A Guide to Stimulant Medication: The most common type of medication used to manage ADHD symptoms10/14/2021
Author: Sadie O'Hara ADHD symptom management is different for each individual, but one common tool for managing troublesome ADHD symptoms is stimulant medication. The purpose of this article is to provide some information about stimulant medications, and to address some common myths surrounding stimulants. You may be wondering, what are stimulants? Stimulants, also known as psychostimulants, are a class of medications that stimulate the central nervous system (CNS). Most people are familiar with stimulants such as caffeine and nicotine, which generally make one feel more alert and energetic. With hyperactivity being a primary feature of ADHD, stimulant medication can seem counterintuitive. However, for those with ADHD, stimulant medications have been shown to reduce distractibility, improve sustained attention, reduce impulsive behaviors, and improve activity level. To understand how stimulants might achieve these effects, we need to consider what is already known about ADHD. We are still learning about ADHD, but current evidence suggests that many symptoms may be related to levels of dopamine and norepinephrine in the brain. Dopamine and norepinephrine are two molecules used by the nervous system to transmit messages. The level of dopamine and norepinephrine in the brain can impact a person’s mood, attention, motivation, and movement. Dopamine and norepinephrine also play an important part in the brain’s reward system. Experts believe that people with ADHD have an increased number of transporters that remove dopamine and norepinephrine, leading to decreased levels. Stimulant medications are believed to increase the availability of dopamine and norepinephrine in the brain. This can be achieved in different ways, such as by slowing down the removal of these neurotransmitters or by increasing their release. This increased availability allows dopamine and norepinephrine to properly bind to receptors and transmit their message more effectively. This is an extremely simplified version of how stimulant medications produce their effects. It is beyond the scope of this article to fully explain the various proposed hypotheses on the neurobiology of ADHD. For more information please see the referenced article Neurobiology of ADHD: A Review, and other sources cited blow this article. A few stimulant medications are most commonly prescribed for ADHD: methylphenidate, amphetamine, and lisdexamfetamine. You may know of methylphenidate by a brand name, such as Ritalin, Concerta, Daytrana, Metadate, Methylin, Quillivant XR, or QuilliChew ER. Amphetamine is often combined with dextroamphetamine and sold under the brand name Adderall. Lisdexamfetamine brand name is Vyvanse. You may notice some medications have ER, SR, XL, XR, or CD after the name, this means the medication is an extended-release medication. These medications are different from immediate-release medications which are are formulated to release the drug immediately after it is taken, causing a rapid onset of effects but a shorter duration. Stimulants have been available in immediate-release formulations for over 60 years, but can cause more side-effects and require multiple doses each day. Extended-release formulations have been developed more recently to decrease side-effects and increase convenience. These medications often contain the same active drug ingredients as previously used immediate-release medications, but the extended-release formulation allows the drug to be delivered in a more controlled manner. Generally, extended-release medications are designed to work in phases. Some of the drug is released shortly after you take the medication and the rest is slowly released over 6-12 hours, depending on the medication. One benefit of extended-release formulations is that they can offer symptom relief all day with just one pill. They also cause fewer ups and downs throughout the day. Of the stimulant medications, response to a specific drug is highly variable with some people responding better to one drug than others. For some people, an immediate release stimulant may be prescribed in addition to the extended-release stimulant to relieve symptoms in the morning or evening. Common side effects of stimulant medications can be managed with dose adjustments or may diminish over time and can include: sleep problems, decreased appetite, weight loss, increased blood pressure, dizziness, headaches, stomachaches, nervousness, moodiness, and irritability. Liquid, chewable, sprinkled capsule, wearable patch, and orally disintegrating tablet formulations are also available for people who may have difficulty swallowing traditional pills. The dose of a stimulant medication required for optimal symptom reduction with minimal side effects also varies greatly from person to person and will likely have to be adjusted. It is important for people with ADHD to communicate with their healthcare provider so that dosages and formulations can be adjusted to achieve optimal symptom reduction. There have been numerous studies demonstrating that stimulants are an effective and safe way to manage troublesome ADHD symptoms, however myths surrounding stimulants to be prevalent. This section will address some common myths. Myth: ADHD medications cause drug and alcohol abuse Fact: ADHD medications do not cause drug and alcohol abuse Studies have found that people with ADHD are at high risk for alcohol and drug use misuse. Because of this, some reports have suggested that drug use was caused by treatment with stimulant medications. However, studies have found that treating ADHD with stimulant medications can significantly reduce one’s risk of substance abuse or dependence. Myth: ADHD medications are addictive Fact: The therapeutic use of stimulant medications for ADHD can help prevent addiction Stimulant drugs are potentially addictive but their ability to cause addiction depends on how they are used. There is no evidence that using oral, therapeutic doses of stimulant medication leads to addiction. Myth: Stimulants make you aggressive Fact: Stimulants are able to reduce aggressive and antisocial behaviour Myth: Stimulant medications are overprescribed Fact: ADHD remains under-recognized, under-diagnosed, and under-treated even though it is the most treatable psychiatric disorder in Canada It is important to note that approximately one third of people with ADHD do not respond adequately to and/or tolerate stimulants. For individuals who cannot or do not wish to take stimulant medications, nonstimulant ADHD medications are a secondary option. People with ADHD can benefit from a wide variety treatments other than or in combination with stimulant medication such as behavioral and psychosocial treatments. A friendly reminder: The content in this post is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. References Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: A review for practitioners. Translational Pediatrics, 7(1), 36-47. https://doi.org/10.21037/tp.2017.08.02 Caye, A., Swanson, J. M., Coghill, D., & Rohde, L. A. (2018). Treatment strategies for ADHD: An evidence-based guide to select optimal treatment. Molecular Psychiatry, 24(3), 390-408. https://doi.org/10.1038/s41380-018-0116-3 Mattingly, G. W., Wilson, J., & Rostain, A. L. (2017). A clinician’s guide to ADHD treatment options. Postgraduate Medicine, 129(7), 657-666. https://doi.org/10.1080/00325481.2017.1354648 Mehta, T. R., Monegro, A., Nene, Y., Fayyaz, M., & Bollu, P. C. (2019). Neurobiology of ADHD: A review. Current Developmental Disorders Reports, 6(4), 235-240. https://doi.org/10.1007/s40474-019-00182-w Comments are closed.
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