Overview of Medication Options for ADHD Treatment.
- Dr. Phillip Lodico
- Jul 1
- 4 min read
Attention-Deficit/Hyperactivity Disorder (ADHD) affects millions of individuals in the United States. At its core ADHD is really an inhibitory control problem. Individuals with ADHD struggle to inhibit their initial responses, interrupt ongoing actions, and protect self-directed behaviors. This inhibition is not just about stopping an action, but also about preventing interference from irrelevant stimuli and managing emotional responses. A proper treatment plan includes improving knowledge of the condition, therapy, lifestyle optimization and medication. Knowing the medication options for treating ADHD is crucial for those diagnosed with the disorder and their caregivers.
This post aims to detail the types of medications available. All medications that treat ADHD, regardless of class, have the same therapeutic benefit. They are intended to calm down symptoms. Not stimulate. Stimulation is a side effect of stimulants, as well as the non-stimulant, Wellbutrin. A patient generally develops rapid tolerance to the stimulating nature of these medications over the course of a few days with continued use. This tolerance is sustained as long as medication is continued without interruption.
Stimulant Medications
Methylphenidate and amphetamine improve symptoms by normalizing function in the ADHD brain. They are reuptake inhibitors. Blocking the reuptake of the neurotransmitters, dopamine and norepinephrine. By preventing reuptake, these medications increase the concentration of dopamine and norepinephrine in the synapse, leading to prolonged and amplified signaling. This is beneficial for patients who have ADHD. They experience a calming of racing thoughts, distractibility, impulsivity and restlessness.
The goal of therapy is to reduce the risk of harm from untreated ADHD. Ideally the medication normalizes a patients brain function for the entirety of the day from morning until bedtime.
In the U.S., over thirty stimulant formulations are on the market. Unfortunately only seven of these formulations are available generic. These medications are similar with key differences. Concerning the patients experience, they largely differ in duration of action and individual preference. Best practice guidelines state patients should trial multiple stimulant medications in order to make the most informed decision.
Lisdexamfetamine (Brand: Vyvanse)
Lisdexamfetamine is unique because it is inactive until metabolized by the body. This gradual release mechanism generally results in a smoother therapeutic effect. The medication tends to be less harsh and more natural feeling. Duration 12-14 hours at the correct dose. Making it suitable for all-day management. Considered to have less abuse potential. No medication is perfect for everyone but Vyvanse tends to have the highest patient satisfaction rates.
Mixed Amphetamine Salts (Mydayis, Adderall, Adderall XR)
This combination medication includes one part levoamphetamine and three parts dextroamphetamine.
Mydayis: Most recent FDA approved oral medication. It has three doses of medication released over the day. This triple beaded release provides coverage from 14-16 hours a day on a single dose. Has less side effects compared to Adderall & Adderall XR. Considered to have less abuse potential.
Adderall: Onset within 20 minutes. Duration closer to 4 hours, rare up to 6 hours. Abrupt onset and offset which can lead to a surge at onset and a crash at offset. Generally dosed two to three times daily for adequate coverage.
Adderall XR: Two doses of Adderall inside a capsule. Duration closer to 8 hours, rarely up to 12 hours. Half immediate release, half delayed by 4-5 hours. Similar onset, abruptness and crash as Adderall as it is the same medication.
Dextroamphetamine & Dextroamphetamine XR (Dexedrine, Zenzedi)
Similar to Adderall and Adderall XR in action, duration and patient experience.
Dexmethylphenidate (Focalin, Focalin XR)
A refined version of methylphenidate, dexmethylphenidate offers similar benefits with potentially fewer side effects. Patients may experience less insomnia and reduced anxiety levels compared to other stimulants. Duration 5-6 hours for Focalin. Usually dosed twice a day. Focalin XR around 12 hours on a single dose.
Methylphenidate (Ritalin, Ritalin LA, Concerta)
Methylphenidate is one of the most prescribed medications for ADHD. Available in various formulations, including long-acting and immediate-release forms. Ritalin and Ritalin LA have similar duration as Adderall and Adderall XR. Concerta provides symptomatic relief for 10 hours on average.
It’s important to remember that individual responses can vary.
Non-Stimulant Medications
Non-stimulant medications are great options for those who responded favorably. They tend to be better tolerated, have less side effects and they work around the clock, normalizing the brains function even when asleep.
Strattera (Atomoxetine)
Strattera is the first non-stimulant medication approved for ADHD treatment. It selectively inhibits norepinephrine reuptake, enhancing attention and reducing impulsivity. It may also improve anxiety and depressive symptoms. Although it can take several weeks to notice improvement, studies show it maintains a lower risk of addiction compared to stimulants, making it an appealing choice for many.
Intuniv (Guanfacine Extended-Release)
Initially developed as a blood pressure medication, Intuniv has shown promise in improving attention, impulse control, and hyperactivity in children and adolescents. It is the one medication that can directly improve emotional dysregulation of ADHD. Providing a veil of emotional armor without muting emotions.
Wellbutrin XL (Bupropion)
One of the most prescribed psychiatric medications and simultaneously one of the most misunderstood. Classified as an atypical-antidepressant, Wellbutrin XL has gained attention for its effectiveness in treating ADHD in adults. It influences norepinephrine and dopamine levels. Adult patients may appreciate Wellbutrin as it is known to improve mood, weight loss, sleep quality and libido.
Final Thoughts
Navigating the landscape of ADHD medications can be complex, but understanding the various options is essential for effective management. While stimulant medications are widely used and highly effective for many, non-stimulant alternatives like Strattera, Intuniv, and Wellbutrin XL offer valuable choices for those who cannot tolerate stimulants. Collaborating closely with healthcare providers is critical to developing a personalized treatment plan that addresses individual symptoms and needs.
Finding the right medication may take time and careful evaluation, but with the right support and informed choices, individuals with ADHD can thrive in their daily lives. LodicoHealth.com
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