There is little available data on the intermittent use, or ‘pulse treatment’, of weight-loss drugs. Most guidelines advocate a consistent use of medication for up to 12 months duration, during which time significant and long-term habit change is to be encouraged and supported. However, as our experience of modern weight-loss agents grows, it is apparent that many patients need clinical support long after a formal weight-loss programme. It would seem reasonable that where a patient remains highly motivated, and where the clinical risk supports it, repeated periods of drug treatment are justified to support weight maintenance and prevent the return or worsening, of comorbid disease markers such as type 2 diabetes. Obesity is a chronic disease and even the most successful patients will require long-term support and intervention. It would seem short-sighted to withhold medication when the need is evident. This approach is not common in everyday practice but is likely to be increasingly seen in the years ahead as both the number of treated patients and general clinical experience increases.
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Q: Do adults with ADHD need advocates too?
A: In a manner of speaking, yes. Most adults with ADHD are quite capable of taking care of themselves, that is, of being their own advocates. But sometimes the problems and issues associated with ADHD become so intense that the ADHD patient feels overwhelmed. In times like these, family members may need to act as advocates on their loved one’s behalf.
As with child advocacy, this can cover a lot of territory. For example, it may involve explaining to friends, neighbors, and family members what ADHD is and how it affects the patient’s behavior; or battling with your insurance company to ensure that medication and other forms of treatment arc hilly covered (many companies see ADHD only as a childhood disorder and are reluctant to reimburse treatment for adults); or working closely with the patient to help him avoid the day-to-day obstacles that can make life so miserable for people with ADHD.
In most cases, however, being an advocate for an adult with ADHD simply means offering ample amounts of love, compassion, and, most importantly, understanding. Dealing with ADHD can be extremely difficult when you’re a child. But it’s even more arduous when you’re an adult.
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Looked at objectively, the use of will-power mechanisms to ignore a signal which is a warning of overload of the nervous system, would seem foolish, and expensive. It is. However, some people make a habit of doing just that. They have been trained to ignore body feelings of tension and anxiety, and to suppress open display of emotion.
Many different cultures set out deliberately to train young people to do this, placing great value on keeping a stiff upper hp. During World War II, the personality characteristic of being able to endure stressful circumstances, feeling fear and anxiety but not outwardly showing it, was considered a desirable quality for selecting people for aircraft crew. However, an undesirable side-effect of selecting unflappable people to fly aircraft and drop bombs in situations of great peril, was the selection of a number of people who had the potential to break down quite suddenly.
My understanding of the case histories of pilots and other air crew, who broke down under combat stress, is that these men habitually kept their emotions in check until they ran right out of inhibitory reserve and then, quite unexpectedly, they broke down. This is not to say that these people were any more or any less capable of carrying out their duties while under severe life-threatening stress than others who tended instead to express their anxiety and fear.
The airmen, who were able to suppress displays of emotion, gave their superiors no hint of warning before their breakdowns. On the other hand, those who displayed their feelings of anxiety readily tended to be grounded because their superiors felt they might break down and become unreliable and inefficient under further stress. For this reason, the men with stoic personalities were over- used and put at risk for sudden breakdown. On the other hand, the anxious worriers were not over-used and tended therefore to be less susceptible to breakdown under stress.

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