ADHD Medication: A Comprehensive Guide

ADHD affects millions worldwide, causing difficulties in attention, hyperactivity, and impulsivity that significantly impact daily life. Adults and children with ADHD may struggle with relationships, education, employment, and navigating life whilst untreated. Fortunately, several treatments, including ADHD medication, therapy, and lifestyle adjustments, are available to help manage these challenges.

ADHD Overview

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity. Individuals with ADHD often struggle with maintaining focus, organizing tasks, and managing impulsive behaviors, significantly impacting daily life [9].

While ADHD is commonly diagnosed in childhood, it can persist into adulthood. Diagnosis typically involves a comprehensive psychiatric evaluation, including clinical interviews, behavioral assessments, and sometimes standardized tests. Treatment for ADHD usually combines behavioral therapy, psychoeducation, and medication such as stimulants or non-stimulants to manage symptoms and improve quality of life effectively [9].

Purpose of ADHD medication

ADHD medications are used to alleviate symptoms of Attention Deficit Hyperactivity Disorder. They improve focus, control impulses, and manage hyperactivity by targeting neurotransmitters like dopamine and norepinephrine in the brain. This can enhance performance in school, work, and social interactions. Medication is an essential part of treatment, alongside behavioral therapy and lifestyle adjustments, for effectively managing ADHD.

What is the most effective ADHD medication?

The effectiveness of ADHD medicines can vary significantly from person to person. Stimulant medications are often considered highly effective and are commonly used to treat ADHD. However, non-stimulant medications or antidepressants are also available for individuals who don’t respond well to stimulants or can’t tolerate their side effects.

Related: Alternatives to Adderall

ADHD Medication: Types and How They Work

Stimulants

Stimulant medications are the primary treatment for ADHD. These medications increase the levels of specific neurotransmitters in the brain, such as dopamine and norepinephrine [4, 13]. These chemicals help improve attention, focus, and impulse control in individuals with ADHD by enhancing communication between neurons involved in these cognitive processes [4, 13].

There are two types of stimulant drugs [4, 13]:

• Immediate-release (Short-acting): Taken as needed, these last up to four hours but can lead to a “crash” afterward, causing mood swings and hunger.
• Extended-release (Long-acting): Taken once daily, they last up to 16 hours, offering more stable symptom control throughout the day.

Stimulant Side Effects

While stimulant medications are effective for managing ADHD symptoms, they can come with potential side effects. It’s important to be aware of these, as they vary from mild to more significant and may affect individuals differently.

Common side effects include [4, 13]:

• Decreased Appetite: Approximately 80% of people may experience reduced appetite.
• Weight Loss: Some individuals may experience unintended weight loss.
• Difficulty Sleeping: Stimulants can affect sleep patterns, making it harder to fall asleep and reducing sleep quality.
• Rebound Effect: After the medication wears off, some individuals may experience a period of increased activity, fatigue, or mood changes.
• Anxiety: Stimulants can occasionally lead to new or increased feelings of anxiety.
• Tics: Some individuals may experience sudden, repetitive movements or sounds, such as eye blinking or throat clearing.
• Minor Growth Delay: Stimulant use may temporarily slow growth in children and adolescents, though it typically doesn’t affect final height.
• Upset Stomach: Nausea and vomiting may occur as potential side effects.
• Changes in Blood Pressure and Heart Rate: Stimulant medications can cause minor fluctuations in blood pressure and a slight increase in heart rate.

These side effects are typically mild and often lessen as the body adapts to the medication or with adjustments in dosage or timing. Healthcare providers monitor these effects closely to ensure effective management.

Stimulants Used to Treat ADHD

Stimulant medications are a cornerstone of ADHD treatment, primarily targeting symptoms of inattention, hyperactivity, and impulsivity. Here, we explore two commonly prescribed stimulants: Methylphenidate and Amphetamine.

Methylphenidate:

Methylphenidate (MPH) is a medication primarily used to treat Attention Deficit Hyperactivity Disorder (ADHD) in both children and adults. It is also sometimes used to manage narcolepsy [8].

Mechanism of Action

Methylphenidate works by inhibiting the reuptake of dopamine (DA) and norepinephrine (NE), which increases their levels in the brain [8]. It blocks the norepinephrine transporter (NAT) and interacts with the vesicular monoamine transporter 2 (VMAT-2), balancing the availability of dopamine between the synaptic space and the intracellular pool [8]. Unlike some other stimulants, MPH has a slower entry into the brain and a slower clearance, which reduces the risk of abuse and neurotoxic effects [8].

Generic and Brand Names

Methylphenidate is available under several generic and brand names, including [4]:

• Dexmethylphenidate hydrochloride (Focalin, Focalin XR)
• Methylphenidate hydrochloride (Methylin, Ritalin, Ritalin XR, Ritalin SR, Ritalin LA, Adhansia XR, Concerta, Jornay PM, Metadate ER, Methylin ER, Quillichew ER, Quillivant XR).
• Serdexmethylphenidate and dexmethylphenidate (Azstarys)
• Methylphenidate (Cotempla XR ODT, Daytrana (a transdermal patch))

Side Effects

Common side effects of Methylphenidate include:

• Loss of appetite
• Insomnia
• Dry mouth
• Headache
• Agitation

Most side effects are mild and temporary. However, in some cases, more severe reactions like psychosis, arrhythmia, hallucinations, and abnormal movements may occur. Severe side effects are rare and often self-limiting, but they require medical attention.

Precautions

1. Route of Administration: The risk of severe toxicity is higher if MPH is administered intravenously. Oral or nasal use is associated with fewer severe risks.
2. Older Adult Populations: Limited data suggests that the risk-to-benefit ratio of MPH in older adults is similar to that in younger adults, but more research is needed.
3. Pregnant or Breastfeeding Women: There is insufficient safety data for the use of MPH during pregnancy and breastfeeding. Although MPH is not considered teratogenic, it may increase the risk of miscarriages, cardiac malformations, and other pregnancy complications. Therefore, it is generally not recommended for pregnant or breastfeeding women.

Amphetamine

Amphetamine is a medication primarily used to treat attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. It belongs to a class of drugs known as central nervous system stimulants [10].

Common Generic and Brand Names

Amphetamine is available under several generic and brand names, including [4]:

• dextroamphetamine mixed salts and amphetamine (Adderall, Adderall XR)
• methamphetamine hydrochloride (Desoxyn)
• amphetamine sulfate (Evekeo, Evekeo ODT, Dexedrine)
• dextroamphetamine sulfate (Zenzedi, ProCentra)
• amphetamine (Adzenys, Adzenys XR, Adzenys ODT, Dyanavel XR
• mixed salts of a single-entity amphetamine (Mydayis)
• lisdexamfetamine dimesylate (Vyvanse, Vyvanse Chewable)

Mechanism of Action

Amphetamine works by increasing the levels of dopamine and norepinephrine in the brain [10]. These chemicals are neurotransmitters that play critical roles in mood, attention, and behavior [10]. By enhancing their availability in the brain, amphetamine helps to improve focus, reduce impulsiveness, and control hyperactivity [10].

Side Effects

Like all medications, amphetamine can cause side effects.

Common side effects include [10]:

• Insomnia
• Headache
• Dry mouth
• Increased heart rate
• Restlessness

In children, it may affect growth, though this effect is usually small and related to reduced appetite while on the medication [10]. Serious side effects such as severe cardiovascular events (e.g., heart attacks) are rare but have been reported, particularly in patients with pre-existing heart conditions [10].

Precautions

Amphetamine is a controlled substance due to its potential for misuse and addiction [10]. It should be used cautiously in patients with a history of drug misuse, agitation, or cardiovascular disease [10]. Amphetamine is contraindicated in individuals with hypersensitivity to any of its components [10]. It should not be used concurrently with monoamine oxidase inhibitors (MAOIs) or within 14 days of their discontinuation due to the risk of hypertensive crisis [10].

Related: Navigating Online ADHD Prescriptions: Medications and Alternatives

Non-Stimulants for ADHD

Non-stimulant medications are prescribed for ADHD treatment without being classified as controlled substances like stimulants. They primarily work by increasing norepinephrine levels in the brain [4].

How do Non-Stimulants Work?

Non-stimulant ADHD medications typically take longer to start working compared to stimulants, often requiring several weeks of regular use to achieve full therapeutic effects [4].  By increasing norepinephrine levels, these medications help improve attention, focus, and impulsivity control over extended periods, sometimes up to 24 hours [4].

Side Effects of Non-Stimulants

Common side effects of non-stimulant ADHD drugs include: [4].:

• Upset stomach
• Sleep disturbances
• Mood changes (less common than with stimulants).

These side effects are typically mild and may decrease as your body becomes accustomed to the medication. Consult with a healthcare provider to monitor and manage any side effects effectively.

Alpha-Adrenergic Agonists

There are two non-stimulant medications called alpha-adrenergic agonists that may be used to treat ADHD; these include clonidine hydrochloride (Kapvay) and guanfacine hydrochloride (Intuniv) [4].

Clonidine hydrochloride (Kapvay)

Kapvay stimulates alpha2-adrenergic receptors in the brain, although its exact mechanism for treating ADHD is not fully understood. It comes in extended-release tablets and is often prescribed alone or in combination with other ADHD medications[6].

Precautions and Contraindications

Before taking Kapvay, tell your healthcare provider if any of the following apply to you [6]:

• Have kidney problems
• Have high or low blood pressure
• Have a history of fainting (syncope)
• Have heart issues, including a history of heart attack
• Have experienced a skin reaction (like a rash) from using clonidine patches
• Have any other medical conditions
• Are pregnant or planning to become pregnant (It’s uncertain if Kapvay could affect an unborn baby, so discuss this with your doctor)
• Are breastfeeding or planning to breastfeed (Kapvay can pass into breast milk, so discuss the best feeding options for your baby with your doctor)

Provide your doctor with a list of all your medications, including prescriptions, over-the-counter medicines, vitamins, and herbal supplements. Kapvay may interact with other medications, potentially causing severe side effects. Your doctor may need to adjust other medication doses while you are taking Kapvay [6].

Precautions

Before starting Kapvay, you should consider the following precautions [6]:

• Allergic Reactions: Patients who have experienced allergic reactions to clonidine in other forms, such as the transdermal system, may also react to oral clonidine hydrochloride.
• Abrupt Discontinuation: To avoid potential withdrawal effects, patients should not stop taking Kapvay abruptly. Instead, they should taper the dose gradually under medical supervision.
• Cardiovascular Effects: Regular blood pressure and heart rate monitoring is essential before starting treatment and periodically during therapy due to the potential for lowering blood pressure and heart rate.
• Central Nervous System Effects: Patients should use caution when driving or operating machinery until they know how Kapvay affects them, as drowsiness has been observed.
• Pregnancy and Breastfeeding: Patients should consult their physician if they are pregnant, planning to become pregnant, or breastfeeding, as the effects of Kapvay on unborn babies and nursing infants are not well studied.
• Medication Interactions: It’s essential to inform healthcare providers about all medications, including over-the-counter drugs and supplements, as Kapvay may interact with other medicines, potentially causing severe side effects.
• Dehydration and Overheating: Patients should avoid becoming dehydrated or overheated while taking Kapvay, as it can exacerbate its effects.

Guanfacine hydrochloride (Intuniv)

Guanfacine hydrochloride, branded as Intuniv, is another alpha-adrenergic agonist used to treat ADHD.

Precautions and Contraindications

Before starting Intuniv, consult your healthcare provider if you have any of these conditions or a history of the following [11].

• Bradycardia (slow heart rate)
• Dehydration
• Depression
• Recent heart attack
• Heart block or other heart conditions
• History of stroke or kidney failure
• Syncope (fainting)

Other Precautions

• It is also important to use Intuniv cautiously with liver or kidney disease and inform healthcare providers before surgery or emergency treatments.
• Inform your physician if you are allergic to guanfacine hydrochloride.
• Exercise caution if you are pregnant, planning to become pregnant, breastfeeding, have alcohol dependence, operate machinery, or take other medications.

Always follow your doctor’s instructions and promptly report any concerning symptoms [11].

Antidepressants Used to Treat ADHD

While primarily approved for treating depression, certain antidepressants can also be used off-label to manage ADHD symptoms. These medications work by increasing levels of brain chemicals called neurotransmitters in the brain, which can help alleviate ADHD symptoms [14].

Serotonin-Norepinephrine Reuptake Inhibitor (SNRI):

SNRIs are one type of antidepressant medication that increases levels of serotonin and norepinephrine in the brain and works to alleviate ADHD symptoms [14].

Common Side Effects of SNRIs [14]:

• Nausea and vomiting
• Weight gain
• Diarrhea
• Sleepiness
• Sexual problems

These side effects may vary depending on the specific SNRI medication prescribed. It’s important to discuss any concerns or side effects with your physician or healthcare provider.

SNRI Medications [4, 14].

Atomoxetine hydrochloride (Strattera):

Strattera is a non-stimulant medication used to manage symptoms in children aged 6-12, teens, and adults.

Before starting Strattera, you should consider the following precautions [15]:

• Medical History: Inform your doctor about any history of heart problems, high blood pressure, liver issues, or narrow-angle glaucoma.
• Medication Interactions: Discuss all current medications, including antidepressants and asthma treatments, as they can interact dangerously with Strattera.
• Allergies and Conditions: Avoid Strattera if you’re allergic to atomoxetine or have untreated narrow-angle glaucoma. It’s also contraindicated if you’ve taken MAOIs recently or have a rare tumor called pheochromocytoma.
• Pregnancy and Breastfeeding: Consult your doctor if you are pregnant or nursing, as Strattera may pose risks to fetal development and is passed through breast milk.
• Monitoring: Throughout treatment, monitor for any new or worsening mental health symptoms, such as anxiety, agitation, or suicidal thoughts. Regular check-ups for blood pressure, heart rate, and liver function are also recommended.

Viloxazine (Qelbree)

Qelbree, an extended-release SNRI capsule, treats ADHD symptoms in children and adults. Dosage adjustments consider age and individual response.

Before starting Qelbree, you should consider the following precautions [12]:

• Allergies: Inform your doctor of allergic reactions to viloxazine or other medications.
• Use in Pediatrics and Older Adults: Safety and efficacy are not established for children under six or older adults.
• Breastfeeding: Discuss risks and benefits with your doctor before using viloxazine while breastfeeding.
• Drug Interactions: Viloxazine can interact with several medications, including MAO inhibitors, alosetron, and duloxetine. These interactions can lead to serious side effects or reduce the effectiveness of either medication.
• Medical Conditions: Viloxazine should be used with caution in individuals with bipolar disorder, depression, heart disease, heart rhythm problems, hypertension, mental illness, or severe kidney disease. It may worsen these conditions or lead to adverse effects.
• Proper Use: Follow your doctor’s instructions precisely regarding dosage and administration. Do not adjust your dose without medical advice. Viloxazine should not be taken with MAO inhibitors or within 14 days of stopping these medications due to the risk of severe hypertension.
• Monitoring: Blood pressure and heart rate should be regularly monitored during viloxazine treatment. Report any unusual changes in behavior, mood, or physical symptoms to your doctor promptly.
• Driving and Hazardous Activities: Viloxazine may cause drowsiness or dizziness. Avoid driving or operating machinery until you know how this medication affects you.

Off-Label Antidepressant Use

Some antidepressants are sometimes used off-label to treat ADHD by increasing levels of neurotransmitters implicated in ADHD symptoms. However, they are not FDA-approved specifically for this use [4]. This off-label use may be considered when standard ADHD treatments are not suitable or effective.

Norepinephrine-Dopamine Reuptake Inhibitors (NDRI)

NDRIs are a class of antidepressant medications that enhance the levels of norepinephrine and dopamine in the brain [4]. These neurotransmitters play a vital role in controlling attention, concentration, and impulsivity.

The primary NDRI used for treating ADHD in adults is bupropion hydrochloride, available as Wellbutrin, Wellbutrin SR, and Wellbutrin XL [4]. By blocking dopamine and norepinephrine reuptake, bupropion enhances their levels in the brain, helping manage ADHD symptoms [2].

Precautions and Contraindications

Before starting bupropion, tell your doctor if you have [7]:

• A history of seizures: Avoid bupropion if you have a history of seizures or conditions increasing seizure risk, such as brain tumors or significant CNS diseases.
• Allergies: Do not take bupropion if allergic to it or its components.
• Medications: Inform your healthcare provider about all current medications, especially MAOIs, linezolid, and methylene blue, to prevent serious drug interactions.
• Alcohol: Limit alcohol consumption while using bupropion to reduce side effects.

Common side effects of bupropion may include [7]:

• Insomnia
• Headache
• Agitation
• Dry mouth

More severe side effects can include a lowered seizure threshold and an increased risk of suicidal thoughts, particularly in younger patients with mood disorders [7]. It’s crucial to discuss any concerns promptly with your healthcare provider.

Overdose and Emergency Situations

In cases of overdose, bupropion toxicity can cause seizures, hallucinations, and cardiovascular effects. Seek immediate medical attention if you suspect an overdose [7]. Treatment involves supportive care, focusing on managing seizures, which can occur even several hours after ingestion in extended-release formulations [7].

Tricyclic Antidepressants (TCAs):

While tricyclic antidepressants are traditionally used for depression, they have been found to benefit ADHD patients by targeting neurotransmitters such as norepinephrine and serotonin, which help to improve attention span, impulse control, and hyperactivity [3].

Common Generic and Brand Name TCAs [4]:

• Desipramine hydrochloride (Norpamin)
• Imipramine hydrochloride (Tofranil)
• Nortriptyline hydrochloride (Pamelor)

Usage and Considerations

TCAs are considered for ADHD treatment when other options are unsuccessful or if you have specific medical conditions. Unlike stimulants that primarily target dopamine and norepinephrine, TCAs affect various neurotransmitters, including serotonin, which can alleviate symptoms of depression and anxiety often associated with ADHD [5]. Their dual-action capability makes them advantageous for ADHD patients with concurrent mood disorders or tic disorders [5].

Common Side Effects:

The following side effects are common with TCAs [16]:

• Blurred vision
• Constipation
• Dizziness
• Drowsiness
• Weight gain
• Dry mouth
• Upset stomach
• Increased sweating
• Sun sensitivity (can cause burns).

Serious Side Effects

TCAs may cause an increased risk of [16]:

• Suicide
• Seizures
• Vision problems

Additionally, they may initially impair driving and machine operation.

Precautions

Before starting a TCA, tell your healthcare provider if you have [16]:

• Medical Conditions to Avoid Tofranil: Individuals with heart disease, narrow-angle glaucoma, hyperthyroidism, seizure disorders, or liver disease should avoid Tofranil.
• Mental Health Caution: Tofranil may exacerbate depression or trigger new mental health issues such as psychosis or bipolar disorder.
• Other Considerations: Diabetics may experience difficulties in blood sugar control. There’s also a risk of serotonin syndrome when combined with certain medications, and caution is needed if you are pregnant or breastfeeding.
• Interactions: Avoid combining Tofranil with MAOIs and alcohol. Use caution with anticholinergics, blood pressure medications, thyroid drugs, and other medications that cause drowsiness or affect serotonin levels.
• Monitoring: Regularly monitor for side effects, changes in mental health status, and potential drug interactions.

Is Medication All You Need To Treat ADHD?

No, taking ADHD medication alone is often insufficient to manage ADHD symptoms effectively. A comprehensive treatment approach, including lifestyle changes such as diet, exercise, and therapy, is crucial for achieving the best outcomes [1].

While medications like stimulants can significantly improve ADHD symptoms for many individuals, incorporating specific types of therapy including behavior therapy, cognitive behavioral therapy (CBT), dietary adjustments, and mindfulness practices is also essential. These complementary approaches help in symptom management, target specific behaviors, and enhance overall well-being, thereby maximizing the effectiveness of treatment beyond medication alone [1].

Related: How to Treat ADHD Without Meds

Professional Help and Support for ADHD

While there is no “cure”, ADHD management involves using a variety of treatments, including psychiatric medications like stimulants and non-stimulants, to control symptoms. However, for the best results, it’s crucial to combine these medications with behavioral therapy and lifestyle changes. This approach improves symptom management and enhances overall well-being and quality of life.

If you or a loved one is struggling with ADHD, reach out to Neuro Wellness Spa. We have a compassionate team of psychiatrists and mental health experts who specialize in treating ADHD, helping you manage symptoms through a wide range of treatment options. Our psychiatric practitioners will work with you to find out if medication management is appropriate. The psychotherapy program we offer utilizes a wide range of therapeutic modalities that have proven to be effective to treat ADHD including CBT, MBCT, and DBT. We use alternative methods like TMS therapy which stimulates the production of neurotransmitters in regions of the brain known to be affected by ADHD. Discover how we can help you better manage ADHD symptoms and improve your quality of life. Contact us today to schedule your consultation!

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