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Dr. Bob's
Psychopharmacology Tips

Coffee and ADD

Date: Fri, 15 Dec 1995 00:12:03 -0800 (PST)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: Coffee and ADD

There are a number of published reports of attempts to use coffee as a rx for ADD kids. As I remember, none showed positive results.

Date: Fri, 15 Dec 1995 07:45:38 -0600
From: crismonl@mail.utexas.edu (M. Lynn Crismon)
Subject: Coffee and ADD

The studies I have seen examining the potential effects of caffeine in ADD have shown no efficacy.

Subject: Coffee and ADD
From: eliot.gelwan@channel1.com (Eliot Gelwan)
Date: Fri, 15 Dec 1995 08:11:00 -0640

On 12-14-95, Robert Hsiung said:

To get an indication of whether someone with difficulty concentrating might respond to a stimulant, I often ask if they drink coffee and, if so, if it helps them focus or makes them more distractible.
My ADD patients have often self-medicated with coffee, indicating (anecdotally) that it is naturally selected as treatment. They are consistently high-caffeine users.

For an indication of stimulant responsivity (and also to assess the potential additive effect of psychostimulants plus their habitual caffeine consumption), I ask them the question you do, but also I look for the "paradoxical calming" phenomenon with caffeine. Most of my ADD patients have no difficulty going to sleep no matter how much caffeine they've recently consumed and in fact the coffee may *facilitate* their winding down for sleep; and they do not experience caffeine jitters until they've vastly vastly overdosed on it.

Date: Fri, 15 Dec 1995 17:51:11 -0500
From: gsdavids@niagara.com (George Davidson)
Subject: Coffee and ADD

I ask my adult ADHD patients about coffee. Many will say they use coffee for its Ritalin-like effects, but the good effects are limited by irritability, "edginess", tremor, sweating, etc., which prevents them from taking an adequate dose. So, no, you can't treat ADHD with coffee effectively.

Date: Wed, 27 Dec 1995 20:51:34 +0000 (GMT)
From: Ian N Ford <ianford@dircon.co.uk>
Subject: Coffee and ADD

A personal anecdote may not be good science, but...

I was diagnosed as "hyperactive" at age three in the late 50s but the paediatrician just told my parents to get on with it because "some children are like that" <g>. These were the days when "Minimal Brain Dysfunction" was used for what we would now recognise as ADHD, but the diagnostic criteria were more rigid.

I also had asthma and allergies, and in those pre-inhaler days was taking promethazine, an antihistamine, for the allergic symptoms. Some readers may recall that it was research into the sedative effect of promethazine by Henri Laborit in the 1940s that led to the development of chlorpromazine. Promethazine is still used as a paediatric sedative. Yet despite taking the maximum dose it had no sedative effect on me -- I still only slept four hours / night. The doctor used to prescribe it literally by the litre bottle, the pharmacist's wholesale pack!

Around nine or ten I started to "outgrow" the worst of the asthma and was switched to Orciprenaline when needed. Here is the significant bit: I started drinking coffee. It started off as two or three cups a day. A year later I was taking a 30 oz flask of coffee to school. In the equivalent of junior high I was probably drinking three or four pints / day.

When I was finally diagnosed as having mild ADD (non-hyperactive) this year, at age 41, I was drinking up to twenty or more 10 oz mugs of strong coffee a day. In order to concentrate on my work I would have a coffee roughly every half hour. Yet I did not get a "high" from it, and if I stopped I did not get any obvious withdrawal symptoms.

When I came to the US for the ADD assessment I tried Jolt Cola. I had two double espresso coffees and two bottles of Jolt ... then went back to my hotel room and fell asleep.

I am now taking Ritalin 10 mg four or five times / day and have switched to decaffeinated coffee and sodas. Ritalin has made a huge difference in my concentration, and also I feel a lot less impulsive, etc.

So my subjective view is that caffeine can help ADD, but the quantities needed to have any effect would probably be unhealthy.

I found that an antihistamine called phenindamine (Thephorin) helped. This is unusual in that it is not as sedating as many antihistamines and in fact has a mild CNS stimulant effect. It is available in the UK from pharmacies without prescription (note 1). It was when trying to fight off an attack of hayfever that I discovered that a dose of Thephorin and a pint of coffee would stop me from losing concentration. This was particularly useful when driving at night, given that I had an unhealthy tendency to focus on the headlights of oncoming cars and steer towards them...

On another occasion, at scout camp, I was teaching archery and was very badly bitten by bugs. I was using topical mepyramine (Anthisan, note 2) as well as the oral form and probably had a plasma concentration slightly above that recommended. The strange thing was that my concentration on the class and my actual performance in shooting improved. I believe I have heard that someone tried a combination of antihistamine and stimulants for ADD. Again, this is just one case history, but Anthisan and coffee did help me.

I have a friend who also has ADD. He is taking prescribed antihistamines for allergies and drinks huge amounts of coffee and Mountain Dew. He is sure that this is effective treatment.

As I say, these are just personal anecdotes. I would not advocate self-diagnosis or self-medication. A proper clinical evaluation followed by a trial of prescribed medication with appropriate monitoring by an experienced clinician is the best way forward. Also, medication is not a "magic cure" for ADHD and often needs to be combined with coaching or "talking therapies" to address underlying issues.

1. available in the US by prescription only
2. not available in the US

Copyright 1996 Ian N Ford FRSH. This post may be downloaded in its entirety (including this notice) for personal use or professional education only. Publication in whole or in part (whether in print or by electronic means) other than "fair use" for research or criticism without the consent of the author is expressly prohibited.

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[dr. bob] Dr. Bob is Robert Hsiung, MD, dr-bob@uchicago.edu

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