The medical community is still learning how to best treat ADHD in adults. But with increased research focusing on adults with the disorder, medication treatment options have expanded.
Stimulant Treatment Options
Many of the first-line medications used to treat ADHD function as central nervous system (CNS) stimulants, and have been FDA approved for the treatment of both adult and childhood attention deficit hyperactivity disorder (ADHD) as well as narcolepsy in adults.
Although it is not known exactly how stimulants reduce the symptoms of adult ADHD, it is believed that they increase the flow of the neurotransmitters, chemicals that carry the signal between neurons (cells of the nervous system). This can enhance a person’s ability to focus over extended periods of time. The following are some of the stimulant medications used to treat adult ADHD.
The general categories of stimulants used to treat adult ADHD include these listed name brands followed by their generic equivalent:
· Brands: Concerta, Metadate CD, Metadate ER, Methylin ER, Ritalin, Ritalin LA, Ritalin-SR, Daytrana; Generic: Methylphenidate
· Brands: Dexedrine, Dextrostat; Generic: Dextroamphetamine
· Brand: Adderall; Generic: Amphetamine with Dextroamphetamine
· Brand: Focalin; Generic: Dexmethylphenidate
· Brand: Vyvanse; Generic: Lisdexamfetamine Dimesylate
· Brand: Desoxyn; Generic: Methamphetamine Hydrochloride
· Brand: Cylert ; Generic: Pemoline*
Side Effects and Precautions of Stimulant Use
The common side effects of stimulants include:
· Dry mouth
· Upset Stomach
· Diarrhea or Constipation
· Irritability and Restlessness
· Loss of appetite
· Difficulty falling asleep
· Weight loss
Most minor side effects of stimulants resolve over the first week or two, as your body adjusts to the medication.
With the use of stimulants, there is the potential for increasing tolerance to the medication over long-term use as well as the danger of abuse. And this type of medication is not recommended for people who have a history of drug abuse. Amphetamines may also not be right for those who have a history of heart problems.
Many stimulants are not recommended for people with overactive thyroid, glaucoma, epilepsy and seizure disorders, severe anxiety or agitation and those who have recently taken MAO inhibitors.
Methylphenidate, dextroamphetamine and amphetamine are pregnancy category C medications, which may be harmful to an unborn baby. These drugs can also pass into breast milk and may be harmful to your baby if you nurse. Cylert is a category B medication.
Non-stimulant Treatment Options – Catapres®
Catapres® is the brand name for an anti-hypertensive medication FDA approved for the treatment of mild to moderate high blood pressure. Its generic equivalent is called clonidine hydrochloride. Although not FDA indicated for the treatment adult ADHD, Catapres® (clonidine hydrochloride) is generally well accepted as an alternative to the use of stimulants in treating ADHD.
It is unclear exactly how this blood-pressure reducing medication works in treating ADHD. It is known to reduce activity of the sympathetic nervous system and has been shown to have a calming effect on certain areas of the brain.
Sedation is the most universal adverse effect of clonidine hydrochloride. Other common side effects include: constipation, dizziness, dry eyes, dry mouth, and decreased heart rate. After a few weeks of treatment, minor side effects usually diminish considerably.
It is very important that clonidine hydrochloride be taken as directed and that you do not stop this medication suddenly without consulting your physician. Sudden discontinuation can result in possible serious, and even fatal, withdrawal symptoms.
Hot weather and fever can significantly lower blood pressure and may necessitate that your current dose of clonidine hydrochloride be adjusted.
Catapres® is a category C medication that may be harmful to an unborn baby.
Another popular non-stimulant treatment option is Strattera®, which is FDA approved to treat both childhood and adult ADHD. It is a selective norepinephrine reuptake inhibitor, which works to improve concentration and decrease hyperactivity and impulsivity. Advantages of using Strattera® include its high success rate (about 75%), its non-addictive nature (it’s not a stimulant and can be discontinued at any time without adverse effect), and its long-lasting effects (works for a full day).
Strattera® (atomoxetine hydrochloride) has many of the same minor side effects of Catapres®. Strattera® can also cause liver damage, suicidal ideation, and impair sexual function.
Strattera® is a category C medication that may be harmful to an unborn baby.
Antidepressants – Wellbutrin®
Antidepressants are another category of useful medications, with the most popular choice being Wellbutrin®. Antidepressants are often used in patients with both adult ADHD and depression, or in conjuction with a stimulant.
Wellbutrin® (Bupropion) is a norepinephrine and dopamine reuptake inhibitor which increases feelings of motivation and enjoyment.
Wellbutrin® can cause seizures and other side effects associated with antidepressants.
Total Treatment of ADHD
Medications used to treat ADHD should be used as a part of a total treatment program. Comprehensive treatment of the adult ADHD often includes education, support groups, regular doctor appointments and therapy or counseling.
* Cylert has generally been one of the least favorite stimulant ADHD drugs, due to its potential to cause serious side effects, including liver damage. In 2005, the manufacture of Cylert was discontinued in US markets.
Watkins MD, C. (2006) New Medications for Adults with ADHD. Northern County Psychiatric Associates