ADHD and Stimulants

Stimulants are considered a first-line therapy for ADHD. In 1999, the National Institute of Mental Health conducted a study that showed that stimulation medication is the most effective means of reducing the symptoms of ADHD.¹

The study is among 200 additional well-controlled studies confirming that stimulation medication as the fastest and most effective treatment against ADHD symptoms.² That said some studies and anecdotal evidence have questioned its safety and long-term efficacy.

Types of Stimulants

Generally speaking there are two different types of stimulants: methylphenidate and amphetamines. A third type of stimulant—magnesium pemoline (Cylert)—lost its FDA approval due to its high risk of causing individuals to experience liver failure. A list of specific stimulants and their brand names is as follows:

• Methylphenidate (Ritalin, Methylin, Metadate, Concerta and Daytrana)
• Dexmethylphenidate (Focalin)
• Amphetamines-dextroamphetamine (Adderall)
• Dextroamphetamine (Dexedrine, Destrostat)
• Lisdexamfetamine (Vyvanse)

Short- Versus Long-Acting Formulas

Stimulation comes in short-, medium- and long-acting formulas. However, the American Academy of Child and Adolescent Psychiatry (AACAP) recommends starting with the shorter-acting formulas before trying a longer-acting formula. There are several advantages to long-acting formulas:

1. Individuals can take them in privacy before the school or workday begins;
2. Individuals are less likely to skip a dose; and
3. Individuals are less vulnerable to the “rebound effect.” Thirty percent of people with ADHD will experience even worse symptoms than before treatment when the medication wears off.³

• ADHD and Methylphenidate
• ADHD and Amphetamine

Stimulants enhance the speed and fluidity by which messages are passed through the brain’s neural network. They do this by either increasing the release or slowing the reuptake of the brain chemicals used in neurotransmission. The resulting neurotransmitter boost improves a variety of cognitive functions, including the ability to process information, slow down, focus, remember, self-monitor and self-motivate. Stimulants, however, by no means cure ADHD; they only work for as long as they remain in a person’s system. Although stimulant use does not increase intelligence, it can dramatically improve an individual’s academic performance. Stimulants facilitate the communication systems needed for an individual to access their intelligence. This is why so many ADHD dropouts are able to resume their studies once they begin stimulation medication.

Benefits

One of the benefits of stimulants medication is the speed at which it begins working—immediately. Stimulants are also highly effective. Research shows that stimulants work in 80 percent of individuals with ADHD. Many researchers argue that the benefit of keeping ADHD symptoms at bay outweigh the drawback of possible side effects. Indeed, some researchers believe the “side effects” of untreated ADHD in the form of academic failure, low self-esteem, loneliness, social isolation and depression far outweigh the side effects of stimulant medication. Some kids with ADHD have even been known to be suicidal. “Untreated or inadequately treated ADD syndrome often severely impairs learning, family life, education, work life, social interactions, and driving safely. Most of those with ADD who receive adequate treatment however, function quite well.”⁴

Read more details about Stimulants.

Stimulation medication comes in a variety of forms, including tablets (regular and chewable), capsules, solutions and even a skin patch (Daytrana). Doctors are generally advised to start with the recommended minimum amount and titrate up every three to seven days. Minimum dosages vary per stimulant. Guidelines exist for different age groups; however, dosages aren’t dependant upon a person’s age, weight or severity of symptoms. For example, a small child could require the maximum dosage while a full-grown adult could benefit from a small amount. Due to the danger of the use of stimulation medication in people with heart conditions, the American Heart Association (AHA) recommends that children receive cardiac testing.⁵ This should include a complete patient and family history, physical exam and, if need, an electrocardiogram.

Dosages

Stimulant medication is best prescribed as part of a larger treatment plan for ADHD and should only be administered by a doctor. Dosages vary according to the type of medication used and the individual’s age—although age is not always a good determinant as to the amount of stimulation drug needed. A list of general guidelines has been issues by the American Academy of Child and Adolescent Psychiatry (AACAP). For children and adolescents, the AACAP recommends a starting dose of 5 mg of stimulant medication administered twice daily. Each dose should be titrated in 5 mg intervals up to 20 mg. For preschoolers aged 3 to 5, the recommended starting dose is 1.25 mg with titration at 1.25 mg intervals up to 7.5 mg three times per day. During this time, clinicians are advised to monitor the drug’s efficacy, increasing the dose in the case of a lack of an adequate response provided that no significant side effects are present. Possible side effects such as weight loss and sleeplessness should be closely monitored.⁶

All stimulation medications come with risks. Research shows that in both children and adults, stimulants are linked to an increase risk for heart attacks, stoke and high blood pressure. In addition to the increased risk for heart problems, stimulants have been associated with a slower growth rate in children. However more recent studies have shown that children with ADHD who take stimulation medication may have a slowing of growth rate but tend to catch up by the time they reach adolescence.⁷ Another study suggests that children with ADHD who take stimulants grow at the same rate as children with ADHD who don’t take stimulants. The study went on to conclude ADHD—not stimulants—may be the reason a slower growth rate in children.^^ Stimulants can also be dangerous for individuals with mental illness, as they can trigger psychosis, mania, aggression, hostility and/or suicidal tendencies.

Methylphenidate works by blocking roughly half of the dopamine transporters in the brain. This results in slowing the normal reuptake process, causing an increase in the amount of [dopamine...

Read more about ADHD and Methylphenidate.

Amphetamines increase the synaptic activity of the dopamine and norepinephine neurotransmitters. Amphetamines stimulate the release of dopamine, block dopamine reuptake, inhibit dopamine storage and...

Read more about ADHD and Amphetamine.

1. William P. Pelham Jr., Ph.D. “The NIMH Multimodal Treatment Study for Attention-Deficit Hyperactivity Disorder: Just Say Yes To Drugs Alone?” Canadian Journal of Psychiatry 44 (1999): 981–990.
2. Thomas E. Brown, Ph.D., Attention Deficit Disorder: The Unfocused Mind in Children and Adults, (New Haven and London: Yale University Press, 2005): 18.
3. Stephen W. Garber, Ph.D., Marianne Daniels Garber Ph.D., and Robyn Freedman Spizman, Beyond Ritalin (New York: Villard Books, 1996): 92.
4. Vetter et al., “Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder [Corrected]: A Scientific Statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing,” Circulation 117, no. 18 (May 6, 2008): 2407–2423.
5. Thomas E. Brown, Ph.D., Attention Deficit Disorder: The Unfocused Mind in Children and Adults, (New Haven and London: Yale University Press, 2005): 296.
6. Thomas E. Brown, Ph.D., Attention Deficit Disorder: The Unfocused Mind in Children and Adults, (New Haven and London: Yale University Press, 2005): 255.
7. Thomas E. Brown, Ph.D., Attention Deficit Disorder: The Unfocused Mind in Children and Adults, (New Haven and London: Yale University Press, 2005): 263.
8. Thomas Spencer, Joseph Biederman, et al. “Growth Deficits in ADHD Children Revisited: Evidence for Disorder-Associated Growth Delays?” Journal of the American Academy of Child and Adolescent Psychiatry 35, no. 4 (1996): 409–432.