ADD is a neurological disorder that begins in early childhood and can have a significant
impact on a child�s school performance and social abilities. The clinical features of the
disorder generally appear in early childhood and are present before seven years of age. The
disorder affects 3% - 5% of school age children. Boys are affected more frequently than girls
by a margin of approximately 4 to 1, but girls can certainly be affected.
Most cases involve some aspect of hyperactivity, which can range from fidgety behavior to
overt reckless motion. Some children with ADD do not have any hyperkinetic features.
The diagnosis of ADD is purely clinical and is based on a very careful history by a physician.
The pediatric subspecialists involved in the diagnosis include child neurologists and child
psychiatrists. Treatment is available for the disorder and includes both pharmacological and
non- pharmacological approaches. A combination of therapies is often employed to help the child
reach his or her social and academic potential.
New England Neurological Associates has a learning diagnostic team consisting of pediatric
neurologists, child psychologists, neuropsychologists, and learning specialists. One or more
of these specialists may be involved in consultation with a child, depending on the particular
child�s history. Consultation often starts with the child neurologist, who begins with a very
careful history and physical, and decides whether the diagnosis is appropriate and whether
further work-up consultation is required.
New England Neurological Associates staff with a particular interest in ADD include pediatric
neurologists Dr. Peter Raffalli and Dr. Michael Robbins.
Depression is a common medical illness, with 10-25% of women and 5-12% of men
developing depression over their lifetimes. Symptoms may include depressed mood, anhedonia
(being unable to enjoy previously pleasurable activities), sleep disturbance (either too little
or too much sleep), weight changes, fatigue or loss of energy, inability to think or
concentrate, difficulty making decisions, and recurrent thoughts of suicide or death.
Other symptoms may occur, including headaches, backaches, constipation, memory difficulties,
and increased irritability. To make a diagnosis of major depression these mood changes must
occur every day for at least two weeks.
Treatment of depression often includes both medication and psychotherapy. The most commonly
used medications to treat depression are the selective serotonin reuptake inhibitors (SSRIs),
which include Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), and Luvox
(fluvoxamine). Other newer medications to treat depression include Wellbutrin (bupropion),
Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Older antidepressants
include the tricyclic antidepressants (TCAs) and the monoamine oxidase inhibitors (MAOIs).
The tricyclic antidepressants include: amitryptyline (Elavil), nortriptyline (Pamelor, Aventyl),
imipramine (Tofranil) and desipramine (Norpramine). The monoamine oxidase inhibitors
include phenelzine (Nardil) and tranylcypromine (Parnate).
All of these medications have similar efficacy in treating depression, being effective
60-70 percent of the time. They differ in a variety of ways, including how they work, how long
they last in the body, and the side effects they can cause. The newer antidepressants are used
more frequently because they tend to have fewer side effects and are safer. Further, they are
not associated with dietary restrictions as are the monoamine oxidase inhibitors.
Various psychotherapies are also used to treat depression. Among the most effective are
cognitive therapy and interpersonal psychotherapy. Cognitive therapy focuses on recognizing
how one�s thinking becomes negatively distorted in the context of depression and then offers
strategies to combat these distortions. Interpersonal psychotherapy is a brief (12-16 week)
treatment which focuses on current interpersonal problems and utilizes techniques such as
reassurance, clarification of feeling states, and improvement in interpersonal
communication.
At New England Neurological Associates our psychiatrists are Marc Sadowsky, M.D.
and Devra Cohen, M.D. and our psychologists are Robert Moverman, Ph.D., Karen Karpman, Ph.D.,
and Karen Spangenberg, Ph.D.
Manic Depression
Manic depression is a mood disorder characterized by moods which can range from profound
elation to profound depression. The elated states are called mania while the depressed states
are called depression. This illness is also referred to as bipolar disorder with the two poles
being mania and depression.
Mania is characterized by elated or irritable mood, increased energy, racing thoughts,
decreased need for sleep, and an increase in goal directed activities, including taking on more
projects at work or at home. During a manic episode people may experience an increase in their
sex drives leading to promiscuous behavior and they may engage in spending sprees, spending
thousands of dollars on unnecessary items. In more severe cases of mania psychotic symptoms
may develop in which the person believes that he is a famous, wealthy, or powerful person.
Such beliefs are known as delusions of grandeur.
While mania can often feel very good, it often comes at a cost. Manic episodes are
often followed by depressive episodes which can be severe and in which the person may become
unable to function, depressed, unable to eat, and suicidal. Further, left untreated, these
episodes can worsen over time, becoming more intense and frequent.
Manic depression is a medical illness treated with medications. Psychotherapy and
family involvement are also very important elements in the treatment.
The medications used in manic depression are called mood stabilizing medications.
The most commonly used medication is lithium (Lithonate, Lithobid, Eskalith CR and others).
This is a very effective and safe medication which has been used in Europe since the early
1960s and in the US since the early 1970s. Valproic acid (Depakote) is another common
medication used in this illness. It is an anticonvulsant medication which has been shown to
be effective in manic depression and is now the second most prescribed medication for this
illness. Carbamazepine (Tegretol), another anticonvulsant medication has also been shown to
be an effective mood stabilizer. Newer anticonvulsants including lamotragine (Lamectil)
and gabapentin (Neurontin) are also showing promise but clinical studies regarding their
effectiveness are still ongoing.
Psychiatrists specialize in the pharmacologic treatment of mood disorders. At New
England Neurological Associates our psychiatrists are Marc Sadowsky M.D. and
Devra Cohen, M.D.
Anxiety Disorders
Anxiety disorders are common conditions in the US. According to a recent study,
24.9 percent of Americans will develop an anxiety disorder during their life, with women
(30.5 percent) being more likely than men (19.2 percent) to develop such a disorder.
Anxiety disorders include panic disorder, agoraphobia, generalized anxiety disorder,
simple phobia, and social phobia, with social phobia being the most common at 13.3 percent
of the population.
Panic Disorder
Panic disorder afflicts approximately 3.5 percent of Americans over their lifetimes,
with women (5 percent) being more likely to develop panic than men (2 percent).
A panic attack is defined as a discrete period of intense fear or discomfort in which
people experience the onset of at least four of these symptoms within ten minutes of onset:
1.) palpitations, pounding heart, or accelerated heart rate; 2.) sweating; 3.) trembling
or shaking; 4.) sensations of shortness of breath or smothering; 5.) feeling of choking;
6.) chest pain or discomfort; 7.) nausea or abdominal distress; 8.) feeling dizzy,
unsteady, lightheaded, or faint; 9.) derealization (feeling of unreality) or depersonalization
(being detached from oneself); 10.) fear of losing control or going crazy; 11.) numbness or
tingling sensations; 12.) chills or hot flashes.
Panic disorder is defined as one or more of panic attacks that were unexpected and not
triggered by being the focus of attention of other people. Further, four of these attacks
must occur in a four week period or one or more attacks followed by a one month period of
persistent fear of having another attack.
Panic disorder is often a very disabling condition. People with panic attacks often
feel as though they are having a heart attack and present to an emergency room where they
undergo diagnostic tests which are all normal. This is often quite frustrating because the
person knows that there is something wrong with them but may be told "it�s just a panic
attack" or "it�s in your head."
Although there are no commonly available tests to diagnose panic, there is clear
evidence that there is something different about the nervous systems of people with panic.
For example, most people with panic will develop an attack when injected with a chemical
called sodium lactate, while those without panic will not develop any symptoms.
We also know that medications are often helpful in treating panic, as is psychotherapy.
The two classes of medication used for panic include antidepressants and benzodiazepines.
The antidepressants which have been effective include the selective serotonin reuptake
inhibitors (SSRIs): Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine) and Luvox
(fluvoxamine). The older tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors
(MAOIs) are also effective. The benzodiazepines are the common anti-anxiety medications,
including Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), and Valium (diazepam). The more potent benzodiazepines, Xanax and Klonopin seem to have the greatest efficacy in treating panic disorder.
The antidepressants, although effective, take longer to work than the benzodiazepines
and are often associated with more side effects. However, these are usually once a day
medications and are not addictive. The benzodiazepines work more quickly but have to
be taken several times per day and are medications which are associated with physical
dependence. People with panic are often more sensitive to the side effects of medications
and often benefit from starting with low doses of medication and very gradual increases
in the dosages.
Psychotherapy, particularly cognitive behavioral psychotherapy, is often a very
effective treatment for panic. This therapy focuses on helping the person identify the
symptoms of panic and recognizing that these are not dangerous symptoms but rather exaggerated
responses to normal physiologic phenomena.
At New England Neurological Associates , our psychiatrists are Marc Sadowsky, M.D.
and Devra Cohen, M.D. and our psychologists are Robert Moverman, Ph.D., Karen Karpman, Ph.D.,
and Karen Spangenberg, Ph.D.
The Learning Diagnostic Center provides comprehensive evaluation for children from
kindergarten to college age who are having difficulty in school. The Center offers a
multi-disciplinary team approach by a pediatric neurologist, neuropsychologist and
learning disability specialist who provide a detailed and coordinated assessment of
learning patterns.
By assessing intellectual, academic, social and emotional abilities, the team creates
a comprehensive report as the basis for an individually tailored plan of care. Difficulties
may range from neurological problems to a specific learning disability, emotional issues or
a combination of these factors.
The Center also offers an array of counseling, assessment and education services
for parents, schools and gifted individuals.
The Learning Diagnostic Center team includes Pediatric Neurologist Michael B.
Robbins, M.D., F.A.A.P, Pediatric Neurologist Peter C. Raffalli, M.D., Neuropsychologist
Karen E. Karpman, Ph.D., Neuropsychologist Karen B. Spangenberg, Ph.D., Tobi K. Levis,
Carol Strout, and Heather L. Graves.
Disclaimer: The information and references contained
herein are intended solely for the information.
It should not be used for treatment purposes, but rather for
discussion with the patient's own physician.
220 Sutton Street, North Andover, MA 01845
Phone (978) 687-2321 Fax (978) 685-7265