ADD/ADHD and Fibromyalgia (FMS): Where Is the Connection?
Glenda H. Davis, MD, and Patricia Stephens, CNC
We will refer to both ADHD and ADD as "ADD." We encourage you to: 1) forget any preconceived ideas about what ADD is or isn’t; 2) read with an open mind; 3) seek to learn all you can about adult ADD.
Two years ago we raised the question, "Is there a connection [between ADD and FMS]?"(2). We believe there is, since ADD and FMS: a) respond to the same medications (stimulants), b) have similar symptoms, c) run in the same families.
An ADD work-up typically evaluates emotional and behavioral, but not physical, symptoms, whereas an FMS work-up usually evaluates physical, but not emotional or behavioral, symptoms. But when ADD and FMS patients are asked the same questions, the similarities between these two conditions are more obvious.
NOTE: There is no advantage for an ADD patient to seek a FMS diagnosis, and there may be disadvantages. Stimulants cannot legally be used to treat the FMS. However, if a FMS patient meets ADD criteria and obtains treatment for ADD, the FMS symptoms improve as well.
The Connecting Link: Autonomic Nervous System Dysfunction
ADD and FMS may actually be different manifestations, at different ages, of a common underlying autonomic nervous system dysfunction. ADD is usually diagnosed in childhood; FMS is usually diagnosed in adulthood. But many FMS adults struggle with concentration all their lives, compensating, often using lists and other reminders to help them remember important things. Secretaries often organize for executives with ADD. Some who memorize easily perhaps excelled in school, but never really learned the material. Others performed at an above average level, but still below their ability.
Thousands of letters responding to www.add-fibromyalgia.com support our hypothesis that ADD and FMS frequently coexist. Compensating for ADD throughout life can be stressful. Chronic stress eventually takes a physical toll --peptic ulcers, irritable bowel syndrome, headaches, muscle aches, fatigue, and other commonly associated FMS symptoms. Dr. Daniel Amen expresses the same view in his book Healing ADD. "Fibromyalgia and ADD commonly coexist. I think the chronic stress associated with ADD is in part responsible for the muscle pain"(1).
Autonomic Dysfunction Disorder = the real ADD?
The common denominator for ADD and FMS may be autonomic nervous system (ANS) dysfunction. The ANS is composed of the sympathetic ("fight or flight"), parasympathetic ("rest and digest"), endocrine (hormones), and enteric (gut) nervous systems. When these systems are balanced, the body is healthy. When they are unbalanced, the body is not. Since the ANS affects every organ system in the body, it is not surprising that the symptoms associated with ADD and FMS are so varied. It may show up in several members of one family, in several different presentations.
In general, with increased sympathetic nervous system tone, the person is geared up --"hyper"-- and has difficulty relaxing; with increased parasympathetic nervous system tone, the person appears "lazy" or "sluggish." But the systems are interrelated in complex ways, with innumerable possible variations. An excellent book on the many presentations of adult ADD is DRIVEN TO DISTRACTION by Drs. Hallowell and Ratey.
Symptoms common to both ADD and FMS
· Low stress tolerance
· Concentration or memory problems
· Mood swings, depression, anxiety
· Poor organizational skills
· Low energy
· Difficulty relaxing
· Sleep disturbances
· Poor regulation of body temperature
· Skin rashes, itching
· Urinary frequency
· Reflux, gastritis, ulcers, constipation or diarrhea
· Aches and pains
· Low or high blood pressure
· Yeast or fungal infections
· Allergies, asthma, bronchitis, sinusitis
· Sexual over- or under-arousal
· Numbness and tingling (carpal tunnel symptoms, legs "going to sleep," etc.)
· Heart-related symptoms (chest tightness, palpitations, etc )
· Poor coordination, other gross motor skills
· Poor handwriting, other fine motor skills
· Impulsive eating or spending
How Do the Stimulants Work?
Stimulants seem to act by increasing levels of dopamine and norepinephrine at neuronal synapses. Based on our observations, they also stimulate the adrenal glands to produce more cortisol. When on a stimulant for ADD, a person’s immune system works better--less asthma, allergies, infections, and skin rashes.
The right dose of the right medication (stimulant) for ADD/FMS (ADD with FMS) is the least amount that produces maximal benefits with NO side effects. See www.add-fibromyalgia.com for specifics on regulating medications.
When a woman with ADD/FMS is on the right dose of the right medication, it is like turning on the light in a previously dark room. The difference is amazing! But if a person has always lived with what we call "ADD" (with the attention deficit being only a small part of the picture), she thinks nothing is wrong. She has always been that way. And since he is like other family members, problems are minimized, because "it runs in the family." We gauge "normal" in relation to ourself and our family. That is why it is sometimes a challenge to convince an individual with ADD to consider treatment, even when problems are obvious to others. If the person could ever experience "normal" (whatever that is), then he could make a better-informed decision as to whether he prefers to be treated or not.
No problem with addiction to stimulants has been observed, even in people with a history of drug abuse. If an individual has a history of drug abuse, we monitor them closely, but no habituation has been noted. That is, once we find the optimal dose, it continues to work indefinitely without any need to increase dosage. If a patient takes other medicines, especially pain medicine, they are often able to reduce the dosage of these other medicines.
The stimulant dose needed sometimes varies with hormonal fluctuations and with increased or decreased stress levels. During those times, we recommend adjusting the dose slightly as needed (with the doctor’s permission), up or down, depending on how your system works. If your maintenance dose begins causing side effects, it may mean you need to cut back. At times of major hormonal upheavals, such as puberty, pregnancy, childbirth, and menopause, permanent adjustments may have to be made, either up or down. They should be made slowly, based on response. Some women need hormone replacement for the stimulant to be most effective. Other women do not need hormonal supplementation and do well in menopause taking only the stimulant.
Herbal Supplements and Treatment of ADD/FMS
Herbal supplementation is valid in the treatment of ADD/FMS. But the stimulants are much easier to regulate initially if there are no supplements on board. The more supplements on board, the more difficult it is to regulate the stimulant. If you anticipate getting an ADD work-up, stop all the supplements you can before going to the doctor. If you must take supplements while beginning a stimulant, take the supplements faithfully, not intermittently. If you change what you take from day to day, it becomes nearly impossible to know which medication or supplement is causing a particular effect.
Once you have attained better clarity of mind, better physical well-being, and better organizational ability, you may want to tackle the herbal route. But initially the stimulants are much easier to use to attain quality of life. If you cannot find a physician, or prefer to use herbals, or stimulants do not agree with you, herbals are an option. See our web site (www.add-fibromyalgia.com) for details.
Important points to remember:
Be patient. It takes some detective work to find the right dose, but it is worth the effort. The stimulant may have to be used with an antidepressant or another medication. What works for one woman will not necessarily work for another. You were created as a unique human being.
Be perceptive. If you have side effects with the stimulant, notice what they are, what time they occur, and when you took your last dose. It may be a side effect of the medication, or it may be time for another dose. Report all this information to your physician or coach, so they can help you adjust the dose or the timing.
Be persistent. Never give up! You may not feel significantly better until you are near the right dose. We start with small doses to minimize side effects, so it may take a while to titrate to your right dose. But there is a better life available. Keep studying and pursuing answers until you have them.
Be pro-active. Share your successes with others. Once you find your right combination, help others find theirs. Talk with people who can change laws to allow freedom in prescribing stimulants for those who need them. Encourage others to seek treatment if needed. Be willing to tell them your experience.
1. Amen, D (2001).Healing ADD. Putman's Sons Publishing Co., pp. 261-262.
2. Davis, GH. (2000). "ADD/ADHD and Fibromyalgia: Is There a Connection?" ADDvance Magazine, Jan/Feb, pp. 13-16.
3. Krause KH, Krause J, Magyarosy I, et al.(1998). "Fibromyalgia Syndrome and Attention Deficit Hyperactivity Disorder: Is there a comorbidity and are there consequences for the therapy of Fibromyalgia Syndrome?" The Journal of Muscoloskeletal Pain, 6, pp.111-116.
4. Stephens, P. (Jan/Feb, 2000). "Fibromyalgia Responds to Attention Deficit Disorder Medications," ADDvance Magazine, p. 17.
(The following article was published in ADDvance On-Line Magazine August 2002.)