ADD & ADHD Medications

Medication for ADD & ADHD: What you need to know

Making ADD / ADHD medication decisions can be difficult, but doing your homework helps. The first thing to understand is what the medications for ADD and ADHD can and can’t do. It's important to be realistic. ADHD medication may help improve the ability to concentrate, control impulses, plan ahead, and follow through with tasks. However, it isn’t a magic pill that will fix all of you or your child’s problems. Even when the medication is working, a child with ADD / ADHD might still struggle with forgetfulness, emotional problems, and social awkwardness, or an adult with disorganization, distractibility, and relationship difficulties.

It’s also important to understand that medication doesn’t cure ADD / ADHD. It can relieve symptoms while it’s being taken, but once medication stops, those symptoms come back. Also, ADD / ADHD medication works better for some than for others. Some people experience dramatic improvement while other experience only modest gains.

Because each person responds differently and unpredictably to medication for ADHD, its use should always be personalized to the individual and closely monitored by a doctor. When medication for ADD / ADHD is less carefully monitored, it is less effective and more risky.

Stimulant medications for ADD & ADHD

Stimulants are the most common type of medication prescribed for attention deficit disorder. They have the longest track record for treating ADD / ADHD and the most research to back up their effectiveness. The stimulant class of medication includes widely used drugs such as Ritalin, Adderall, and Dexedrine.

Stimulants are believed to work by increasing dopamine levels in the brain. Dopamine is a neurotransmitter associated with motivation, pleasure, attention, and movement.

For many people with ADD or ADHD, stimulant medications boost concentration and focus while reducing hyperactive and impulsive behaviors.

Stimulants for ADD / ADHD come in both short and long-acting dosages. Short-acting stimulants peak after several hours, and must be taken 2-3 times a day. Long-acting or extended-release stimulants last 8-12 hours, and are usually taken just once a day.

The long-acting versions of ADD / ADHD medication are often preferred, since people with ADHD often have trouble remembering to take their pills. Taking just one dose a day is much easier and more convenient.

Stimulant medications may also cause personality changes. Some people become withdrawn, listless, rigid, or less spontaneous and talkative. Others develop obsessive-compulsive symptoms.

Stimulant safety concerns

Beyond the potential side effects, there are a number of safety concerns associated with the stimulant medications for ADD / ADHD.

• Effect on the developing brain — The long-term impact of ADD / ADHD medication on the youthful, developing brain is not yet known. Some researchers are concerned that the use of drugs such as Ritalin in children and teens might interfere with normal brain development.
• Heart-related problems — ADD / ADHD stimulant medications have been found to cause sudden death in children and adults with heart conditions. The American Heart Association recommends that all individuals, including children, have a cardiac evaluation prior to starting a stimulant. An electrocardiogram is recommended if the person has a history of heart problems.
• Psychiatric problems — Stimulants for ADD / ADHD can trigger or exacerbate symptoms of hostility, aggression, anxiety, depression, and paranoia. People with a personal or family history of suicide, depression, or bipolar disorder are at a particularly high risk, and should be carefully monitored when taking stimulants.
• Potential for abuse — Stimulant abuse is a growing problem, particularly among teens and young adults. College students take them for a boost when cramming for exams or pulling all-nighters. Others abuse stimulant meds for their weight-loss properties. If your child is taking stimulants, make sure he or she isn’t sharing the pills or selling them.

ADD / ADHD stimulants are not recommended for those with:

• Any type of heart defect or diseases
• High blood pressure
• Hyperthyroidism
• Glaucoma
• High levels of anxiety
• A history of drug abuse

Non-stimulant medications for ADD & ADHD

In addition to the traditional stimulant drugs, there are several other medications used to treat ADD / ADHD, including Strattera, atypical antidepressants, and certain blood pressure medications. In most cases, non-stimulant medications are considered when stimulants haven’t worked or have caused intolerable side effects.

Strattera

Strattera, also known by its generic name atomoxetine, is the only non-stimulant medication approved by the FDA for ADD / ADHD treatment. Unlike stimulants, which affect dopamine, Strattera boosts the levels of norepinephrine, a different brain chemical.

Strattera is longer-acting than the stimulant drugs. Its effects last over 24 hours—making it a good option for those who have trouble getting going in the morning. Since it has some antidepressant properties, it’s also a top choice for those with co-existing anxiety or depression. Another plus is that it doesn’t exacerbate tics or Tourette’s Syndrome.

On the other hand, Strattera doesn’t appear to be as effective as the stimulant medications for treating symptoms of hyperactivity.

Common side effects of Strattera include:

• Sleepiness
• Headache
• Abdominal pain
• Nausea and vomiting
• Dizziness
• Agitation or irritability

Straterra can also cause insomnia and appetite suppression, but these side effects are more common in stimulants.

Other ADD & ADHD medication options

The following medications are sometimes used “off-label” in the treatment of attention deficit disorder, although they are not FDA approved for this purpose. They should only be considered when stimulants or Strattera aren’t viable options.

• High blood pressure medication for ADD / ADHD — Certain blood pressure medications can be used to treat ADD / ADHD. Options include clonidine (Catapres) and guanfacine (Tenex). They are especially beneficial for those with tics or Tourette’s Syndrome. But while these medications can be effective for hyperactivity, impulsivity, and aggression, they are less helpful when it comes to attention problems.
• Antidepressants for ADD / ADHD - For people suffering from both ADHD and depression, certain antidepressants, which target multiple neurotransmitters in the brain, may be prescribed. Wellbutrin, also known by the generic name bupropion, is most widely used. Wellbutrin targets both norepinephrine and dopamine. Another option are the tricyclic antidepressants.

Deciding whether or not to take ADD & ADHD medication

Even when armed with all the facts, deciding whether or not to take ADD / ADHD medication isn’t always easy. If you’re unsure, don’t rush the decision. Take your time to weigh the options. And if the medication is for your child, be sure to get his or her input in the decision-making process.

Most importantly, trust your instincts and do what feels right to you. Don’t let anyone—be it your physician or the principal at your child’s school—pressure you into medication if you’re not comfortable with it or ready to take that step.

Questions to ask an ADD / ADHD specialist

Consulting with an ADD / ADHD specialist or an experienced psychiatrist can help you understand the pros and cons of medication. Here are some questions to ask:

• What ADD / ADHD treatments do you recommend?
• Can my symptoms be managed without medication?
• What medications do you recommend and what are the side effects?
• How effective is medication for ADD / ADHD?
• How long will the medication be necessary for treatment?
• How will the decision be made to stop medication? 

Guidelines for taking ADD & ADHD medication

To maximize the effectiveness of medication for ADD / ADHD and to minimize the side effects and risks, it’s important to take the drug as directed. Here are some guidelines for safe use:

• Learn about the medication. Find out everything you can about the ADD / ADHD medication you or your child is taking, including potential side effects, how often to take it, special warnings, and other substances that should be avoided, such as over-the-counter cold medication.
• Be patient. Finding the right medication and dose is a trial-and-error process. It will take some experimenting, as well as open, honest communication with your doctor.
• Start small. It’s always best to start with a low dose and work up from there. The goal is to find the lowest possible dose that relieves you or your child’s symptoms.
• Monitor the drug’s effects. Pay close attention to the effect the medication is having on your or your child’s emotions and behavior. Keep track of any side effects and monitor how well the medication is working to reduce symptoms.
• Taper off slowly. If you or your child wants to stop taking medication, call the doctor for guidance on gradually decreasing the dose. Abruptly stopping medication can lead to unpleasant withdrawal symptoms such as irritability, fatigue, depression, and headache.

Talking to your child about ADHD medication

Many kids and teens with ADD / ADHD don’t take their medication correctly—or stop taking it without talking to their parents or doctor—so if your child is on ADD meds, make sure that he or she understands how to take the medication correctly and why following prescription guidelines are important. Encourage your child to come to you with any medication-related concerns so you can work together to solve the problem or find another treatment option.

Dealing with the side effects of ADD & ADHD medication

Most children and adults taking medication for ADD / ADHD will experience at least a few side effects. Sometimes, side effects go away after the first few weeks on the medication. You may also be able to eliminate or reduce unpleasant side effects with a few simple strategies.

Tips for minimizing side effects

• Loss of appetite — To deal with reduced appetite, eat healthy snacks throughout the day and push dinner to a later time when the medication has worn off. You might also consider protein shakes, energy bars, or liquid meals.
• Insomnia — If getting to sleep is a problem, try taking the stimulant earlier in the day. If you or your child is taking an extended-release stimulant, you can also try switching to the short-acting form. Also avoid caffeinated beverages, especially in the afternoon or evening.
• Stomach upset or headaches — Don’t take the medication on an empty stomach, which can cause nausea, stomach pain, and headaches. Headaches can also be triggered by medication that’s wearing off, so a switch to long-acting drug may help.
• Dizziness — First, have you or your child’s blood pressure checked. If it’s normal, you may want to reduce your dose or switch to a long-acting stimulant. Also make sure you’re drinking enough fluids.
• Mood changes — If medication is causing irritability, depression, agitation, or other emotional side effects, try lowering the dose. Moodiness may also be caused by the rebound effect, in which case it may help to overlap the doses or switch to an extended-release medication.

If troublesome side effects persist despite your best efforts to manage them, talk to your doctor about adjusting the dose or trying a different drug. Many people respond better to the long-acting or extended release formulations of ADHD medication, which build gradually in the bloodstream and then wear off slowly. This minimizes the ups and downs caused by fluctuating medication levels and causes less of a rebound effect—where symptoms return, often worse than before, as the drug wears off.

Related links for ADD / ADHD medications

General information about ADD / ADHD medications

Attention-Deficit Hyperactivity Disorder: Medications — Covers common ADHD medications for children and adults, including side effects, long-term complications, and concerns for abuse. (University of Maryland Medical Center)

ADHD Treatment: Your Guide to Common ADD Drugs - Find answers to parents' top 10 questions about the ADD / ADHD medications. (ADDitude)

An Update On Medications Used In The Treatment Of Attention Deficit Disorder — Article by John Ratey, M.D., assistant professor of psychiatry at Harvard Medical School, on ADD drugs. (Attention Deficit Disorder Association)

Stimulant Medication and ADHD — In-depth article on stimulants for ADD / ADHD, including side effects, treatment guidelines, and effectiveness. (Northern County Psychiatric Associates)

ADHD Medications — Article written for teens about ADHD medications and their safety. (Nemours Foundation)

Side Effects and Safety Concerns of ADD / ADHD Medication

FDA Asks Attention-Deficit Hyperactivity Disorder (ADHD) Drug Manufacturers to Develop Patient Medication Guides — Overview of the FDA’s requirement for ADHD drug labels, with links to each specific medication. (U.S. Food and Drug Administration)

Early Ritalin Exposure May Cause Long-Term Effects on the Brain — A new study suggests that the misdiagnosis of ADHD combined with prescription drug use in children may lead to a higher risk of developing depressive symptoms in adulthood. (McLean Hospital)

ADD / ADHD Medication Guidelines

ADD Drugs 101: Stimulant Strategies — Guidelines for taking ADD / ADHD stimulant medications safely and effectively. (ADDitude)

ADD Drugs: Say No to Side Effects — Guide to finding the right medication for you or you child and minimizing side effects. (ADDitude)

What If Einstein Had Taken Ritalin? — Examines the effects of Ritalin and other ADHD drugs on active kids and questions what effects these drugs might have had if some famous people had taken them. (Overmatter.com - reprint of Wall Street Journal article)

Melinda Smith, M.A., Deborah Cutter, Psy.D., Robert Segal, M.A., and Jeanne Segal, Ph.D., contributed to this article. Last modified on: 6/13/08.