ADHD Treatment Overview: Stimulants

Stimulant therapy for ADHD is a first-line treatment, recognized as safe and effective when taken as prescribed.

Stimulant therapy is one of the most commonly used types of treatments to treat ADHD.

Stimulants are an effective way of managing ADHD symptoms such as short attention span, impulsive behavior and hyperactivity. They may be used alone or in combination with behavior therapy.

These drugs improve ADHD symptoms in 70% of adults and 70%-80% of children shortly after starting treatment. Improvements include reduced interrupting, fidgeting and other hyperactive symptoms as well as improved task completion and home relationships.

Improvements in behavior and attention span usually continue as long as the medication is taken, although benefits in social adjustment and school performance have not yet been shown to endure over the long term.

These medications are not considered to be habit forming when used to treat ADHD in children and adolescents, and there is no evidence that their use leads to drug abuse. Nonetheless, there is a potential for abuse and addiction with any stimulant medication, especially if a person has a history of substance abuse.

Common Stimulants for ADHD

There are many stimulants available: short acting (immediate-release), intermediate-acting and long-acting forms. Common stimulants include:

• Adderall (intermediate-acting)
• Adderall XR (long-acting)
• Concerta (long-acting)
• Dexedrine (short-acting)
• Dexedrine spansule (intermediate-acting)
• Metadate CD (long-acting)
• Metadate ER (intermediate-acting)
• Methylin ER (intermediate-acting)
• Ritalin(short-acting)
• Ritalin LA (long-acting)
• Ritalin SR (intermediate-acting)
• Vyvanse (long-acting)

The short acting forms of the drug are usually taken every four hours and the long acting ones just once a day.

Newer forms of some stimulant drugs may reduce side effects and relieve symptoms for a longer period of time. They include Concerta (10-12 hour duration), Ritalin LA (6-8 hours), Metadate CD (6-8 hours), Dexedrine Spansules and Adderall XR (10-12 hours).

How Do Stimulants for ADHD Work?

Stimulants regulate impulsive behavior and improve attention span and focus by increasing the levels of certain chemicals in the brain, such as epinephrine and norepinephrine, which help transmit signals between nerves.

Who Should Not Take a Stimulant Drug?

People with any of the following conditions should not take stimulants.

• Glaucoma (a condition that causes increased pressure in the eyes and can lead to blindness.)
• Severe anxiety, tension, agitation or nervousness
• Treatment with a type of medication called monoamine oxidase inhibitors, such as Nardil or Parnate, within 14 days of starting stimulant therapy
• People with motor tics or a personal or family history of Tourette's Syndrome

What Are the Side Effects of Stimulant Drugs?

Common side effects include:

• Headache
• Upset stomach
• Increased blood pressure

These typically resolve after a few weeks of treatment as the body adjusts to the medication.

Other side effects may respond to a dosage adjustment or by changing to another type of stimulant. They include:

• Decreased appetite. This affects about 80% of people who take stimulant therapy.
• Weight loss. This is an issue with 10%-15% of children who take stimulant drugs to treat ADHD. It can often be managed by taking the medication after meals or adding protein shakes or snacks to the diet.
• Nervousness
• Sleeplessness

Growth reduction has been observed in some children and adolescents who take stimulants, but it has not been shown to affect final height. Children and adolescents should be followed for weight loss and growth while taking stimulants.

Allergic reactions, with skin rashes and other, more serious allergic symptoms, can occur with stimulants, so it is best to notify your doctor if any new or unusual symptoms occur.

Tips and Precautions When Taking Stimulants for ADHD

When taking stimulant therapy for ADHD, be sure to tell your health care provider:

• If you are nursing, pregnant, or plan to become pregnant
• If you are taking or plan to take any dietary supplements, herbal medicines or nonprescription medications
• If you have any past or present medical problems, including high blood pressure, seizures, heart disease, glaucoma or liver or kidney disease
• If you have a history of drug or alcohol abuse or dependency, or if you have had mental health problems, including depression, manic depression, or psychosis.

If you miss a dose, just go back to the regular prescribed dosage schedule - dont try to catch up by taking additional doses.

The following are useful guidelines to keep in mind when giving your child stimulants for ADHD:

• Always give the medication exactly as prescribed. If there are any problems or questions, call your doctor.
• When starting stimulant therapy, do so on a weekend so that you will have an opportunity to see how the child responds.
• Your doctor will probably want to start out at a low dose and increase gradually until symptoms are controlled.
• Try to keep to a regular schedule, which may mean that doses will have to be given by teachers, nurses or other caregivers.
• Children usually respond better to continuous medication use, but "medication vacations" may be planned for a day or more for children who are doing well when activities permit.

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