Galantamine for Primary Inattentive ADD

Q I have primary inattentive ADD, which, as you probably know, is characterized by distractibility, memory problems, inattention to detail, procrastination, lateness, daydreaming, disorganization, and a slew of other symptoms. The most common medications for treating this problem are Adderal® (amphetamine) and Ritalin® (methylphenidate). I’m taking Adderal, and it’s now easier to think and pay attention, and it improves my mood. It also makes it easier to think with my whole brain. I can use my rational and emotional faculties equally well and simultaneously. This makes it much easier to discuss issues with my wife.

I really like these aspects, but Adderal does seem to make me a bit agitated. I think that is primarily because the effect of Adderal (which is essentially amphetamine and dextroamphetamine salts) is to release dopamine. It also releases lesser quantities of noradrenaline and acetylcholine.

According to research conducted by Dr. Richard Todd at Washington University in St. Louis, primary inattentive ADD is related to a mutation in a gene called CHRNA4, which controls the sensitivity of the nicotinic acetylcholine receptors in the brain. He began his research because a number of psychiatrists were starting to suspect that many primary inattentive ADD patients were self-medicating with nicotine. Nicotine binds to the nicotinic receptors and locks their ion-transmission channels open for around 40 minutes.

Many inattentive ADD patients have noticed that nothing alleviates their symptoms as well as nicotine. Maybe Dr. Todd’s research explains why. At the end of his study, he recommends further research into medications such as ABT-418 to cure the problem. ABT-418 was an experimental acetylcholine agonist that was not readily available and is now out of production.

My question is: If galantamine is known to be one of the most beneficial acetylcholine agonists and works via two different mechanisms—as a reuptake inhibitor and a resensitizer—why wouldn’t it make sense to use galantamine for inattentive ADD rather than Ritalin or Adderal? I’m not asking for a recommendation, because I know you can’t do that. I’m just curious in a theoretical sense.

Unfortunately, only one psychiatric researcher (in the hard-to-find Polish Journal of Psychiatry) has considered acetylcholinesterase inhibitors such as galantamine for inattentive ADD. Currently galantamine, in the form of Reminyl®, is being prescribed for Alzheimer’s patients. Interestingly, one of the reports I’ve read remarks that, in some ways, inattentive ADD resembles a permanent, low-level case of Alzheimer’s. Considering the neuroprotective effects of nicotine, acetylcholine, and galantamine and the possible shortage of acetylcholine in inattentive ADD sufferers, it makes me wonder whether they are more susceptible to Alzheimer’s.

There is an excellent article by Silvia Petrova about the neurological effects of galantamine within the acetylcholine system posted on the Alzheimer Research Forum’s Web site at www.alzforum.org/res/adh/cur/petrova/default.asp.

By the way, at my effective dose for inattentive ADD, Adderal has two side effects that nicotine does not have: slight agitation and stammering (these are well known). Nicotine actually has the opposite effect: it calms me down and makes me an eloquent speaker (not to mention improving my memory).

JAMES, Kirkwood, MO

A We know little about the use of galantamine for inattentive ADD other than what the abstract for the Polish article states. The text of that article is, unfortunately, in Polish [Kloszewska I. Acetylcholinesterase inhibitors—beyond Alzheimer’s disease. Psychiatr Pol 2002 Nov-Dec;36(6 Suppl):133-41. Review.] If anyone has a translation (or the scientific expertise to translate it), please contact us. And if anyone has had success using galantamine for inattentive ADD, please relate your experiences to us.

Regarding Dr. Silvia Petrova: she is a psychiatrist from Sofia, Bulgaria, who apparently has read some of our material, judging from her use of the phrase “gift from the gods” to describe galantamine. Her article is definitely worth reading.

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