Attention disorders—including AHDH—are one of the most common mental health issues in the United States. According to recent estimates, more than six million U.S. children (9.4%) have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). [1]
While ADHD and other attention disorders tend to be associated primarily with children, adults of any age—including seniors—can also struggle with this condition. In fact, research suggests that around 4.4% of U.S. adults have an attention disorder. [2]
While ADHD can affect adults of any age, there’s very little research on how it impacts those who are well past middle age, i.e., the senior or older adult population. Because there’s no standardized screening for ADHD in seniors, it’s often more difficult to diagnose older adults with ADHD. Unless the person received an ADHD diagnosis when they were young, they are not likely to get one as an adult.
Also, research has confirmed that seniors with ADHD experience a unique cluster of symptoms that overlap with and are often mistaken for normal signs of aging. [3] As a result, ADHD is frequently misdiagnosed, and the symptoms are mismanaged in people over the age of 60. If memory and focus problems are plaguing a person at midlife or beyond, it could be undiagnosed ADHD. [4]
For people interested in learning more about ADHD in seniors—and the treatment options available for themselves or a loved one—the sections below provide vital information.
Topics covered include how to identify ADHD in older adults, how ADHD affects older women differently than men, and a range of treatment possibilities including transcranial magnetic stimulation (TMS)—a cutting-edge drug-free therapy that has shown great promise.
What is ADHD?
Attention deficit/hyperactivity disorder—or ADHD for short—is a neuropsychiatric and neurodevelopment disorder that typically begins in childhood and continues throughout a person’s life. [5]
Neuropsychiatry deals with behavioral or psychiatric disorders in people with neurological conditions. Neurodevelopmental disorders have to do with the functioning of the brain and neurological system. A person with ADHD has differences in brain development and brain activity that affect their capacity to concentrate, their ability to sit still, and their self-control.
ADHD symptoms can seriously disrupt a person’s school, work, family, and social relationships. Tasks that require calmness, focus, and sustained attention tend to be very challenging for children or adults with an attention disorder. If ADHD is left untreated, it can hamper a child’s social and educational growth, interfere with an adult’s ability to pursue their life goals, and tarnish the “golden years” of older adults.
Three Major ADHD Symptoms
In order to diagnose ADHD, counselors, psychiatrists, and other mental health professionals use the criteria described in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). [6]
According to the DSM-5, ADHD has three major symptoms, which are:
- Inattention—not being able to concentrate or stay focused.
- Hyperactivity—an excessive movement that is not appropriate to the setting.
- Impulsivity—hasty actions that occur without appropriate forethought.
Depending upon which symptoms are most prevalent, an individual may be diagnosed with an inattentive type of ADHD or with a hyperactive/impulsive type of ADHD. If both sets of symptoms are present, they will be diagnosed with a combined type of ADHD.
Do People Outgrow ADHD?
Is it likely for a child who has been diagnosed with ADHD to eventually outgrow the disease? While this was once commonly believed, recent research suggests that it’s generally not true.
When symptoms of ADHD first appear in childhood, it’s very common for them to continue into adulthood. Although there may be periods during which the disorder goes into remission, 90% of children with ADHD continue to experience at least some symptoms as adults. [7]
ADHD in Seniors
Symptoms of attention-deficit/hyperactivity disorder may flare up in a person’s midlife or elder years. This is because ADHD symptoms can intermingle with—and often be confused with—age-related cognitive decline and physical health challenges. In addition, the lack of daily structure that often accompanies retirement may exacerbate certain ADHD symptoms.
Older Adult ADHD Symptoms
The symptoms of ADHD can look quite different during the various stages of a person’s lifetime. With the transitions from childhood to adolescence, to young adulthood and midlife, and then to the senior years—ADHD symptoms tend to shift and change. While there will be some overlap, what ADHD looks like in a young child and what it looks like in an older adult are likely to be quite distinct.
For instance, older adults with ADHD tend to struggle most with attention, memory, and planning. They may have a hard time finishing projects or consistently recalling information. They may frequently become distracted during conversations—finding it hard to stay focused. And they may find it challenging to cultivate and/or maintain relationships. [8]
Older adults who have recently retired—and so no longer have a well-defined and consistent workday structure—may experience an exacerbation of ADHD symptoms. This is akin to children or young adults with ADHD losing the structure of the school day, either during summer vacation or after graduating. During their retirement years, seniors may experience challenges with time management or procrastination—perhaps accompanied by feelings of guilt or anxiety.
As a person grows older, the expression of their ADHD symptoms may change. While each individual will have a unique symptom profile, the following symptoms appear quite frequently in older adults with ADHD:
- Feeling restless or impatient
- Being easily distracted
- Being disorganized
- Forgetfulness
- Leaving tasks unfinished
- Problems focusing on a task
- Physical, verbal, and/or emotional hyperactivity
- Having trouble relaxing
- Poor time management
- Being late
- Difficulty starting a task
- Interrupting others
- Angry outbursts
- Mood swings
- Difficulty prioritizing activities
- Extreme impatience
- Impulsivity or recklessness
- Excessive fidgeting
- Talking too much
- Interrupting others
- Trouble following conversations
- Inability to sit quietly for long
- Low frustration tolerance
- Losing or misplacing items
- Forgetting words or names
- Brain going “blank” every now and again
- Difficulty learning new things
- Problems maintaining relationships
Challenges for Older Adults with ADHD
Attention deficit/hyperactivity disorder can negatively impact the lives of older adults in a variety of ways. Some of the biggest challenges faced by seniors with ADHD include the following:
* Not getting things done. Struggles with procrastination, lack of self-discipline, or inability to follow through with a plan of action.
* Having “Swiss-cheese memory.” Having a memory that—while not consistently failing—is no longer entirely dependable. Certain things are easy to remember, but others slip through the cracks.
* Experiencing out-of-control emotions. Feeling agitated or irritable more often than in the past; struggling with anxiety or other mood disorders.
* Having time-management issues. Problems establishing and maintaining a daily routine; or making and following through with planned activities or meetings.
* Enduring the remnants of hyperactivity. Feeling restless, on edge, or fidgety; talking too much; or having random thoughts swirling in mind.
* Social awkwardness. Feeling misunderstood or judged, missing social cues, interrupting or speaking impulsively.
ADHD in Older Women
Because of hormonal changes associated with perimenopause, ADHD affects older women differently than it does older men. These changes typically occur for women in their mid-40s to early-50s. And ADHD symptoms may become more severe during these years. [9]
During perimenopause, estrogen levels within a woman’s body decrease steadily. The decreasing estrogen levels negatively impact short-term memory and the ability to concentrate—contributing to the “brain fog” described by many women during perimenopause. With estrogen levels plummeting in this way, even ADHD stimulant medication may become ineffective in relieving ADHD symptoms.
When estrogen levels decrease, it also affects dopamine levels. Dopamine is one of the feel-good neurotransmitters—a chemical in the brain that plays a role in motivation, reward, and the experience of pleasure. Since dopamine already tends to be low in people with ADHD, a perimenopause-related dip can result in more intense mood swings, feelings of depression and anxiety, and an inability to focus among older women with ADHD.
ADHD Treatment
What treatments are available for senior ADHD?
Within the western medical community, pharmaceutical medications are often the first line of treatment for children or adults diagnosed with ADHD. These medicines are of two general types: stimulants and non-stimulant. While these medicines can sometimes be effective at reducing ADHD symptoms, there are side effects—some of which are of special concern for older adults.
Medications for ADHD
Most prescription ADHD medications come in tablet, capsule, or liquid form, which the person takes by mouth. Stimulant and non-stimulant varieties of ADHD medications affect the brain in slightly different ways.
Stimulant medicines increase the levels of the neurotransmitters dopamine and norepinephrine within the brain. These brain chemicals enhance an individual’s ability to stay focused and motivated—so increasing their levels can help to ease the symptoms of a person struggling with ADHD.
Common brand names of stimulant ADHD medications include Ritalin, Adderall, Focalin, Concerta, and ProCentra.
Nonstimulants are a newer variety of ADHD medicine. Non-stimulant ADHD medicines work by increasing the levels of the neurotransmitter norepinephrine in the brain. Some common brand names of non-stimulant medications include Strattera, Qelbree, Intuniv, and Kapvay.
The Problem with ADHD Medication
While ADHD medications may reduce symptoms for some people, they may also be entirely ineffective. These medicines may fail to significantly reduce symptoms and/or may have debilitating side effects that are as bad as or even worse than the ADHD symptoms.
Some common side effects of ADHD medications include:
- Headache
- Weight loss
- Mood changes
- Sleep problems
- Upset stomach
- Decreased appetite
- Growth delay
- Exacerbated tic disorder
- Blood pressure and heart rate changes
Some of the side effects of ADHD medications may affect older adults in potentially dangerous ways. For instance, as a person ages, their ability to tolerate drugs safely is likely to change. And newly added drugs may interact with other medicines they also take to treat other conditions.
Seniors must also consider the cardiac risks of ADHD medications. These risks include the potential for increased blood pressure and heart rate, along with damage to the heart’s conduction system, including the increased risk of an arrhythmia (irregular heartbeat). These ADHD side effects are particularly relevant for people with a history of heart problems. [10]
Other Strategies to Manage ADHD
There are a variety of self-care and lifestyle changes that can help manage the symptoms of ADHD. These non-drug strategies include:
- Psychological counseling
- Neurofeedback
- Mindfulness training
- Organizational skills training
- Time management training
Psychological therapy, in particular, can be especially useful for cultivating tools to more skillfully relate to ADHD symptoms. A skilled counselor—utilizing modalities such as cognitive behavioral therapy, dialectical behavior therapy, mindfulness-based cognitive therapy, music therapy, or art therapy—can effectively help a person with ADHD:
- Keep their temper in check
- More effectively control their impulses
- Reduce anxiety
- Feel better about themselves
- Improve their relationships with family and friends
- Manage their time and increase productivity
- Get organized—with lists, alarms, daily planners, calendars
- Enhance life satisfaction
Additionally, lifestyle strategies such as these can be useful in managing ADHD symptoms at home:
* Exercise regularly. Physical activity increases the level of neurotransmitters such as dopamine, norepinephrine, and serotonin—which can help alleviate ADHD symptoms. So, exercising daily is one of the best ways for older adults struggling with ADHD to feel better.
* Get plenty of sleep. Adults with ADHD tend to have significant sleep problems that further complicate their focus and concentration. So having a regular sleep/wake cycle is another excellent strategy for helping to manage ADHD symptoms. Turn off computers, phones, tablets, gaming stations, and TVs at least an hour before bedtime. Install the free app f.lux to decrease blue light exposure during evening hours.
* Reduce or avoid caffeine. Adults with ADHD tend to use caffeine to self-medicate their ADHD. So, best to reduce or avoid caffeine intake. In particular, it’s best for a person with ADHD to avoid caffeine after noon since drinking it later in the day tends to interfere with sleep.
* Create a support network. A person struggling with ADHD is wise to enlist the support of friends and family members to help with creating structure, simplifying tasks, and maintaining meaningful relationships.
ADHD Treatment at Brain Therapy TMS
Brain Therapy TMS provides transcranial magnetic stimulation (TMS) in San Diego, California. TMS can be used to effectively treat a variety of mental health and neuropathic disorders—including attention-deficit/hyperactivity disorder—without the use of medication.
TMS is a proven breakthrough therapy that heals specific areas of the brain that are impaired by brain cell dysfunction. The end result is a significant improvement in mood, function, energy, focus, and general well-being.
Transcranial magnetic stimulation has proven effective in the treatment of childhood ADHD, teen ADHD, as well as adult ADHD. TMS treatments have proven helpful in resolving adult ADHD by:
- Increasing capacity to focus on important tasks
- Decreasing feelings of jitteriness and worry
- Improving organizational strategies
- Enhancing efficiency in work and recreation
- Amplifying feelings of confidence and control
Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of ADHD. During a TMS session, an electromagnet delivers a painless magnetic pulse that stimulates nerve cells in the region of the brain involved in the creation of ADHD symptoms. It activates regions of the brain that have decreased activity in the older adult with ADHD.
The benefits of TMS for older adults diagnosed with ADHD include:
- High success rate: TMS has a considerably higher success rate than any other treatments
- Medication reduction: Enables people with ADHD to entirely stop or significantly reduce ADHD medications
- Non-Invasive: TMS treatment is entirely external to the body
- Non-Sedative: TMS requires no sedation and is relatively painless
- Minimal to No Side Effects: TMS has no side effects in the vast majority of patients
The mission of our San Diego TMS Therapy Clinic is to help adults resolve the debilitating effects of ADHD with TMS, which has been proven to be a highly effective long-term solution.
To learn more about TMS therapy and how it can support the healing of ADHD in older adults, sign up for a free consultation today.
FAQs
Is TMS approved for ADHD? ›
TransCranial Magnetic Stimulation or TMS is an FDA approved and evidence-based mental health treatment. This treatment uses a medical device that applies magnetic pulses noninvasively to the cortex of the brain to depolarize neurons. Studies have found that TMS is a safe, non-intrusive, and effective way to treat ADHD.
What is the average cost of TMS therapy? ›Although the price will vary depending on where it is administered, one TMS therapy session typically costs approximately $300. Due to the necessity of having multiple sessions over several weeks, the total cost for a course of TMS therapy is roughly between $6,000 and $12,000.
Who is not a candidate for TMS therapy? ›You may not be a candidate for TMS if:
You have implants controlled by physiological signals. This includes pacemakers, implantable cardioverter defibrillators (ICDs), and vagus nerve stimulators (VNS) You are at high risk such as those with epilepsy, a history of head injury, or other serious neurologic issues.
Facial twitching during the treatment. Skin redness at site of coil placement. Anxiety before and during treatment.
Can you take Adderall while doing TMS? ›Stimulant Medication to Improve rTMS Treatment Outcome
We have recently found that patients treated in our clinic who were taking low dose psychostimulant medications (e.g., Adderall or Ritalin), tended to have greater improvement during their course of TMS treatment.
Transcranial Magnetic Stimulation (TMS) is a new innovative treatment for those who suffer from ADHD. TMS involves influencing the electrical activity in the human brain. This is done to treat a variety of different mental health disorders.
What is the failure rate of TMS? ›Most TMS providers find that TMS has a success rate at between 70% or 80%, meaning that the vast majority of individuals find significant relief after treatment. About 50% of people experience complete remission, meaning that the symptoms of depression are absent after just one course of treatment.
How long does TMS results last? ›Most patients who complete TMS treatment experience relief from symptoms of depression for six months to a year. Your results could also last for more than a year.
How many TMS sessions per week? ›TMS takes multiple treatments — typically three to five per week — spread out over several weeks. For FDA-approved protocols for depression, a typical TMS course happens every weekday over six weeks for a total of 30 treatments.
Do you still take antidepressants with TMS? ›TMS therapy can be combined with medication like antidepressants if needed. For example, some patients get some benefits from antidepressants, but they still have many symptoms that interfere with their quality of life. Such patients can benefit from continuing with medication while getting TMS treatments.
What is an alternative to TMS therapy? ›
Electroconvulsive Therapy for Depression
But ECT is proven to be effective in the treatment of depression, so it's an option for patients who don't see success with TMS.
What is the Criteria for TMS Therapy? To qualify for coverage, patients must have been diagnosed with MDD and already tried psychotherapy and at least four antidepressants from two different drug classes (SSRIs, SNRIs, MAOIs, or atypical agents) without seeing results.
Why is TMS controversial? ›TMS has several harmful potential side-effects, including induced seizures, syncope, transient induction of hypomania, discomfort or pain, cognitive changes, hearing loss, and transient impairment of working memory [20].
Does TMS cause memory loss? ›Does TMS Therapy cause memory loss? No, the NeuroStar TMS Therapy system was systematically evaluated for its effects on memory. Clinical trials demonstrated that NeuroStar TMS Therapy does not result in any negative effects on memory or concentration.
Are there permanent side effects of TMS? ›TMS (neither rTMS nor dTMS) is also not associated with any long-term side effects. Short-term side effects that have been reported include scalp discomfort and headache that often go away within the first week of treatment.
What is the best medication for ADHD and depression? ›SSRIs are the most commonly prescribed antidepressants and include sertraline (Zoloft), fluoxetine (Prozac), and paroxetine (Paxil). These medications may also be prescribed along with ADHD stimulant medications to help alleviate symptoms of both.
Will TMS give me more energy? ›In most cases, the first positive effect noticed is an improvement in sleep quality. As the sessions continue, the individual will begin to notice increased energy levels, improved concentration, and eventually improved mood. TMS is noninvasive, meaning no surgery or implanting of a device is involved.
Does caffeine affect TMS? ›Try Caffeine Prior to Treatment
Caffeine is a stimulant that can work to increase the positive benefits of what TMS does – stimulate parts of the brain affected by depression by sending magnetic pulses.
Cognitive-Behavioral Therapy for ADHD
Cognitive-behavioral therapy is generally considered the gold standard for ADHD psychotherapy. While “regular” CBT can be helpful for ADHD, there are also specific types of CBT for ADHD.
TMS Treatment for the Elderly
TMS is extremely well-tolerated in the Elderly and causes none of the side effects of medications.
What is the best stimulation for ADHD? ›
High-risk activities — driving fast, motorcycle riding, and waterskiing — motivate ADHD brains to focus. Some extreme activities, like daring ski jumps, sky-diving, or taking fast-acting street drugs, elicit a dopamine spike, the brain's most intense reward.
Does TMS rewire the brain? ›It delivers small electrical currents to specific parts of the brain. This energy helps stimulate nerves in the area, improving brain chemical balance and communication in neural networks. With regular treatment, this process can produce longer-lasting changes in brain activity, essentially rewiring how it works.
Does TMS disrupt the brain? ›These magnetic fields do not directly affect the whole brain; they only reach about 2-3 centimeters into the brain directly beneath the treatment coil.
Can TMS disrupt brain function? ›In motor cortex, a single TMS pulse can cause disruption in the contralateral hand muscles for ∼200 ms. These different temporal windows of disruption across different brain regions suggest that TMS differentially affects different cortical tissue, which may depend on overall neuronal size and orientation.
Does TMS cause weight gain? ›But the one thing that is not associated with weight gain is TMS. Transcranial Magnetic Stimulation is becoming a fantastic means of treating depression or PTSD (amongst many other forms of mental illness) and thus far, weight gain is not a side effect.
How many sessions does it take for TMS to start working? ›How many sessions does it take for TMS to work? These therapy sessions generally take place five days per week for four to six weeks, with 30 or more sessions within that time frame. Patients tend to gain benefits within this treatment period, while the point at which you first notice results may vary.
How many times can you have TMS? ›During a typical course, you'll receive around 36 treatments over a nine week period. You'll undergo five treatment sessions per week for the first six weeks, and then taper down the remaining six sessions over the following three weeks.
Are you asleep during TMS? ›TMS does not require any sedation or general anesthesia, so patients are fully awake and aware during the treatment.
What is the success rate with TMS? ›Based on the data available from most TMS providers, the success rate stands between 70% and 80%, meaning that most people who undergo treatment experience relief after the treatment. Approximately 50% of patients go into full remission, meaning they become completely asymptomatic after one treatment routine.
Is TMS treatment painful? ›TMS is so painless that the procedure is done while patients are awake and alert. Unlike prescription drug therapy, TMS does not cause side effects that may alter other systems of the body.
Can you drive after TMS? ›
Unlike ECT, TMS does not require any sedation or general anaesthesia, so patients are fully awake and aware during the treatment. There is no “recovery time”, so patients can drive home afterwards and return to their usual activities.
Can you drink alcohol after TMS therapy? ›Alcohol is a depressant, so if you are going through TMS therapy, it may be counteractive to drink on the weekends. A glass of wine or a beer every so often won't hurt, but excessive drinking should be avoided.
How is life after TMS treatment? ›Life After TMS Therapy
Following treatment, you'll likely notice the improvement in your symptoms. You may find yourself sleeping better, feeling less sad or hopeless, being less fatigued or exhausted, or having more interest in things you typically would enjoy. Your lived experience is a great reporting tool.
- rTMS-repetitive Transcranial Magnetic Stimulation. ...
- dTMS-deep Transcranial Magnetic Stimulation. ...
- iTBS-intermittent Theta Burst Stimulation. ...
- aTMS-accelerated Transcranial Magnetic Stimulation TMS.
This procedure has been used for diagnostic and therapeutic purposes, with an approved therapeutic application for a subset of people with depression. There are 3 basic types of TMS: single-pulse, paired pulse, or repetitive TMS (rTMS). In single-pulse TMS, one pulse is applied no faster than once every few seconds.
Is TMS worth the cost? ›The results of TMS will also last for a year for over 62.5% of patients. Additionally, aside from being an effective cost alternative to antidepressants, TMS is also efficient in relieving the symptoms of treatment-resistant depression. Some also find no side effects to this therapy.
How long does it take insurance to approve TMS? ›After that, the time it takes for the insurance company to authorize the treatment will depend on several factors. Most insurance companies that are in-network will only take five to seven business days to approve the procedure. In rare cases, it can take up to fifteen days.
What are the age requirements for TMS? ›TMS is authorized by the FDA for adults 18-70 years of age, and is considered an "off-label" procedure for persons under 18 years.
Does TMS require a psychiatrist? ›A TMS or transcranial magnetic stimulation needs a psychiatric evaluation.
What diagnosis is TMS approved for? ›Transcranial Magnetic Stimulation (TMS) is FDA approved for the treatment of depression and obsessive-compulsive disorders.
What has the FDA approved TMS for? ›
These include MDD, OCD, smoking cessation, Alzheimer's Disease (AD), autism, bipolar disorder, chronic pain, multiple sclerosis (MS), Parkinson's Disease, post-stroke rehabilitation, post-traumatic stress disorder (PTSD) and the negative symptoms of Schizophrenia.
Can EFT help with ADHD? ›EFT is used for many challenges — including those that arise from the symptoms of attention deficit disorder (ADHD or ADD) — to provide rapid and lasting results. It can be done with a practitioner, or, if learned correctly, by yourself.
What is TMS approved to treat? ›TMS has approval from the U.S. Food and Drug Administration (FDA) to treat four conditions: Major depressive disorder (MDD) (including treatment-resistant depression). Obsessive-compulsive disorder (OCD). Migraines.
What are the long term side effects of TMS? ›TMS (neither rTMS nor dTMS) is also not associated with any long-term side effects. Short-term side effects that have been reported include scalp discomfort and headache that often go away within the first week of treatment.
What is the success rate of TMS therapy? ›Does TMS work? Approximately 50% to 60% of people with depression who have tried and failed to receive benefit from medications experience a clinically meaningful response with TMS.
How long does TMS therapy last? ›Most patients who complete TMS treatment experience relief from symptoms of depression for six months to a year. Your results could also last for more than a year.
Is TMS safer than medication? ›TMS is a non-invasive, targeted treatment that is statistically safer than any antidepressant medication.
What is the new type of TMS therapy? ›The investigators from Stanford University and nearby Palo Alto University made use of a new form of TMS known as intermittent theta-burst stimulation, which can deliver therapeutic doses of magnetic energy in as little as three minutes. With this reduced time, the researchers could set up multiple sessions in one day.
Can you do TMS at home? ›TMS home devices are becoming popular among those suffering from depression, anxiety, and insomnia as they can implement home brain stimulation in a cost-effective and safe setting. Before purchasing a TMS device, it is essential to understand how the self-guided treatment works to ensure it is suitable.
How can I stimulate my brain with ADHD? ›High-risk activities — driving fast, motorcycle riding, and waterskiing — motivate ADHD brains to focus. Some extreme activities, like daring ski jumps, sky-diving, or taking fast-acting street drugs, elicit a dopamine spike, the brain's most intense reward.
How can I stimulate my brain with ADHD naturally? ›
Exercise helps the ADHD brain function more effectively and efficiently. One well-known benefit of exercise is an increase in endorphins, which can improve mood. Exercise also elevates the brain's levels of dopamine, norepinephrine, and serotonin, which increases focus and attention.
What does TMS do to your brain? ›These electrical currents activate cells within the brain which are thought to release neurotransmitters like serotonin, norepinephrine, and dopamine. Since depression is thought to be the result of an imbalance of these chemicals in the brain, TMS can restore that balance and, thus, relieve depression.
Do you need medication after TMS? ›TMS eliminates the need for medication – Many people begin their TMS therapy treatment while still on antidepressant medications, and then slowly taper off. Often, the TMS is so effective that they are able to live symptom-free without medication.
How many treatments before TMS works? ›How many sessions does it take for TMS to work? These therapy sessions generally take place five days per week for four to six weeks, with 30 or more sessions within that time frame. Patients tend to gain benefits within this treatment period, while the point at which you first notice results may vary.