lower plasma concentrations than anticipated in adults. Thus, children may require higher doses of medications to attain therapeutic response (measured in mg/kg/d) than adults. Special precautions must be taken when dosing psychiatric medications in the treatment of adolescents and children to achieve therapeutic effect while staying safely below toxic levels.

Although the mood stabilizers have not been established as primary treatment of bipolar disorders in adolescents or children by controlled studies, they are used clinically in this context. Mood stabilizers include lithium carbonate, valproic acid or sodium divalproex, and carbamazepine. These medications still are considered first-line agents in managing bipolar disorders in pediatric patients because case reports and limited studies have suggested that efficacy and safety are sufficiently present to benefit the patient with symptom relief and control.

Lithium carbonate is effective in approximately 60-70% of adolescents and children with bipolar disorder and remains the first line of therapy in many settings. Approximately 15% of children receiving lithium medication have enuresis, primarily nocturnal enuresis. In those who do not respond to lithium, sodium divalproex is generally the next agent of choice. As with adult patients with bipolar disorder, carbamazepine often is considered a third choice, after sodium divalproex and lithium carbonate have been tried at optimal doses for a sufficient length of time. This medication often is tried after an acute or crisis state has been stabilized and adverse effects of either sodium divalproex or lithium carbonate are intolerable.

Lamotrigine has been approved for bipolar maintenance therapy in adults, but data in pediatric patients are lacking. Other antiepileptic medications (eg, gabapentin, oxcarbazepine, topiramate) have had mixed results in adults with bipolar disorder in case reports and studies. However, limited data are available regarding the potential usefulness of these medications in pediatric patients with bipolar disorder, though a benefit may theoretically be possible.

Emerging evidence indicates that atypical antipsychotic agents may be used in pediatric patients with bipolar disorder who presents with or without psychosis. Given the antimanic properties demonstrated in adult and limited adolescent studies, olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal) may be considered first-line alternatives to lithium, valproate, or carbamazepine. Pediatric studies with ziprasidone (Geodon) and aripiprazole (Abilify) are limited at this point; this limitation indicates that these agents should be considered second-line alternatives if first-line mood stabilizers or atypical antipsychotic agents are ineffective or if they result in intolerable adverse effects. Clozapine (Clozaril) may be considered only in treatment-refractory cases given its need for frequent hematologic monitoring due to the risk for agranulocytosis.

An important consideration with atypical antipsychotics is the potential for weight gain and metabolic syndrome. The patient's weight should be measured, and a fasting lipid profile and serum glucose level should be evaluated before these agents are started, and these values should be monitored periodically during treatment. Patients and families should be advised of the need to appropriately manage diet and exercise. Limited data indicate that ziprasidone and aripiprazole may have a low potential for these adverse effects and that they may be considered in patients at high risk because of a family or personal history of metabolic abnormalities. Atypical antipsychotics also pose a potential risk for extrapyramidal symptoms and tardive dyskinesia.

Common adverse effects and special concerns for mood stabilizers are listed in Table 1.

Table 1. Mood Stabilizers: Common Adverse Effects and Special Concerns

Mood Stabilizer	Common Adverse Effects	Doses	Special Concerns
Lithium Carbonate (Eskalith CR, Lighobid)	Gastrointestinal distress, lethargy or sedation, tremor, enuresis, weight gain, alopecia, cognitive blunting	10-30 mg/kg/d Dose must be adjusted by monitoring serum level and patient response Titrate up on bid schedule	Hypothyroidism, diabetes insipidus, toxic in dehydration, polyuria, polydipsia, renal disease
Sodium divalproex/valproic acid (Depakote, Depakene)	Sedation, platelet dysfunction, liver disease, alopecia, weight gain	15-60 mg/kg/d Dose must be adjusted by monitoring serum levels Titrate up on bid/tid schedule	Elevated liver enzymes or liver disease, drug-drug interactions, bone marrow suppression
Carbamazepine (Tegretol)	Suppressed WBC, dizziness, drowsiness, rashes, liver toxicity (rarely)	10-20 mg/kg/d Dose must be adjusted by monitoring serum blood levels Titrate up on bid schedule	Drug-drug interactions, bone marrow suppression
Risperidone (Risperdal)	Weight gain, sedation, orthostasis	0.25 mg bid or 0.5 mg at bedtime initially; titrate as tolerated to target dosage of 2-4 mg/d; not to exceed 6 mg/d	Galactorrhea, extrapyramidal symptoms
Quetiapine (Seroquel)	Sedation, orthostasis, weight gain	50 mg bid initially; titrate as tolerated to target dosage of 400-600 mg/d	Decrease dosage with hepatic impairment, may cause neuroleptic malignant syndrome (NMS) or hyperglycemia
Olanzapine (Zyprexa)	Weight gain, dyslipidemia, sedation, or orthostasis	2.5-5 mg at bedtime initially; titrate as tolerated to target dosage of 10-20 mg/d	Metabolic syndrome, extrapyramidal symptoms

While mood stabilizers are first-line agents for patients with bipolar disorder, adjunctive medications often are used to control psychosis, agitation, or irritability and to improve sleep. Commonly, antipsychotics and benzodiazepines are used to reduce these symptoms.

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Benzodiazepines and Antidepressants for Treating Bipolar Symptoms

Benzodiazepines, such as clonazepam and lorazepam, generally are avoided, but they may be temporarily useful in restoring sleep or in modulating irritability or agitation not caused by psychosis. Because of the slow-on and slow-off action of clonazepam (Klonopin), the risk of abuse is lower with this drug than with fast-acting benzodiazepines such as lorazepam (Ativan) and alprazolam (Xanax). In the outpatient setting, clonazepam may be preferred because of the efficacy and the lowered risks of abuse by the patient or others. Clonazepam can be dosed in the range of 0.01-0.04 mg/kg/d, and it is often administered once per day at bedtime or twice per day. Lorazepam is dosed to 0.04-0.09 mg/kg/d and administered 3 times per day because of its short half-life.

When a patient with bipolar disorder is having a depressive episode, the use of an antidepressant may be considered after a mood stabilizer or atypical antipsychotic agent has been started and after a therapeutic response or level is achieved. Caution must be exercised in starting an antidepressant in a person with bipolar disorder because it may precipitate mania. An antidepressant with a potentially lowered risk of inducing mania is bupropion (Wellbutrin).

Selective serotonin reuptake inhibitors (SSRIs) may also be used. However, because of the risk of mania, doses should be low and titration should be slow. The only SSRI currently FDA approved for the management of unipolar depression in adolescents is fluoxetine (Prozac). However, this agent should be used carefully in patients with bipolar disorder because of its long half-life and because of its potential to exacerbate manic symptoms when not coadministered with an antimanic or mood-stabilizing agent.

All medications used in pediatric bipolar disorder pose a risk of adverse effects or interactions with other medications. These risks should be clearly discussed with patients and families and weighed against the potential benefits. Medication should be started only after informed consent is obtained.

Drug Category: Mood stabilizers -- Indicated for control of manic episodes occurring in bipolar disorder. Mood stabilizers include lithium carbonate, valproic acid or sodium divalproex, and carbamazepine. These medications are considered first-line agents in managing bipolar disorder in pediatric patients.

Drug Name	Lithium (Lithotabs, Lithobid, Lithane, Eskalith) -- Used to manage and prevent acute manic episodes. Influences reuptake of serotonin and/or norepinephrine at cell membrane.
Adult Dose	300-600 PO tid/qid in divided doses Maintenance: 2.4 g/d or 450-900 mg bid of SR dosage form
Pediatric Dose	10-30 mg/kg/d PO divided bid/tid; titrate upward gradually from lower range while monitoring serum levels and patient response
Contraindications	Documented hypersensitivity; severe cardiovascular or renal disease
Interactions	Thiazide diuretics, haloperidol, phenothiazines, neuromuscular blockers, carbamazepine, fluoxetine, and ACE inhibitors may decrease elimination and increase toxicity
Pregnancy	D - Unsafe in pregnancy
Precautions	Toxicity is closely related to serum levels and can occur at therapeutic doses; caution in hypothyroidism, cardiovascular or renal compromise, and diabetes insipidus; decreased intake of sodium may cause increased lithium levels

 

Drug Name	Valproic acid (Depakote, Depakene, Depacon) -- Although mechanism of action is not established, activity may be related to increased brain levels of GABA or enhanced GABA action. Valproate also may potentiate postsynaptic GABA responses, affect potassium channel, or have a direct membrane-stabilizing effect. Has proven effectiveness in treating and preventing mania. Classified as a mood stabilizer and can be used alone or in combination with lithium. Useful in treating patients with rapid-cycling bipolar disorders and has been used to treat aggressive or behavioral disorders. A combination of valproic acid and valproate (ie, divalproex [Depakote]) has been effective in treating persons in manic phase, with a success rate of 49%.
Adult Dose	10-20 mg/kg/d PO divided bid; may gradually titrate upward by 5-10 mg/kg/d at weekly intervals; not to exceed 30-60 mg/kg/d
Pediatric Dose	Administer as in adults
Contraindications	Documented hypersensitivity; hepatic disease or dysfunction
Interactions	Coadministration with cimetidine, salicylates, felbamate, and erythromycin may increase toxicity; rifampin may significantly reduce valproate levels; in pediatric patients, protein binding and metabolism of valproate decrease when taken concomitantly with salicylates; coadministration with carbamazepine may result in variable changes of carbamazepine concentrations; may increase diazepam and ethosuximide toxicity (monitor closely); may increase phenobarbital and phenytoin levels while either one may decrease valproate levels; may displace warfarin from protein-binding sites (monitor coagulation tests); may increase zidovudine levels in patients with HIV
Pregnancy	D - Unsafe in pregnancy
Precautions	Thrombocytopenia and abnormal coagulation parameters have occurred; risk of thrombocytopenia increases significantly at total trough valproate plasma concentrations >110 mcg/mL in females and >135 mcg/mL in males; before initiating therapy, at periodic intervals, and prior to surgery, determine platelet counts and bleeding time; reduce dose or discontinue therapy if hemorrhage, bruising, or a hemostasis or coagulation disorder occurs; hyperammonemia may occur, resulting in hepatotoxicity; monitor patients closely for appearance of malaise, weakness, facial edema, anorexia, jaundice, and vomiting; may cause drowsiness

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Drug Name	Carbamazepine (Tegretol) -- Effective in patients who have not responded to lithium therapy. Also can act to inhibit seizures induced through the kindling effect, which is thought to occur by way of repeated limbic stimulation. Has been effective in treating patients who have rapid-cycling bipolar disorder or those who have not been responsive to lithium therapy.
Adult Dose	200 mg PO bid (100 mg PO qid if susp) May increase at weekly intervals by no more than 200 mg/d tid/qid (bid with ER) until best response obtained; not to exceed 1600 mg/d
Pediatric Dose	10-20 mg/kg/d PO divided bid (qid with susp)
Contraindications	Documented hypersensitivity; history of bone marrow depression; administration of MAOIs within last 14 d
Interactions	Serum levels may increase significantly within 30 d of danazol coadministration (avoid whenever possible); do not administer concurrently with MAOIs; cimetidine may increase toxicity, especially if taken in first 4 wk of therapy; carbamazepine may decrease primidone and phenobarbital levels (their coadministration may increase carbamazepine levels)
Pregnancy	D - Unsafe in pregnancy
Precautions	Caution with increased intraocular pressure; obtain CBCs and serum-iron baseline prior to treatment, during first 2 mo, and yearly or every other year thereafter; can cause drowsiness, dizziness, and blurred vision; caution while driving or performing other tasks requiring alertness

 

Drug Name	Risperidone (Risperdal) -- Binds dopamine D2-receptor with 20 times lower affinity than for 5-HT2-receptor. Indicated for short-term (3-wk) treatment of acute mania associated with bipolar disorder. May use alone or combined with lithium or valproate.
Adult Dose	2-3 mg PO qd up to 3 wk; may increase by 1 mg/d at 24-h intervals, not to exceed 6 mg/d
Pediatric Dose	Data limited; 0.25 mg PO bid or 0.5 mg qhs initially; titrate as tolerated to target dosage of 2-4 mg/d; not to exceed 6 mg/d
Contraindications	Documented hypersensitivity
Interactions	Coadministration with carbamazepine may decrease effects; may inhibit effects of levodopa; clozapine may increase levels; PO solution not compatible with cola or tea
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	May cause extrapyramidal reactions, hypotension, tachycardia, and arrhythmias; hyperglycemia (some cases extreme) may occur, resulting in ketoacidosis, hyperosmolar coma, or death; do not split or chew PO disintegrating tablets

 

Drug Name	Quetiapine (Seroquel) -- May act by antagonizing dopamine and serotonin effects. Newer antipsychotic used for long-term management. Improvements over earlier antipsychotics include fewer anticholinergic effects and less dystonia, parkinsonism, and tardive dyskinesia.
Adult Dose	Initial: 25 mg PO bid/tid; increase by 25-50 mg bid/tid on day 2 or 3 to achieve range 300-400 mg divided bid/tid by day 4; adjust as needed at intervals of >2 d with adjustments of 25-50 mg bid Maintenance: 150-750 mg/d PO; not to exceed 800 mg/d
Pediatric Dose	Data limited; 50 mg PO bid initially; titrate as tolerated to target dosage of 400-600 mg/d
Contraindications	Documented hypersensitivity
Interactions	May antagonize levodopa and dopamine agonists; phenytoin, thioridazine, and other liver enzyme inducers may reduce levels; cytochrome P450 (CYP) 3A inhibitors (eg, ketoconazole, fluconazole, erythromycin) increase serum concentration
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	May induce orthostatic hypotension associated with dizziness, tachycardia, and syncope; has been associated with NMS and tardive dyskinesia; hyperglycemia (some cases extreme) may occur, resulting in ketoacidosis, hyperosmolar coma, or death; caution in hepatic impairment (decrease dose)

 

Drug Name	Olanzapine (Zyprexa) -- Mechanism of action for acute manic episodes associated with bipolar I disorder unknown. Available as tab, PO disintegrating tab (Zyprexa, Zydis), and IM dosage forms.
Adult Dose	10-15 mg PO qd; adjust by 5 mg/d at intervals >24 h; not to exceed 20 mg/d Agitation associated with bipolar mania: 10 mg IM once; may repeat after 2 h; not to exceed 30 mg/24 h Geriatric or debilitated individuals: 2.5-5 mg IM/dose
Pediatric Dose	Data limited; 2.5-5 mg PO qhs initially; titrate as tolerated to target dosage of 10-20 mg/d
Contraindications	Documented hypersensitivity
Interactions	Fluvoxamine may increase effects; antihypertensives may increase risk of hypotension and orthostatic hypotension; levodopa, pergolide, bromocriptine, charcoal, carbamazepine, omeprazole, rifampin, and cigarette smoking may decrease effects
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Caution in narrow-angle glaucoma, cardiovascular disease, cerebrovascular disease, prostatic hypertrophy, seizure disorders, hypovolemia, and dehydration; hyperglycemia (some cases extreme) may occur, resulting in ketoacidosis, hyperosmolar coma, or death; administration of >1 IM injection associated with substantial orthostatic hypotension (33%), maintain patient in recumbent position and monitor blood pressure before repeating IM doses

Sources:

• Kowatch RA, Bucci JP. Mood stabilizers and anticonvulsants. Pediatr Clin North Am. Oct 1998;45(5):1173-86, ix-x.
• Kowatch RA, Fristad M, Birmaher B, et al. Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. Mar 2005;44(3):213-35.
• Medication information listed in tables is from package inserts for each medication.

next: Childhood Bipolar and Special Education Needs
~ bipolar disorder library
~ all bipolar disorder articles

"Many men feel shy or awkward about seeking outside help, and therefore do not get the professional treatment they need when they suffer of eating disorders. But there are numerous medical and emotional side effects of eating disorders, and only experienced professionals have the tools to help. If you have an eating disorder, unless you are the kind of guy who builds his own house, performs dental procedures on himself, and is his own lawyer, you need to get professional guidance!" It is important to understand that even if the individual does not meet all the diagnostic criteria they may indeed still be in severe pain and should seek treatment before things become worse as they often do.

Statistically speaking, those who seek early treatment for their eating disorder will progress through recovery more quickly than those who waited years before seeking help. When the behaviors and critical thinking have been ingrained over a significant period of time, it will take longer for the individual to disengage from their disorder. In these cases, longer orTreatment Options for Eating Disorders Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimi more intensive treatment is needed.

"For most men and women who suffer, their eating disorder represents an impaired sense of self. Without effective treatment, they are unable to establish a healthy inner dialogue. What makes eating disorders difficult to overcome without professional help is the insidious way they progressively damage an already-impaired self. They ultimately become the person's identity, rather than merely an illness the person experiences. In addition, habit patterns, altered physiology, and probably neurochemical changes further lock in the disorder."

Therapy

Therapy for eating disorders provides safe and validating connections with people who know how to care for that hurt self and who understand the complexity of the illness. For men, the therapist needs to understand not only what it is like to be a person with an eating disorder, but also what it is like to be a man with an eating disorder. Although it seems obvious, the therapist needs to have genuine respect for the patient and appreciate the degree of shame that he might have simply from being a man who has what has traditionally been viewed as a "woman's problem."

Medical Management

Medical management by a physician is highly recommended. It is important to go to someone who can be understanding and compassionate allowing the man to be able to feel free enough to be honest about the eating disorder. A complete physical is recommended including appropriate blood work studies.

Nutritional Counseling

The dietitian has an important role in the man's recovery process from an eating disorder. To treat the anoretic, the dietitian has to loosen the hold on restrictive eating in a very reassuring manner. Sensitivity to the man's fears of becoming "fat" are imperative. For the bulimic or binge-eater, the dietitian must help the man normalize food consumption. It is important to keep in mind that no single meal plan works for everyone, so the dietitian must establish one that is individualized for the particular individual. Often the dietitian helps enable the person to incorporate new challenges to assist him in overcoming fears of portions, increased variety and specific foods. The focus mRole Relationships ust be removed from calories and fat grams substituting a healthy more balanced approach to meals.

Treatment for Men

Although the vast majority of issues related to eating disorders are common to men and women, there are issues unique to men, such as the shame they feel for suffering with what was formally known as a "woman's" illness, hormone changes, gender roles, and male body image. Ideally treatment for men should include segregated programs allowing them to work on gender-specific issues. They can express their masculine emotions with others who can relate. Additionally they can be monitored for hormonal needs and focus on male body image.

There are a variety of treatment options available but not all are segregated:

• Outpatient treatment suffices for most people entering treatment and in less severe cases
• Day hospital programs offer a flexible, though structured, treatment setting during the daytime.
• Inpatient hospital programs are geared to stabilize medically-compromised patients.
• Residential treatment at treatment centers for eating disorders is specifically designed for patients with severe cases, or who have been unsuccessful with the other levels of treatment. (At this time only Rogers Memorial Hospital, in Oconomowoc, Wisconsin offers a residential program specifically designed for men)
• There are relatively few programs available specifically for men. Some partial programs exist.
• St. Anthony's Medical Center in St. Louis provides specialized out-patient groups for men's eating disorders.
• It is important to understand what you may face with respect to insurance companies

How Can Loved Ones Help

"Regardless of the nature of your relationship, or his problems, you are vital to his healing process, and will ultimately benefit from his feeling better about himself. Keep in mind how difficult it must be living with the "stigma" of having a "woman's disease". Men have been suffering in the silence of a "macho" culture of denial, shame, and secrecy."

Men are typically silent about what bothers them, or they may not even be able to articulate their feelings or thoughts. However, when obsessions are serious, they are signs of deep emotional pain--people who focus on their looks often do so to avoid or compensate for internal issues.

"Given the complexity of men's problems, it stands to reason that the recovery process takes time and effort. Once he gets past denial, you can help him sort out his situation and make a plan. Let him do the talking. Ask questions, be a good listener, interject observations once in a while, but mainly listen."

next: Eating Disorders in Men and Boys
~ eating disorders library
~ all articles on eating disorders

Even with ADHD, a person can get a driver's license in the UK. Getting car insurance when you have ADHD may be another question altogether.

People with ADHD can get accommodations for the theory part (written part) of a driving test. You can ask for extra time or for someone to read the questions.

However you must contact the local Driving Theory Test Centre well in advance for details on how to apply.

ADD-ADHD and Driving

People with ADD/ADHD are not precluded from driving solely because of their diagnosis. It may take someone with ADHD a lot longer to learn all the implications of driving, but it should not affect how long it takes to learn the rules and facts in The Highway Code, nor the correct physical handling of the controls of a vehicle. What may be a problem is the ability to judge what other road users, pedestrians, animals, etc. might do and how this should affect their own driving; understanding that not all drivers and other road users obey all of the rules all of the time; that it is not their place to judge and sentence other, less able, road users (road rage'). Learning to ride a bike as a child and passing the Cycling Proficiency Test would be a very good foundation for anyone with AS as this will help them become more aware of the possible actions of other drivers and pedestrians.

First Things First

Will a provisional licence be granted?

Before any application for a provisional licence is made, it would be advisable to discuss the plan to learn to drive with a GP. The doctor will have access to the DVLA guidelines for people with disabilities wishing to learn to drive. If in any doubt, contact: The Medical Adviser, D M U, Longview Road, SWANSEA, SA99 1 TU, who would also be able to offer guidance.

If a parent is contacting the Medical Adviser on behalf of their son or daughter, his advice will be useful when reporting back to them. This is a delicate area: If the Medical Advisor has indicated a provisional licence may not be granted. The disappointment / resentment will need careful handling.

Should Driving Be An Option?

The UK Forum of Mobility Centres has 11 places around the country where people with disabilities, including ADHD, are taught to drive. A list of the centres can be obtained from the Disabled Drivers' Association on 01508 489449. The Centres also offer a preliminary off-road assessment after which they will give their opinion as to the candidate's likelihood of learning to drive successfully and over what length of time. Such an assessment would be a good option to consider before sending off for a provisional licence, and before signing up for what might be a long and probably expensive period of learning to drive. Even if the DVLA feel that a provisional licence is likely to he granted, it does not follow that learning to drive is going to be an easy or enjoyable activity. So a "trial run" might he a very good first step. It would also help the prospective driver discover if he is going to be happy and comfortable, not only being a driver in charge of a vehicle, but also spending time learning from a driving instructor. The driving test is an assessment of a candidate's ability to control a motor vehicle during a very short drive, and his knowledge of the Highway Code. It is not an accurate gauge as to how good a driver that person will be under exceptional or emergency situations.

Applying for a Provisional Driver's License

When applying for a Provisional Licence, the applicant must declare his ADHD in the relevant section of the form. If he wants to supply current medical reports to support his application, this would be helpful: otherwise the reports will be requested from his doctor.

Once a provisional licence has been granted, there will be no indication on it that the holder has ADHD.

In order to get a full licence, the learner driver must pass both sections of the driving test, meeting the standards set by the national driving test centres. If he is told that he has passed, and he is therefore able to apply for a full licence, then it must be supposed that he has fully met the necessary test standards. If a full licence is granted, there will be no indication on it that the driver has ADHD.

Getting Insurance When You Have ADHD

When applying for motor insurance, the application form will ask if the applicant has any disability, and if the DVLA is aware of it. Again, it is essential to declare all relevant information, as failure to do so is likely to make the insurance invalid.

Some insurance companies will not quote for people who have disabilities such as ADHD. Some will load the premiums they require for any disability. All companies load their premiums for 'young drivers' (those under 25), whom they consider to have little or no road-use experience.

Many young people with ADHD under 25, therefore, who have a 'disability', may discover to their dismay that once having successfully learnt to drive, passed their driving test and received their full driving licence, affordable insurance is extremely difficult, if not impossible, to find.

READING Knowledge is power: for a good understanding of your own strong and weak points read up as much as you can about any condition you may have.

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