Medication to treat ADHD is very common. In fact, as of 2007, around 2.7 million children ages 4 to 17 (66.3 percent of those diagnosed) were receiving medication treatment for ADHD. (CDC, 2010)
Medication is often an important and difficult reality for parents of children with ADHD. Central nervous stimulants (like Adderall and Ritalin) are the most commonly prescribed drugs, but your doctor may recommend other types as well.
Be sure to research drug information thoroughly, and then discuss with your doctor and/or healthcare professional.
Central Nervous System Stimulants
Central nervous system (CNS) stimulants are the most common type of medication prescribed for ADHD. They have the longest track record of treating ADHD and have the most research to verify their effectiveness.
Scientists are not sure exactly how CNS stimulants ease the symptoms of ADHD. It is believed that these drugs work by increasing dopamine levels in the brain. Dopamine is a brain chemical associated with motivation, pleasure, attention, and movement. For many people with ADHD, stimulants can increase their ability to concentrate and focus. These drugs can also ease hyperactive and impulsive behaviors.
CNS stimulants for ADHD come in both short- and long-acting forms.
Short-acting stimulants peak after several hours and must be taken two to three times a day. These usually come in pill or capsule form. Long-acting, or extended-release, stimulants last for eight to 12 hours and are usually taken just once a day. Extended-release stimulants contain the same drugs as short-acting forms; the difference is the way in which the drug is delivered into the body. Extended-release stimulants are usually taken in the form of a pill or capsule as well. However, an extended-release methylphenidate patch was recently put on the market as an alternative to pills.
CNS stimulants used to treat ADHD include:
- Amphetamine-based stimulants (Adderall, Dexedrine, Dextrostat). These medicines are made up of either dextroamphetamine or a combination of dextroamphetamine and levoamphetamine.
- Dextromethamphetamine (Desoxyn)
- Dextromethylphenidate (Focalin)
- Methylphenidate (Concerta, Daytrana, Metadate, Ritalin)
CNS stimulants are highly addictive. They should only be used under the supervision of a doctor. The medications can cause some adverse side effects, including decreased appetite, weight loss, trouble sleeping, irritability when the medication wears off, and, in rare cases, development of facial tics or heart conditions.
Although stimulants are commonly prescribed for the treatment of ADHD, recent research has discovered that their may be harmful effects on the heart health of children taking them. This is especially true in children with pre-existing conditions, such as diabetes, high blood pressure, or heart-rhythm abnormalities.
A task force of the American Heart Association (AHA) and American College of Cardiology (ACC) recently revised their recommendations on stimulants. The task force added a provision stating that doctors should carefully monitor the heart health of children who require stimulant medication to treat ADHD.
The U.S. Food and Drug Administration (FDA) has also added warnings to the labels of stimulants to warn patients about an increased risk of heart and psychiatric problems.
Non-stimulant drugs are often considered when stimulants have not worked or have caused intolerable side effects.
Atomoxetine is one of only two non-stimulant drugs approved by the FDA for ADHD treatment. As with CNS stimulants, scientists are not sure exactly why atomoxetine works. Atomoxetine, like stimulants, affects levels of neurotransmitters in the brain. However, atomoxetine boosts levels of the chemical norepinephrine. (Stimulants affect dopamine.) Atomoxetine is longer acting than stimulants; its effects can last more than 24 hours.
Because it also has some antidepressant properties, atomoxetine may be a good option for ADHD patients who are also experiencing symptoms of anxiety or depression. However, atomoxetine doesn’t appear to be as effective as stimulant medications for treating symptoms of hyperactivity.
Side effects of atomoxetine may include nausea, sedation, reduced appetite, and weight loss.
Guanfacine (Intuniv) is a non-stimulant approved by the FDA in 2009 for treating ADHD. In 2011, it was also approved for use alongside CNS drugs in treating ADHD in children. Guanfacine is primarily a blood pressure medication, but it has also been shown in clinical trials to effectively treat symptoms of hyperactivity, impulsivity, and aggression. It is less helpful when it comes to attention problems. Other blood pressure drugs (especially clonidine) are sometimes prescribed off-label to treat ADHD.
Although the FDA has not approved antidepressants for the treatment of ADHD, doctors will sometimes prescribe these medications to patients who do not respond well to stimulants or to atomoxetine.
Certain atypical, or second generation, antipsychotics—which target multiple neurotransmitters in the brain—are also sometimes prescribed off-label to treat ADHD in patients who don’t respond well to stimulants or atomoxetine.