For people who cannot be treated with stimulants due to a substance use disorder or other contraindications, atomoxetine is the suggested first line treatment in the UK. In Canada, clinical guidelines suggest that first line treatment be methylphenidate or lisdexamfetamine. Non-stimulant medications are generally second-line treatments in Canada. Non-stimulant medications
The non-stimulant atomoxetine (Strattera), may be an effective treatment for adult ADHD. Although atomoxetine has a half life similar to stimulants it exhibits delayed onset of therapeutic effects similar to antidepressants. Unlike stimulants which are generally controlled substances, atomoxetine lacks addictive potential. It is particularly effective for those with the predominantly inattentive concentration type of attention deficit due to being primarily a norepinephrine reuptake inhibitor. It is often prescribed in adults who cannot tolerate the side effects of amphetamines or methylphenidate. It is also approved for ADHD by the US Food and Drug Administration. A rare but potentially severe side effect includes liver damage and increased suicidal ideation.Viloxazine is a selective norepinephrine reuptake inhibitor that was FDA-approved to treat ADHD in children, adolescents, and adults.Bupropion and desipramine are two antidepressants that have demonstrated some evidence of effectiveness in the management of ADHD particularly when there is comorbid major depression, although antidepressants have lower treatment effect sizes. Psychotherapy
Psychotherapy, including behavioral therapy, can help an adult with ADHD monitor their own behaviour and provide skills for improving organization and efficiency in daily tasks. Research has shown that, alongside medication, psychological interventions in adults can be effective in reducing symptomatic deficiencies.
Alternatively, it is proposed that the high levels of ACTH, β-lipotropin, and γ-lipotropin, which contain weak MSH function, can act on the melanocortin 1 receptor. A variant of Cushings disease can be caused by ectopic, i.e. extra pituitary, ACTH production from, for example, a small-cell lung cancer.When Cushings syndrome is caused by an increase of cortisol at the level of the adrenal glands (via an adenoma or hyperplasia), negative feedback ultimately reduces ACTH production in the pituitary. In these cases, ACTH levels remain low and no hyperpigmentation develops. Causes
Cushings syndrome may result from any cause of increased glucocorticoid levels, whether due to medication or internal processes. Some sources however do not consider the glucocorticoid medication-induced condition as "Cushings syndrome" proper, instead using the term "Cushingoid" to describe the medications side effects which mimic the endogenous condition.Cushings disease is a specific type of Cushings syndrome caused by a pituitary tumor leading to excessive production of ACTH (adrenocorticotropic hormone). Excessive ACTH stimulates the adrenal cortex to produce high levels of cortisol, producing the disease state. While all Cushings disease gives Cushings syndrome, not all Cushings syndrome is due to Cushings disease. Several possible causes of Cushings syndrome are known. Exogenous
The most common cause of Cushings syndrome is the use of prescribed glucocorticoids to treat other diseases (iatrogenic Cushings syndrome). Glucocorticoids are used in treatment of a variety of disorders, including asthma and rheumatoid arthritis, and also used for immunosuppression after organ transplants.