Adults seeking treatment for ADD often come because their children have been identified; others come because they were diagnosed, or at least discussed, as ADD while a child. (For my purposes there is no distinction between ADD and ADHD; only a question of whether mental hyperactivity is externally obvious or not).

Stimulant medication is of course the first line of treatment; and it is most often given by a psychiatrist or a general practitioner who has no intention of providing psychotherapy of any sort, let alone psychotherapy that might be specially directed to adult ADDers. For many patients this simple intervention alone, along with some reading perhaps, can improve functioning enormously.

But what if it doesn’t?

Despite ever mounting evidence of the profound and pervasive influence of attentional disorders in a range of public spheres, from depression to substance abuse, from the educational system to the penal system, these conditions remain poorly understood, inaccurately diagnosed, and ineffectively treated.

I am constantly meeting patients who have been evaluated by multiple psychiatrists and/or multiple therapists. Nevertheless they have no clear idea what the practitioners thought was wrong with them or why they were being given certain medications and/or therapy.

The average patient goes into the average psychiatrist's or psychotherapist's office, or even more likely into the average internist's office, complaining that he or she doesn't feel right. They may talk about physical anxiety, either constant hyperarousal, or intermittent explosions of panic and dread, or perhaps they just can't relax, don't feel themselves.

Bipolar illness is a very common but poorly understood set of conditions, a group of conditions that, like its cousin ADD, is routinely misdiagnosed and mistreated. When people are stuck, when they seem to be mysteriously unable to function at a level commensurate with their intellect, bipolar illness is often the lurking culprit.

A few important points about bipolar illness:

1. Most bipolar illness is not "manic" in the classic sense; (racing speech, hyper-sexuality, senseless spending, no sleep, literally "crazy") Depression is much more common

Its been a busy month for mental health in the media. First there was another university shooting; this time five were killed. This was followed rather quickly by the bloody stabbing and murder of a private psychotherapist in her manhattan office. In between were two front page articles in the New York Times, one that reported depression spiking worldwide across all cultures in the fortties and fifties; and the second that reported an alarming and rapid rise in the rate of suicides among forty and fifty year old americans.

Last week The New York Times printed an article on its front page calling attention to the fact that pharmaceutical companies have been routinely failing to report and publish studies of anti-depressant efficacy that do not support the drugs they are manufacturing/testing. Even the most positive interpretation of antidepressant efficacy studies only claim a 60/40 advantage over placebo;according to the Times when a fuller sample of studies is taken this advantage gets even smaller, perhaps even to the point of nonexistence.

A study has been conducted at the UCLA department of psychiatry testing the proposition that training in mindfulness meditation in a group setting can have a positive effects on the symptoms of adult ADD. Results were highly promising and suggest that there is a role for structured mental exercise of various sorts in the treatment of both the underlying neurophysiology of ADD as well as in addressing the accumulated secondary complications im mood and executive functioning.(Journal of Attention Disorders jad.sagepub.com)

This ia a simply wonderful book by seventh degree black belt and zen priest Jeff Brooks. Jeff runs a dojo ( a karate studio ) and a zendo (a school for buddhist study and practice) in Northamptom Massachusetts and I found his book so inspiring that I began recommending to my patients the very next day. The book describes his journey as a martial artist and as a Buddhist meditator, and talks about the relation between the two, which he views as inextricably bound.