Medication Options for Adults with ADHD
Updated: Sep 18
By Dr. Melissa Shepard
There are many different potential treatment options for ADHD. While medications are not always necessary or desired, they can be a very helpful part of treatment for some people with ADHD. In this post, we will discuss some of the treatment options for adults with ADHD, should you decide to go that route. We will discuss non-medication options in a future post, so stay tuned!
There are two major categories of ADHD medications: stimulant and non-stimulant. We will talk a bit about the pros and cons of these different classes, but the best medication can vary from person to person, so it is essential to discuss your options with your doctor. As always, this is for educational purposes only and is not medical advice. This should not replace the advice of your physician or other mental health professionals.
Stimulant medications include two major families: amphetamines and methylphenidate.
Stimulant medicines work primarily by increasing levels of neurotransmitters like dopamine and norepinephrine in some regions of the brain. People with ADHD often have low levels of these neurotransmitters, leading to common ADHD symptoms like inattention, impulsivity, hyperactivity, and executive dysfunction. Stimulants effectively treat these symptoms in most people with ADHD.
Some people respond better to amphetamines and some to methylphenidate. Unfortunately, there is really no reliable way to tell whether one will work better than another (aside from just trying them).
Most people tolerate stimulant medications well, without any significant side effects. The most common side effects of stimulant medications include difficulty sleeping, decreased appetite, headaches, and irritability. These side effects tend to get better the longer you take the medication, but we can try adjusting the dose or switching to an alternative medicine if they don't. Extended-release versions of stimulant medications are also less likely to cause many of the most common side effects.
Serious side effects are very rare when these medications are used as prescribed. Serious side effects are more likely if the dose is too high or the medications are abused. Possible serious side effects include heart problems (more likely in those with underlying heart conditions), psychosis, and problems with mood. Deaths have been reported in people abusing stimulant medications.
People often worry that they will get addicted to stimulant medications. Thankfully, this is also very unlikely in people who truly have ADHD and who take the medications as prescribed. People who have a history of addiction can be at higher risk for addiction to and dependence on these medications, so your doctor will monitor you closely.
However, a history of addiction (or even active addiction) doesn't mean you can never take a stimulant medication for your ADHD. People with untreated ADHD are at higher risk for substance use problems because of impulsivity, novelty-seeking, and problems regulating their mood. In these cases, stimulant medications can provide more benefit than risk (and can even make it more likely that someone will overcome another addiction).
Amphetamines used for the treatment of ADHD include amphetamine mixed salts, dextroamphetamine, and lisdexamfetamine dimesylate. Some of the brand names for amphetamines in the United States include Adderall, Adderall XR, Adzenys XR-ODT, Dyanavel XR, Evekeo, Mydayis, and Vyvanse.
Methylphenidate (and the related medication, dexmethylphenidate) is found in the brand name drugs Ritalin, Ritalin LA, Concerta, Methylin, Quillivant, QuilliChew, Metadate CD, Aptensio XR, Daytrana, and Focalin.
As a group, these medications are less likely to be effective, which is why we typically start with one of the stimulant medications. But in some cases, they may be just as good as stimulant medications (and may even cause fewer side effects). They are also less likely to cause dependence and are less likely to be abused. Non-stimulant medications work by various mechanisms, and potential side effects also vary.
Atomoxetine (also known by the brand name Strattera) is FDA approved to treat ADHD in adults. Atomoxetine works by increasing the availability of norepinephrine in some regions of the brain. In general, it is less likely to be effective and takes longer to kick in than stimulant medications. The most common side effects of atomoxetine are nausea and tiredness.
Bupropion (also known by the brand name Wellbutrin) is most commonly used in people who have both ADHD and major depressive disorder. Smaller trials have suggested that bupropion may be effective for people with ADHD, but more research is needed.
Tricyclic Antidepressants (Desipramine, Nortriptyline)
Like bupropion, tricyclic antidepressants are most commonly used in people who have "complex ADHD", or ADHD along with another condition like a mood or anxiety disorder. Potential side effects can include serious heart problems, so your doctor will likely want to monitor your blood pressure, heart rate, and EKG as long as you are on the medication.
Clonidine and Guanfacine
Clonidine and Guanfacine are medications that are used to treat ADHD in children. These are less likely to be used in adults because research has shown that they may not be as effective as other medication options.
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