Stimulants for ADHD Medication Guide
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that can affect attention, hyperactivity, and impulsivity in children and adults.
ADHD is one of the most diagnosed mental disorders in children, but ADHD symptoms can last well into adulthood.
In recent years, our understanding of ADHD has changed. The DSM-3 listed ADHD and ADD (attention deficit disorder) as two separate conditions, but the DSM-5 — the latest version of the diagnostic manual — recognizes 3 different types of ADHD: hyperactive, inattentive (similar to the previous understanding of ADD), and combined.
ADHD is a neurodevelopmental disorder that was once thought to primarily affect children, but our understanding of ADHD in adults is constantly changing. Because ADHD symptoms usually appear when the patient is around 6 years old, ADHD is associated with children. However, around 5% of U.S. adults have adult ADHD. ADHD is underdiagnosed in adults, but ADHD symptoms don’t discriminate.
Today, medications have helped alleviate many ADHD symptoms. While some critics of stimulant ADHD anxiety medications point to their unpleasant side effects, stimulants can be helpful and safe when taken under the supervision of a healthcare provider.
ADHD is frequently accompanied by other mental health concerns like depression and anxiety, so ADHD treatment must frequently consider these other conditions.
Types of Stimulant Medications
Stimulant medication for ADHD can be split into two categories or classes of medication: amphetamines and methylphenidate. Some patients with ADHD also benefit from non-stimulant medications. Here’s an ADHD medication guide:
- Amphetamines. Chemists discovered amphetamines over a century ago, but it wasn’t until the 1930s that prescribers began using amphetamines to treat behavioral symptoms associated with ADHD. Amphetamines are still one of the most common stimulant medications for ADHD today under brand names like Adderall (amphetamine and dextroamphetamine), Dexedrine (dextroamphetamine), Vyvanse (lisdexamfetamine), and Desoxyn (methamphetamine).
- Methylphenidate. These stimulants inhibit the reuptake of certain neurotransmitters, making them a well-rounded option for treating ADHD symptoms. Common name brands of methylphenidate include Ritalin, Concerta, and Daytrana (a transdermal patch).
- Non-Stimulant Medications. Stimulants can be effective at relieving ADHD symptoms, but they’re not always the best ADHD medication for adults with anxiety and depression because of their side effects and potential for abuse. While not as prevalent as stimulant treatments, non-stimulants can be useful in treating ADHD, especially when stimulants aren’t safe or effective. Common non-stimulants include Strattera (atomoxetine) and Tenex/Intuniv (guanfacine).
Many stimulant medications come in both quick- and extended-release formulations. Adderall, for example, comes in both regular and XR (eXtended Release) formulations.
Quick-release stimulants can provide quick-acting relief for ADHD symptoms, but the effects of the medication may only last for a few hours. For patients experiencing chronic symptoms, extended-release formulas may offer long-lasting relief, but the tradeoff is that they may take longer to kick in.
How Stimulant Medications Work
Stimulant medications have been around for over a century, but our understanding of how they work is still evolving. So how does ADHD medication work?
•Amphetamines increase the amount of dopamine and norepinephrine in the brain, two neurotransmitters that influence executive function and attention/reward circuits in the brain. They do this by simultaneously triggering nerve terminals to release more of these neurotransmitters while also preventing them from being re-absorbed by the brain. The net effect is that patients produce more dopamine and norepinephrine, and use them for longer.
•Methylphenidate works by a similar principle but focuses on inhibiting the reuptake of dopamine and norepinephrine rather than releasing more in the brain. The net effect can be similar, that the brain has more of these neurotransmitters to make use of, but methylphenidate accomplishes that using a different chemical process.
While people have been using stimulates to treat ADHD for over a century, it’s only within the last decade that scientists have understood the specific mechanism that allows them to function.
Prescribing Stimulants for ADHD
Stimulants can be dangerous if improperly used (more on that in the next section), so prescribers must understand their patients’ symptoms and how to best treat them.
Before writing a prescription, your healthcare provider may ask questions about your symptoms, history, and lifestyle. They may also complete a physical exam to rule out underlying medical issues that may cause similar symptoms.
Prescribers generally start with a low dose of amphetamines — usually 10 or 20 milligrams — and then increase the dosage as needed. Amphetamines like Adderall are more potent than methylphenidate such as Ritalin, so starting doses for methylphenidate may be higher. Since the efficacy of stimulants greatly depends on the patient’s weight, children with symptoms of ADHD generally start with lower doses than adults.
The key to prescribing the right dosage of stimulants is balancing the relief of symptoms with the unpleasant side effects and dangers of overuse, which is why prescribers tend to start low and gradually increase the dosage over time.
However, prescribers must also weigh the severity of ADHD symptoms against the severity of other comorbid conditions and the severity of side effects.
Side Effects and Management
Stimulants can offer valuable relief from unpleasant symptoms, but they can also introduce new unpleasant side effects in the process.
Some of the most common side effects associated with stimulants include Anxiety, Jitters, Paranoia, Sweating, or Headaches.
This is not a complete list of the side effects of every stimulant. In some cases, more serious side effects are possible, such as shortness of breath, chest pain, psychosis, high blood pressure, seizures, and even sudden cardiac death. Always discuss the side effects of your medication with your healthcare provider before you begin taking ADHD and anxiety medication containing stimulants.
Managing Side Effects
Part of the reason prescribers generally start with low doses of stimulants for ADHD is that higher doses are associated with more severe side effects. If side effects are severe, trying a different type of stimulant may help (under your licensed prescriber’s guidance), as can lowering your dose or taking your regular dose less frequently — such as skipping doses on weekends. You should also monitor for serious side effects such as psychiatric and cardiovascular issues or involuntary tics. Your prescriber can help you understand which side effects apply to your specific medication.
Non-Stimulant Medications for ADHD
This guide is focused on stimulant medication for ADHD, but several non-stimulant medications have also proven helpful for treating ADHD symptoms.
Atomoxetine works similarly in the brain to stimulants, inhibiting the reuptake of dopamine and norepinephrine in the brain. However, the key distinction is that because atomoxetine is not a stimulant, it has a lower abuse potential than stimulant ADHD medications like Adderall and Ritalin. However, Atomoxetine also carries possible side effects like itching, hives, and irregular heartbeat, and these side effects have made it less popular than stimulants.
Healthcare providers may prescribe atomoxetine when stimulants are ineffective, or for patients with a history of drug or alcohol abuse.
Special Considerations
When prescribing stimulant medication for ADHD, prescribers should make a few special considerations:
- Children and adolescents need significantly smaller doses of stimulant medication.
- Stimulant medication can worsen preexisting heart conditions like angina and hypertension.
- Patients who are pregnant or breastfeeding should receive special consideration based on the severity of their symptoms.
- Patients with psychosis or bipolar disorder should avoid stimulants as they could exacerbate their symptoms.
Adherence and Abuse Potential
One major consideration for stimulant medication is its high potential for addiction and abuse.
One of the contributing factors of ADHD is an unbalanced reward system in the brain, which stimulants seek to address by rebalancing dopamine and norepinephrine. However, in doing so, they also trigger the brain’s reward system, which can lead to adherence over time as it gets harder and harder to go without a consistent reward.
Stimulants can also be neurotoxic, affecting the brain’s memory, learning, and cognitive functions when abused.
Because of these serious potential consequences, it’s vital to only take stimulant medication according to the dosage prescribed by your healthcare provider and to weigh the potential downsides against the severity of your symptoms. It’s also important to consider non-stimulant treatments for ADHD.
Current Research in ADHD Treatment
While you might expect scientists to understand ADHD more specifically over time, the definitions used by the DSM have only gotten more broad. There is no proven biological marker for ADHD, so diagnosis is based on behavioral factors rather than diagnostic tests. As a result, behavioral changes have been shown to improve patient outcomes.
Because of that, ADHD is now thought to be more diverse than previously thought. Once thought to be primarily a pediatric disorder, ADHD is now understood as affecting a large number of adults. However, adult ADHD has unique characteristics, both neurochemically and socially, and researchers have taken large steps to understand those differences in recent years.
One unique factor in adult ADHD is that the primary symptom is frequently incomplete tasks. Rather than rebalancing neurotransmitters using stimulant medication, some healthcare providers are switching their focus to behavioral and lifestyle changes. For example, “social scaffolding” a process of forming partnerships, can help patients complete tasks they have difficulty completing on their own.
Another recent treatment option for ADHD is transcranial magnetic stimulation or TMS. TMS works non-invasively and has been shown to improve treatment outcomes without resulting in any adverse effects in several studies.
FAQs about Stimulants for ADHD
Stimulants can relieve some symptoms of ADHD, but they also have downsides. They can be addictive and have a high potential for abuse. Only use stimulants under the instruction of a licensed prescriber. For some patients, stimulants are most effective as part of a treatment plan that includes other treatments such as CBT and TMS.
If you (or your child) are experiencing persistent problems with memory, attention, impulsive behavior, or hyperactivity, this could be a sign of ADHD. Tell your healthcare provider about these symptoms as they can help you diagnose ADHD.
The National Institute of Mental Health (NIMH) has many helpful resources for understanding ADHD. The Center for Disease Control (CDC) has additional educational multimedia materials available on its website. ADHD-specific support can be found in organizations such as Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) and the Attention Deficit Disorder Association (ADDA) offer in-person or virtual support groups for both children and adults with ADHD.
If you are experiencing symptoms of an overdose, such as chest pain, vomiting, severe headache, weakness, or stroke, call 9-1-1 immediately. Stimulant overdoses are life-threatening, and these symptoms constitute a medical emergency.
If you’re struggling with stimulant addiction, the 2-1-1 helpline is available 24/7, is confidential, can be anonymous, and connects people to services such as substance misuse treatment programs. Discuss any history of addiction and substance misuse with your healthcare provider.
Stimulant medication can have a calming, focusing effect for some patients, but it can also cause agitation and restlessness. For that reason, anxiety and ADHD medication, while performing a similar function in the brain, are often at odds with each other as stimulants can increase feelings of anxiety.