There are two major categories of medications that are commonly used to treat symptoms of ADHD. Stimulant options, such as forms of methylphenidate and amphetamine, tend to be powerful, quick (effects are noticeable within an hour of use), and are generally considered to be the first-line pharmaceutical approach for ADHD. Non-stimulant options are successful for some individuals with ADHD and are associated with less risk of abuse than stimulant medications. As always, there are pros and cons to both classes of ADHD medications and to each individual medication classified within these categories.
The category of stimulant medications is further sub-divided into two general forms: methylphenidate and amphetamine. Both methylphenidate and amphetamine increase activity of two major chemicals in the brain known as dopamine and norepinephrine that act as neurotransmitters (chemicals that help brain cells communicate with each other). Dopamine and norepinephrine are involved in the process of placing/maintaining attention, motivation, concentration, and other important executive functions. When activity of these neurotransmitters is low (as appears to be the case with ADHD), individuals tend to struggle with these executive functions, and if not properly treated, are at a high risk of self-medicating with illicit substances to compensate for these deficiencies.
While they are more similar than different, there are important distinctions between methylphenidate and amphetamine. Methylphenidate includes medications such as Ritalin, Concerta, and Daytrana. These medications increase the activity of dopamine and norepinephrine to a slightly lesser extent than the amphetamine options and, therefore, may be slightly less effective (particularly for those with more severe presentations) and have slightly reduced abuse potential.
Amphetamine options include Adderall, Dexedrine, and Vyvanse. These are the most powerful ADHD medications on the market; in many cases they are the most effective for managing the symptoms of ADHD, but they are also the medications that are most vulnerable to abuse (though this tends to be more of an issue for the family/friends of the individual with ADHD than the individual themselves) and most likely to cause or exacerbate issues with tics, appetite, sleep, and normal growth in childhood.
The non-stimulant options for ADHD are generally less powerful than the stimulant medications and may take longer to take effect (in many cases they must be taken daily for up to 4 – 6 weeks before maximum benefits can be evaluated). Non-stimulant medications may be preferred for individuals with a history of addiction, those with mild symptoms, and/or those who struggle with tics. These medications are also prescribed for children and adults who do not tolerate stimulants well, which occurs for a variety of reasons.
Strattera was the first non-stimulant medication that was FDA approved for the treatment of ADHD. It works as a norepinephrine reuptake inhibitor, which increases norepinephrine activity in the brain. Kapvay and Intuniv are long-acting forms of medications commonly used to treat high blood pressure. While they can make children feel tired, they are particularly effective for reducing tics, and are therefore very useful for children who struggle with ADHD and tics. Wellbutrin, which is classified as an antidepressant, may also be prescribed for ADHD. It works similarly to Strattera, but also blocks reuptake of dopamine, thereby increasing activity of both of these neurotransmitters (to a much lesser degree than stimulant medications do).
While there are certainly trends in terms of effectiveness of various ADHD medications, it’s important to note that individuals vary widely in their response to pharmacological treatments. Factors such as symptom severity and presentation, genetics, metabolism, lifestyle, medical conditions, and co-occurring mental health disorders, such as depression and anxiety impact an individual’s response to medication and should be taken into consideration by a trained professional such as a psychiatrist when choosing a pharmacological treatment plan. In many cases, trial and error also plays a role; be prepared for the prescribing professional to suggest a trial with multiple medication options and dosages on the path to finding the most effective option and dose for you or your child. It may be challenging at first, but it’s worth the investment of your time and energy to ensure it’s the right fit!
Check in next week for ideas about psychosocial interventions that can be helpful for the management of ADHD!