Adult ADHD: Stimulant and Nonstimulant Medication

Treatment of attention deficit hyperactivity disorder is not two-dimensional.  From childhood to adulthood, treatment requires a comprehensive, or “multimodal”, approach ranging from medical to behavioral to psychological intervention.  However, for 1.5 million adults in the U.S. with ADHD, medication is an essential portion of treatment.  In fact, it is also the only proven treatment.

First, it is important to understand that medication does not cure ADHD; it eases the symptoms. The benefits only last as long as the patient continues to take their ADHD medications.

ADHD medications are like eyeglasses – they minimize the issue when active.  They are not like an antibiotic that cures the disease and allows the patient to cease treatment.

The purpose of medication is to alleviate symptoms of ADHD like “poor attention span, distractibility, impulsive behavior, hyperactivity, and restlessness” and “improve vigilance, cognition, reaction time, response inhibition, and short-term memory”. The Food and Drug Administration has approved two categories of medications for ADHD: stimulants and nonstimulants.

Stimulants are the most effective type of medicinal treatment as they have a responsiveness rate of 70-80%.  Within the stimulant category there are two subcategories: methylphenidate and amphetamines. These medications have similar levels of efficacy, but patients sometimes have a better response to one over the other. Because patients often respond to one medication over another, physicians often do a treatment trial and monitor the patient closely during the beginning weeks of medicinal treatment.  During this time, drug, dosage, and timing adjustments can be made.  Some side effects of stimulants include nausea, weight loss, anorexia, increased blood pressure, and mood lability. The most common brand names of methylphenidate and amphetamine are Concerta and Adderall, respectively.

Nonstimulant medications are administered if the patient did not respond well to stimulant treatment (10-30% of patients).  Nonstimulant medication is a second-line process because it is slower to create positive change. The most common nonstimulant drug is atomoxetine.  One benefit to nonstimulant medication is that it does not have an abuse potential, unlike some stimulants. Side effects include nausea, insomnia, decreased appetite, increased blood pressure and heart rate, and sweating. The dominant brand name for atomoxetine is Strattera.

Often it is a tough decision whether to start medicinal treatment or not.  According to Harvard Medical School, ADHD medications may pose long-term risks.

ADHD drugs may cause cardiovascular problems stemming from an increase in blood pressure and heart rate.  Those with underlying cardiac risk are most likely to experience these heart-related issues. And as mentioned above, some stimulants have potential for abuse since snuffing crushed pills can simulate a cocaine high.  However, these negative results are typically only of major concern if the patient has underlying risks.

Overall, the data on long-term risks do not seriously challenge the idea that adults correctly diagnosed with attention deficit hyperactivity disorder will choose to obtain medicinal treatment in acknowledgment of its benefits outweighing its risks.


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