Your Top Three Questions About ADHD Medication Answered

“Medication levels the neurobiological playing field”  Biederman, J., & Spencer, T. (2002)

After receiving a diagnosis of ADHD, the most commonly asked questions people have are around ADHD medications. Despite the fact that we have been using the same psycho stimulants to treat ADHD for over 60 years, and have studied them over and over again for effectiveness, short term and long term side effects and contraindications, doubt remains.

In order to help provide some answers, dispel some myths and help people stay at choice around their treatment options, here is a synopsis on three of the top questions and their answers around ADHD medication:  

What medications are used to treat ADHD?

Medication for ADHD falls under two major categories: stimulants and non-stimulants.  Stimulants fall under the brand names of Ritalin, Adderall, Concerta, Dexedrine, Focalin, Metadate and Vyvanse.  What these medications “stimulate” is the dopamine in the brains of people with ADHD, which rebalances the deficit of this neurotransmitter that typically exists and causes the ADHD symptoms.  Common non-stimulants used in the treatment of ADHD fall under the brand names Strattera, Wellbutrin, Effexor, Clonidine and Intuniv.  These act on other neurotransmitters either in the brain or the body and are thought to indirectly minimize the ADHD symptoms.

There is no “magic pill” to cure or treat ADHD.  This means that even though medications have been proven to reduce 80% of the symptoms, people still function best when they learn strategies to manage other areas that still challenge them.  It’s important to remember that most ADHD medications do not remain active in your body for 24 hours a day.  Most medications typically last for 4-8 hours.  You still have ADHD the other hours of the day and on weekends.  Medications, when used in combination with learning skills and strategies to better manage your challenges, seems to have the best success.  Behavior modification, biofeedback, coaching, psychotherapy, and support groups are just a few possibilities that can be used along with medication.

Why are “stimulants” used when the problem is hyperactivity?

The physical hyperactivity in behavior seen in some persons with ADHD is actually a symptom of inactivity of the brain.  When people are hyperactive, moving about, and restless, the physical movement of the body helps to increase the amount of dopamine available to the brain.  Lack of enough dopamine getting to the front part of the brain is thought to be the main problem behind ADHD.  When this front part of the brain, or “executive function,” is not fully accessible, the ability to pay attention, focus on things less interesting, stop before we act, etc., is nearly impossible.  It is a bit like expecting someone with a vision problem to simply “focus” so that they can see better…not happening!  When we move, it stimulates the dopamine to be released in our brain.  When more dopamine is available to stimulate these key areas of the brain, the symptoms are reduced because the person doesn’t need to move around anymore.

Are medications for ADHD safe? Will they cause addiction?

As surprising as it may seem, stimulant medication has been used to treat ADHD symptoms for over sixty years.  Ritalin has been used in the treatment of ADHD-type symptoms since the 1950’s.  Because they have been used over such a long period of time, they have been studied extensively, over and over, which means we have the advantage of knowing their long-term effects over generations.  They are as “safe” as any medication can be; in fact, many studies have indicated that individuals treated with prescription medication are less likely to abuse other drugs because they do not feel the need to start seeking out ways to self-medicate their symptoms.

Let me know what other questions you might have around ADHD medications.  Better still, be sure to join me for an upcoming teleclass I will be facilitating called “Taking the Mystery out of ADHD Medications”.  You can register for this class at http://www.coachingforadhd.com/adhd-medications-course/

17 Responses to Your Top Three Questions About ADHD Medication Answered

  1. Steve Preston     September 24, 2012    4:55 pm    Reply

    I have found that Ritalin does help a lot with my ADHD symptoms. However I seem to metabolize medicines quickly (so says the doctor) because the effects are very pronounced yet short lived. Would you happen to know whether other ADHD medicines would have the same effect as Ritalin? I also have a very hard “crash” some time after the last dose.

  2. Laurie     September 25, 2012    4:16 pm    Reply

    HI Steve! Thanks for your comment. The good news is that you seem to have a good response to Ritalin and might only need to “tweak” how you are taking it. The first question I would have is what dose are you on with regards to your Ritalin. Some people need a higher dose to get the same effect as others. The three problems most people have are either it is the wrong dose, it is not the right medication, or it is not being taking at optimimum times. It sounds like Ritalin woks for you but is not lasting long enough. It is very common to add a second dose if this is the case. Is the ritalin short acting or long acting? This can make a difference as to when it kicks in and how long it lasts and how it wears off. The third is to look at when specifically you noticing the medication not working for you. If it is not initially effective when you first take it, you might want to talk to your doctore about dosage. If it works initially, but wears off too soon, you might want to talk to your doctor about adding a second dose. The “crash” you describe, sounds like “rebound” and is common as the medication leaves your system. Many things can help reduce rebound, including taking a small dose of your medication when you normally notice this to make this drop off less steep. Some people find that doing things that naturally increase the dopamine in their brain at this time of the day helps. Things like maybe having a cup of tea with caffeine, 1 cup of coffee, exercising, piece of chocolate, etc. Many find that making sure they are not doing something stressful at that “rebound” time of day also useful. Keep in touch. I hope this is helpful. Keep in touch! ~Laurie Dupar

  3. Dave     November 3, 2012    2:35 pm    Reply

    I am taking vyvanse 70 mg and it works very well but I work 12 hour shifts as an electrical technician. My job is troubleshooting the electronics of multi million dollar pieces of mining equipment. By halfway through my shift the medication has No more effect on me 70 mg is the highest dose available. Can a dose of adderall be taken later in the day after the vyvanse loses its affect.
    Thanks,
    Dave

    • Laurie     November 5, 2012    3:49 pm    Reply

      Hi Dave!

      Thanks for your comment. Sounds like you have a job that requires as much concentration as possible for an extended length of time! Vyvanse, 70 mg is the highest recommended dose and typically lasts for 10-12 hours. Commonly I see people metabolize more quickly and the Vyvanse, although “supposed to” doesn’t last that long. As always, I encourage you to go back to your precriber and ask them this question as they will be following you. I have seen where people take a later dose of regular adderal just as you describe. Another consideration is when you are taking the medication. Something that is helpful to take back to your prescriber is a log that tells them what you are experiencing on your medication. i.e. when you take it, when you notice it kicks in, what you notice when on it with regard to focus, productivity, etc., when it wears off. I developed a tool I call a “medication log” speifically for this purpose you can download a complimentary copy of it at: http://www.coachingforadhd.com/medicationlog/ Perhaps make an appointment to talk with your prescriber about your options as soon as possible and keep this log for about a week so you and they can see how your medication is working and adjust accordingly. I hope this helps. Keep in touch and let me know how it goes! ~Laurie Dupar

  4. jessica     November 7, 2012    9:21 am    Reply

    Hi! My 18 year old daughter has been on strattera for two years. Current dose is 80mg. She has not been put on a stimulant because she is not/never has been an eater. The dr. fears she will lose weight rapidly and she’s 5’1″ and 105 lbs, so she doesn’t have any extra to lose! Also, she’s very anxious and takes lexapro. (Type A personality) Doesn’t seem as though the strattera is working as well as she needs. Can’t focus well in any conversation or sit still for long. Is there anything we can do? Thank you.

  5. Laurie     November 19, 2012    2:32 pm    Reply

    HI Jessica! Thanks for your comment. As always, please make sure you talk with your prescriber about any options. Based on your comment about she still not being able to focus or sit still for long, I would suggest you do talk to your doctor about possible options. I would also be specific with your doctor how this is interfering with perhpas her acadmics, friendships, family, work, etc. Medication needs change or might work differently as people age and their brain goes through other normal changing. I am a big believer in options and not ruling someing out until you try it. It may be that the valuable concern of your doctor is not warrented any longer and your daughter will benefit from another category of medications to help her focus. It it does interfere with her appetite, weight, etc., you can again work closely with your prescriber to try other alternative medications if your daughter wants that. I hope this helps. Keep in touch. ~Laurie Dupar

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  12. Jim Del Monaco     January 7, 2016    7:33 am    Reply

    Hi Laurie!

    I really have come to appreciate your knowledge and background within the field of ADHD. My question is regarding ADHD medication limits with dextroamphetamines (Adderall) for adults. My prescriber just writes scripts and is not willing to make any changes! I’m currently looking for a new prescriber who is willing to work with me and is well versed in the field of ADHD. I’ve learned (very painfully & costly) that a lot of clinicans say they are, but they have no idea and just wing it!. Anyway, as a 51 year old adult male (diagnosed 10 years ago) I’m currently prescribed 120 mg (30×4) a day. However, due to changes in titration the DOE is sometime much less than 4 hours…so each month I run short. Is there any limit, and why, if no significant side effects are present (maybe just dry mouth)? I’ve checked with my heath insurance company (Tufts) and they have no limit on the medication being prescribed, which really surprised me!

    Please help!

    Sincerely,
    Jim (Boston, MA)

  13. Donna     March 2, 2016    1:21 am    Reply

    Ok, I take that back Jim, They don’t believe you, and for great reason!!! NO DOCTOR in their right mind should increase your medicine for you, #1 due to your age, I sure would not want to be responsible for your heart attack!! You really need to think about your health, It comes a time in life when that surpasses all other!! Thank God desperate people always give themselves away, It truely ends up saving them in the long run!! Take your Health Seriously People! You Only Get One Chance!

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