ADHD Medications

ADHD Medications

Also called: ADHD Drugs, ADD Medications, ADD Drugs

Summary

ADHD medications are prescription drugs used to treat attention deficit hyperactivity disorder (ADHD). These drugs are often highly effective in helping to control symptoms such as inability to pay attention, hyperactivity and impulsivity.

ADHD medications improve symptoms by boosting and balancing levels of brain chemicals known as neurotransmitters. This can have a dramatic calming effect on ADHD patients, allowing them to more easily focus on tasks such as learning and working. The drugs may also improve coordination in some patients.

Psychostimulants – often simply referred to as “stimulants” – are the chief form of medication therapy for ADHD. Up to 90 percent of patients who take them report at least some improvement in symptoms, according to the American Psychiatric Association (APA). Certain types of antidepressants and alpha-2 adrenergic agonists are also used to treat ADHD, often in patients who do not respond well to stimulants.

ADHD drugs are usually well-tolerated by patients. However, patients with certain medical conditions may not be good candidates for drug therapy. In addition, some medications – particularly the antidepressants known as monoamine oxidase inhibitors (MAOIs) – may have poor and possibly dangerous interactions with ADHD drugs.

ADHD drugs are available in tablet, capsule and injection form. The U.S. Food and Drug Administration (FDA) also recently approved the first transdermal (skin) patch to treat the disorder in children ages 6 to 12.

Women who are pregnant, thinking of becoming pregnant or breastfeeding are usually urged not to use ADHD medications. In addition, these drugs are not generally prescribed for children under the age of 6. Older adults may use many ADHD medications safely, but dosage levels may have to be adjusted to prevent side effects. In some cases, young patients need to take ADHD drugs only for a year or two before a change in their symptoms renders the drugs unnecessary. However, in most cases patients will continue to take medications into adolescence and possibly into adulthood.

About ADHD medications

ADHD medications are prescription drugs used to treat attention deficit hyperactivity disorder (ADHD), a set of chronic conditions marked by an inability to pay attention, hyperactivity and a tendency to engage in impulsive acts. The drugs are often highly effective in helping patients to control behavioral problems that hinder them in day-to-day life.

Although they are not certain, experts theorize that ADHD medications improve symptoms by increasing activity in certain parts of the brain that are underactive. ADHD medications function by boosting and balancing levels of chemicals known as neurotransmitters in the brain. Patients who take these drugs often experience dramatically reduced levels of hyperactivity and impulsivity. This makes it much easier for them to focus on tasks such as working and learning. These drugs also improve coordination in some patients, making it easier for them to write or engage in athletics.

Individuals may respond differently to the various drugs used to treat ADHD. Parents are urged to work closely with physicians in trying to find the appropriate medication and dosage level for their child.

It is important to remember that medications cannot cure ADHD, but can only help control symptoms during the period that they are working in the body. Behavioral therapy, other forms of psychotherapy and family support are also crucial to helping children cope with ADHD.  

Children who take these drugs and find them to be effective may be asked by a physician to suspend use of the drugs for a period of time to see whether or not they are still necessary. This may be planned around a time such as summer vacation, when a child is more relaxed and has fewer tasks that need to be completed. In some cases, drugs are only necessary for a year or two before a change in a child’s symptoms renders them unnecessary.

In most cases patients will continue to take medications into adolescence and possibly into adulthood. About 80 percent of patients with ADHD take medication into their teenage years, and 50 percent of all patients will continue to require medication as adults, according to the National Institute of Mental Health(NIMH). ADHD drugs are available in tablet, capsule and injection form. The U.S. Food and Drug Administration also recently approved the first transdermal (skin) patch to treat the disorder in children ages 6 to 12.

Types and differences of ADHD medications

The four major categories of drugs used to treat attention deficit hyperactivity disorder (ADHD) are psychostimulants, alpha-2 adrenergic agonists, antidepressantsand norepinephrine reuptake inhibitors.

Psychostimulants, often simply referred to as “stimulants,” inhibit the reabsorption of dopamine, a neurotransmitter that helps to keep the central nervous system(CNS) functioning normally. This leaves more dopamine circulating in the body. Stimulants are the mainstay of ADHD medication treatment, and up to 90 percent of patients who take them report at least some improvement in symptoms such as impulsivity and hyperactivity, according to the American Psychiatric Association(APA). Although these drugs have a stimulating effect on most people, they are calming in patients with ADHD.

Stimulants usually work fairly rapidly, with symptom reduction beginning between 30 and 45 minutes after ingestion. They work for between four and 12 hours and are typically taken two to three times daily. Some longer-acting (extended release) formulations may be taken just once a day. Most of the stimulants are only recommended for children over age 6. However, some amphetamines may be prescribed to children over age 3. The stimulant pemoline is no longer used as a treatment for ADHD as it can potentially cause serious side effects that may harm the liver. It was withdrawn from the market in 2005.

Alpha-2 adrenergic agonists are sometimes used to treat core ADHD symptoms, but more often are used to reduce irritability and aggression related to ADHD. They can also be used to promote sleep in patients who report insomnia.

Depression is a disorder commonly associated with ADHD, and antidepressants are often prescribed to treat lasting feelings of sadness. In addition, antidepressants that increase the availability of the neurotransmitters dopamine and norepinephrine in the body appear to be effective in treating core symptoms of ADHD. The tricylcic antidepressants and the dopamine-norepinephrine reuptake inhibitor bupropion appear to be particularly effective in treating ADHD.

Antidepressants are sometimes used to treat ADHD in patients who do not tolerate stimulants well. These drugs only have to be taken once daily. They are prescribed far more often in adults than in children. Selective serotonin reuptake inhibitors (SSRIs), often used to treat depression and anxiety, have not been effective in treating the symptoms of ADHD.

Patients should be aware that a physician may need to adjust the dosage or change medications to achieve the best results with minimal side effects. In addition, the U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.

Drug TypeGeneric NameBrand Name(s)
StimulantsmethylphenidateRitalin, Metadate, Methylin, Concerta, (Focalin XR),
Daytrana
dextroamphetamineDexedrine
amphetamineAdderall, Desoxyn
Alpha-2 adrenergic agonistsclonidineCatapres
guanfacineTenex
AntidepressantsbupropionWellbutrin
atomoxetine*Strattera

*The drug atomoxetine is not approved for use as an antidepressant by the FDA.

Conditions of concern with ADHD medications

The presence of other medical conditions does not necessarily prohibit the use of ADHD medications. However, individuals should always inform their physician of any existing medical conditions and work closely with their physician to design a treatment plan that meets their unique needs.

Stimulants are usually well-tolerated by patients with ADHD and are rarely abused. However, patients with anxiety disorders should take these medications cautiously, as they aggravate the condition. Usually, a physician will choose to treat and control an anxiety disorder before using stimulants to treat attention deficit hyperactivity disorder (ADHD).

Stimulants should only be used with caution in patients who have a history of seizures, drug and alcohol abuse, kidney disease, high blood pressure (hypertension) or EEG (brain electricity) abnormalities. Patients with diabetes may have to alter insulin intake while using stimulant drugs.

One stimulant in particular, dextroamphetamine (Dexedrine), has been linked to sudden death in children and teenagers with certain heart problems. U.S. officials have asked the drug’s manufacturer to add a label reflecting this risk to the drug’s packaging.

Other conditions of concern that may prohibit the use of stimulants include:

  • Glaucoma (disease that results in increased pressure in the eye)
  • Hypertension (high blood pressure)
  • Hyperthyroidism (excessive production of thyroid gland)
  • Liver disease
  • Motor tics
  • Tourette’s syndrome (or family history of this disease)

Conditions of concern for patients taking antidepressants other than bupropion (Wellbutrin) to treat ADHD include:

  • Cardiovascular disease
  • Certain blood disorders
  • Glaucoma
  • Hypertension
  • Liver or kidney disease
  • Tachycardia (rapid heart rate)

Bupropion poses an increased risk of seizures. Therefore, individuals with seizure disorders may benefit from an alternative medication.

Conditions of concerns for patients taking norepinephrine reuptake inhibitors to treat ADHD include:

  • Cardiovascular disease
  • Hypertension
  • Liver or kidney disease
  • Tachycardia
  • Cardiovascular disease
  • Liver or kidney disease

Conditions of concern for patients taking alpha-2 adrenergic agonists to treat ADHD include:

  • Cardiovascular disease and other heart problems
  • Depression
  • Diabetes mellitus
  • Liver or kidney disorders

It is important to note that these conditions do not prohibit the use of the alpha-2 adrenergic agonists.

Potential side effects of ADHD medications

In the past, some healthcare providers have been reluctant to use medications such as stimulants to treat attention deficit hyperactivity disorder (ADHD) for fear that the patient would become dependent on the drug. However, these fears are largely unfounded. When taken at proper dosage levels, stimulants rise too slowly in the brain to cause the patient to feel “high.” Nonetheless, the number of people who abuse these drugs and use them illicitly appears to be growing.

Some children who take stimulant medications report feeling slightly “funny” or different when taking the drugs. However, this effect is usually minor.

Recent research also indicates that use of stimulants can suppress a child’s growth, although the average growth suppression found in children taking stimulants for the disorder is minimal.

Other Side effects associated with stimulant use include insomnia, loss of appetite, stomachache, dysphoria (condition marked by anxiety, depression and restlessness), lethargy, sedation and/or impaired concentration. In rare cases, stimulant drugs may cause a child to develop a tic. This is typically resolved by changing the child’s dosage level.

Adults who take stimulant drugs may experience mild increases in blood pressure. This can be a significant development for adults who have high blood pressure (hypertension) or liver disease including hepatitis. The risk of abuse is also higher in adults than in children, as adults need to take larger amounts of the drug in order for it to be effective.

Side effects associated with antidepressants taken to treat ADHD may include dry mouth, urinary retention, weight gain, drowsiness and sexual dysfunction, depending upon which antidepressant is used.

In addition, the U.S. Food and Drug Administration (FDA) recently advised that antidepressants, including those used to treat ADHD, may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.

Side effects associated with the alpha-2 adrenergic agonists include sedation, depression, and dry mouth.  An increase in blood pressure (hypertension) may occur after use of these medications is discontinued.

Drug or other interactions

Patients who take drugs to treat attention deficit hyperactivity disorder (ADHD) should consult their physicians before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications.

Stimulant drugs and alpha-2 adrenergic agonists are often combined to treat ADHD. There have been a handful of reported deaths in children who have taken this combination. However, an investigation by the U.S. Food and Drug Administration (FDA) found no significant danger in taking these drugs together.

Caffeine use can decrease the effectiveness of stimulants in treating ADHD. In addition, use of the antidepressant MAO inhibitors (MAOIs) with stimulants can cause severe high blood pressure (hypertension). Vitamin C supplements (ascorbic acid) may shorten the duration of the dosage.

Other drugs that may interact poorly with stimulants include:

  • Antacids
  • Anticonvulsants
  • Anticoagulants (drugs that help prevent blood clots)
  • Antidepressants (in addition to MAO inhibitors)
  • Antipsychotics
  • Bretylium (heart drug)
  • Sedatives such as barbiturates

Drugs that may interact poorly with antidepressants used to treat ADHD include:

  • Other antidepressants
  • Certain blood pressure medications
  • Sedatives such as benzodiazepines

Drugs that may interact poorly with alpha-2 adrenergic agonists used to treat ADHD include:

  • Antidepressants
  • Antihypertensives
  • Central nervous system (CNS) depressants such as alcohol and sedatives
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

Symptoms of ADHD medication overdose

Symptoms of overdose can be similar to the medication’s side effects, but are usually more severe. Patients exhibiting any of these symptoms while taking stimulants should contact their physician immediately:

  • Agitation
  • Confusion
  • Delirium
  • Dry mouth
  • Euphoria
  • Fever
  • Flushing
  • Headache
  • Hallucinations
  • Heart palpitations
  • Nausea and vomiting
  • Seizures

Symptoms of overdose with antidepressants used to treat ADHD include:

  • Ataxia (disorder that affects many tissues and body systems)
  • Seizures

Symptoms of overdose associated with alpha-2 adrenergic agonists used to treat ADHDinclude:

  • Hypotension (low blood pressure)
  • Breathing difficultes
  • Hypothermia (low body temperature)
  • Apnea (cessation of breathing)
  • Seizures
  • Lethargy
  • Agitation
  • Irritability
  • Diarrhea
  • Slow heartbeat
  • Unusual tiredness or weakness

Pregnancy use issues with ADHD medications

Women who are pregnant, thinking of becoming pregnant or who are breastfeeding should not use ADHD medications before discussing the potential advantages and disadvantages of such use with a physician. It is unknown whether some ADHD medications are potentially harmful to fetuses or nursing infants, but many experts advise against using these drugs during pregnancy or breastfeeding.

Child use issues with ADHD medications

The safety of many ADHD medications has not been established in children. In many cases, these drugs are not recommended for use in children under the age of 6. Some stimulant medications have been associated with growth suppression in children.

In addition, the U.S. Food and Drug Administration (FDA) has warned that some children and adolescents who use antidepressants and norepinephrine reuptake inhibitors may experience thoughts of suicide. Although this is rare, it has led experts to urge that children who take antidepressants for ADHD be closely observed for signs of agitation, irritability and unusual changes in behavior.

Elderly use issues with ADHD medications

Dosage levels of some ADHD medications may need to be reduced for elderly patients. In addition, elderly patients may experience additional side effects when taking some ADHD medications. For example, elderly patients who take the alpha-2 adrenergic agonist guanfacine may experience dizziness, drowsiness, hypotension (low blood pressure) and/or faintness.

Questions for your doctor on ADHD medications

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to attention deficit hyperactivity disorder (ADHD) medications:

  1. Are medications the best option for treating my child’s ADHD?

  2. Are ADHD medications safe for my child, given his/her age?

  3. Which type of ADHD medication is best for my child? Why?

  4. Which medical conditions might preclude the use of ADHD medications in my child?

  5. Are there certain drugs my child should not take while using ADHD medications?

  6. What side effects should I watch for in my child?

  7. What are the symptoms of potential overdose that I should watch for in my child?

  8. What other treatments might best supplement my child’s medication therapy?

  9. For how long will my child need to take ADHD medications?

  10. I’m trying to become pregnant – should I discontinue use of my ADHD medications?
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