ADHD is a mental health disorder that generally responds very well to medication. The fact that many symptoms seem to be diminished or reduced by medication lends credence to the fact that ADHD has a biological origin. This fact has led to studies of the disorder making many of the advancements and revealing much of the new information that we now consider to be common knowledge today.
At one time, the fact that a stimulant medication could bring calm and focus to someone with ADHD was a mystery. Now we know that the hyper activity and rapidly changing attention of a person with ADHD may just be their way of increasing dopamine production. With stimulant medication on board and dopamine levels nearing normal, inattention and distraction can be put away and the brain can relax and focus on what it needs to.
What we know
Stimulants are the most commonly used medication for ADHD treatment, The most common ones used for this purpose are methylphenidate (Concerta, Ritalin, Daytrana, Quillivant XR), mixed amphetamine salts (Adderall, Adderall XR) and dextroamphetamine (Dexedrine Spansule, ProCentra, Zenzedi).
Methylphenidate, amphetamine, and dextroamphetamine are short acting stimulants. The XR formulations prolong absorption so that one dose can last from eight to ten hours. Concerta uses a physical delivery system that resembles a capsule. A simple pump mechanism delivers the methylphenidate at a steady rate for a 12 hour dosage from one capsule. The capsule, once spent, is evacuated from the digestive system with other body waste.
Note: Another stimulant medication, magnesium pemoline (Cylert), has had its FDA approval rescinded due to issues with liver damage. It has since been taken off the market. No one is making Cylert or any of its generics anymore.
Not just stimulants
There are more choices of medication for ADHD symptoms now than just stimulants.
Studies have shown that tricyclic antidepressants like desipramine (Norpramin) also help to manage the symptoms of ADHD. Since ADHD symptoms are context sensitive, part of the efficacy of antidepressants may come from the reduced stress that an antidepressant can be responsible for. It should also be noted that depression is a co-morbid condition often associated with ADHD.
Another possible choice of medication, beta-blockers, can be prescribed with or without stimulants to reduce jitteriness. The drugs propranolol (Inderal), and nadolol (Corgard) are frequently used for this purpose.
Tricyclic antidepressants, especially desipramine (Norpramin), are also sometimes effective at treating ADHD. At doses lower than those used for depression, their most serious potential side effect is disturbance of heart rhythms.
Another drug occasionally prescribed for ADHD is clonidine (Catapres, Kapvay, Catapres-TTS, Clonidine ER). Uses for clonodine include alcohol withdrawal, anxiety, atrial fibrillation, benzodiazepine withdrawal, bipolar disorder, high blood pressure, hypertensive emergency, insomnia, stimulant-associated, migraine prevention, restless legs syndrome, smoking cessation, tardive dyskinesia, Tourette’s syndrome, and tic suppression. Treatment of ADHD is now on this list as well.
What we believe
Medications for ADHD primarily affect the areas of the brain that regulate attention and deal with executive function. The precise way in which they effect this benefit for the person with ADHD is unknown, but it is known that, for most people with ADHD, these medications offer extreme and noticeable symptom improvements with few and rare long term or short term side effects.
The effects of ADHD medication are fast acting and short term. Beneficial effects occur almost immediately and wear off in the normal course of the day. Some people on ADHD medication take their dosage on work days and don’t bother to on weekends. Others take them full time but take “holidays” from them at set times. Still others take their medication every day of the year, year after year.
What we don’t know
The long term benefits of medication are not known, although there is some evidence that stimulant treatment does improve development of the areas of the brain that are concerned with ADHD symptoms.
Any possible long term side effects of stimulant medications have yet to be identified and, if any exist, are not likely to be permanent or have any lasting negative effects.
Considerations for choosing medication
ADHD should not be viewed as a simple problem, but acknowledged as a complex neurological developmental disorder that nearly always results in a person who is neurologically well developed enough that people assume them to be what we refer to as neurotypical. Thus the perceived shortcomings that ADHD causes are considered to be unacceptable behavior.
Medication can help with the issues of attention and focus and, possibly to some extent with the problem of time perception, but it cannot deliver appropriate behaviors that have not been learned.
Nor can medication reverse the cumulative effects of stress, frustration, and possibly shame that years of undiagnosed ADHD may have caused.
Medication is not a single solution, but part of an effective treatment. Treatment of ADHD is always easier and more effective if part of it is tolerated medication.
If you choose to use medication to treat your ADHD, you can take comfort in the fact that a lot of research has been done on the effects, side effects, and safety of the various medications used to treat ADHD.
If you choose not to use medication or are one of the few who does not tolerate medication for whatever reason, there are treatments that, although not as effective without the aid of medication, are still of use and show positive results.