Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is the most common childhood neurodevelopmental disorder in the world. It is characterised by symptoms of inattention, hyperactivity and/or impulsivity, and can often prolong from childhood into adulthood. There are many options that patients and their providers can consider when formulating treatment plans, due to the abundance of research that has been conducted to investigate the most efficacious methods of treatment for ADHD. Ultimately, evidence has shown that a combination of both medication and non-pharmacological treatments is ultimately the most effective method of treatment. This article will specifically detail all you need to know about medication as a treatment for ADHD – i.e., what is ADHD medication, who can prescribe it and how it can affect your daily lives.

Common Symptoms of ADHD in Adults

ADHD manifests in 3 different types of symptom presentations. The Inattentive type presents with symptoms involving difficulties in paying attention, but is not hyperactive or impulsive. The Hyperactive/Impulsive type presents with symptoms involving hyperactive and impulsive behaviour, but does not struggle with attentiveness. Finally, the Combined type involves a combination of both inattentive and hyperactive/impulsive presentations of ADHD symptoms.
For adulthood specifically, the common symptoms of ADHD can detrimentally affect the adult’s personal and social relationships within both home and work settings. In adulthood, the expression of certain symptoms of ADHD in adults differs from those in the earlier years. While most symptoms remain the same, the intensity of these symptoms decrease. This is particularly so for hyperactive symptoms. Adults with ADHD can have difficulties with:

  • Paying attention, particularly to details
  • Concentrating for longer period of time
  • Disorganisation
  • Prioritisation
  • Starting and completing tasks that require sustained effort
  • Impulsiveness
  • Emotional regulation

How to Treat ADHD in Adults

There are two main methods of treatment for ADHD in adults: pharmacological and non-pharmacological. Pharmacological treatment involves the use of stimulant medications to treat ADHD. Non-pharmacological treatment involves psychological interventions mainly targeted at behavioural management.

Evidently, every patient is different and each treatment method may vary in effectiveness depending on the patient’s unique circumstances. There are many options that patients and their providers can consider when formulating treatment plans. Ultimately, research evidence has shown that a combination of both medication and non-pharmacological treatments is ultimately the most effective method of treatment.

ADHD Medication as a Treatment for Adult ADHD

Let’s dive into the details of what medication can do as a treatment method for adult ADHD.

What is ADHD Medication?

Medication is the most common treatment option for ADHD, because of its high effectiveness in reducing severity and alleviating the symptoms of ADHD. It is the most widely researched treatment method, and remains a safe and effective way to treat ADHD.

Types of ADHD Medication

There are two main types of medications to treat ADHD: stimulant medications and non-stimulant medications.

Stimulant Medications
The two most common medications used to treat ADHD are methylphenidate and dexamphetamine. Common brands of stimulant medications include Adderall, Ritalin, Vyvanse and Concerta. Stimulant medications tend to be more popularly prescribed as an initial treatment method compared to non-stimulant medications.

Upon starting stimulant medications, most adults with ADHD have reported positive outcomes, with improved attentional and emotional control, better concentration and an overall reduction in the severity of their ADHD symptoms. However, other patients do not have similar pleasant experiences due to the side effects that may arise from using stimulant medications. These side effects may include a decreased appetite, difficulties sleeping, irritability and headaches.

Non-stimulant Medications
Non-stimulant medications include atomoxetine, clonidine and guanfacine. Non-stimulants tend to be prescribed as a second-line of medication treatment, if a patient shows intolerance or lack of a positive response to stimulant medications. Atomoxetine is commonly prescribed by a practitioner if a patient presents with comorbid conditions like anxiety, bipolar disorder, substance abuse, etc. Clonidine and guanfacine are commonly prescribed as supplementary to stimulant medications, due to a smaller effect size of relieving ADHD symptoms.

Upon starting non-stimulant medications, adult patients of ADHD have similarly reported positive outcomes with improved attention and concentration, improved impulse-control and reduced blood pressure. However, these effects may be relatively less significant and shorter in duration compared to stimulant medications.

How does it work? How do medications affect the ADHD brain?

Stimulant Medications
Stimulant medications, such as methylphenidates and dexamphetamines, work by targeting the areas of the brain that release dopamine, a chemical (i.e., neurotransmitter) known to be abnormally low in levels within ADHD patients. Essentially, stimulant medications act on the neurons of the brain to increase dopamine levels ready for uptake.

There are two types of medications under stimulants: extended-release and immediate-release (i.e., short acting). Extended-release stimulants (i.e., long-acting) tend to have longer-lasting effects, which can last for up to 12 hours; immediate-release stimulants (i.e, short-acting) tend to have effects within 30 minutes to 1 hour of ingestion, but have shorter-lasting effects of up to 3-4 hours. Whether a patient takes extended-release or immediate-release stimulants depends on the specific outcomes they desire – for example, the frequency of dosage or relative speed and duration of medication effects.

Non-stimulant Medications
Non-stimulant medications like atomoxetine work similarly to stimulant medications. However, they work by acting on neuron receptors within the brain to increase the levels of norepinephrine instead. Atomoxetine specifically acts on neurons to increase the levels of norepinephrine ready for uptake. Clonidine and guanfacine actively increase the activity of the receptors that receive and absorb norepinephrine.

How to Take ADHD Medication?

Typically, ADHD medication – stimulant or non-stimulant – exists as a form of a capsule or tablet that has to be swallowed and ingested orally.

The type of medication, amount of dosage and frequency of dosage should be discussed with and decided by the patient and the prescribing practitioner, as these prescribing factors may be affected by the treatment outcome desired by the patient.

Who Can Prescribe ADHD Medication?

Most people who are seeking ADHD testing and diagnostic confirmation, count on both medications and psychological treatment/coaching. It is strongly advisable to check the regulations for ADHD diagnosis and treatment in the respective country, to make the whole process time- and cost-efficient.

For example, in most countries a diagnosis of ADHD made by a psychologist or a neuropsychologist is not sufficient to access treatment with medications, however the person may be able to access psychological treatments already.

In Australia general practitioners can make a provisional (tentative) diagnosis of ADHD and initiate certain ADHD medications on their own, without an input from a psychiatrist. A formal ADHD testing and a diagnosis from a psychiatrist will be still required, to access a full range of treatment.

In some European countries, e.g. UK, France, Germany, and Australia the diagnosis must be made by a psychiatrist, in order to access medications and other supports, e.g. financial allowance via certain programs. Family doctor and psychologist can then take over the treatment and continue on with the recommendations from a psychiatrist.

In the United States ADHD can be tested and confirmed by a GP/family doctor as well as by a psychiatrist, and the treatment is initiated by the same doctor who made the diagnosis.

How Does ADHD Medication Affect Adults?

What are the side effects?

Some side effects of taking medications include a decreased appetite, difficulties sleeping, irritability and headaches. These side effects should only be temporary as the brain and body are adjusting to the medication. However, it is without a doubt, that it is important to discuss these side effects with your practitioner to develop the most suitable treatment option.

How does it affect blood pressure?

ADHD medications have been found to increase heart rate and blood pressure after starting treatment for ADHD with stimulant medications like methylphenidate and non-stimulant medications like atomoxetine. While any major cardiac health risks associated with ADHD medications are close to none, it is advisable to actively monitor heart rate and blood pressure upon commencement of ADHD medication as a precautionary measure.

How does it affect sleep?

Sleeping difficulties, such as insomnia, are common comorbid symptoms of ADHD. Stimulant medications are known to induce insomnia, which is why it is advisable to closely monitor sleeping patterns before and after beginning treatment with ADHD medications. Because of this, it is common for practitioners to also treat sleeping difficulties alongside ADHD, either through prescribing medications (e.g., melatonin) or monitoring and implementing healthy sleep schedules. If these difficulties with sleep still arise with taking ADHD medications, it is advisable to seek advice from your doctor to seek alternative treatment options.

How does it affect adults at home?

Upon starting medication treatments, most adults with ADHD have reported positive outcomes, with improved attentional and emotional control, better concentration and an overall reduction in the severity of their ADHD symptoms. From home, this could mean being able to complete daily chores with minimal distraction, keeping a neat and tidy living space and fostering good relationships with close family members and friends.

How does it affect adults at work?

With commencing medication treatment, most adult patients with ADHD have reported positive outcomes, with improved attentional and emotional control, better concentration and an overall reduction in the severity of their ADHD symptoms. From a work environment, this could mean having an improved ability to sustain attention and concentrate for longer periods of time, improved organisation, being able to set and achieve goals, and having good interpersonal relationships with peers and colleagues.

Conclusions

As evidenced by its popularity as a treatment method for ADHD, medication has been proven to be highly effective in relieving symptoms of ADHD. From stimulant to non-stimulant, or long-acting to short-acting, there are many possible options of medication treatments for ADHD. Before starting ADHD medication, it is important to have a thorough discussion with your healthcare provider, because every patient is different and each treatment method may vary in effectiveness depending on the patient’s unique circumstances.

References

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