ADHD MEDS/NYC

Information on ADHD medications for adults by Dr. Nicholas Schwartz.  Dr. Schwartz is a graduate of the Yale School of Medicine and runs a private practice in Manhattan specializing in adult ADHD.  The site reviews important aspects of medications, issues of medication tolerance, and books on ADHD.  There is also contact information for those wishing to consult with Dr. Schwartz

Medications

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A number of medications have proven effective in treating Attention Deficit Hyperactivity Disorder.  The list below describes those most commonly used and explains briefly how they work.  The medications are listed by their generic names with the brand names in parentheses.

I have divided the list into stimulants (also called psychostimulants) and non-stimulant medications.  Stimulants act directly by causing release and blocking re-uptake of certain neurotransmitters (Amphetamines) or by blocking re-uptake without affecting release (Methylphenidate).  Non-stimulants act indirectly on these neurotransmitters or affect different systems altogether. Most clinicians consider stimulants to be superior ADHD medications and use non-stimulants only as add-ons or when stimulants can't be prescribed for one reason or another.

Stimulants

 

Methylphenidate (Ritalin, Concerta, Methylin, Focalin) – One of the first psychostimulants used to treat ADHD.  Why would a stimulant drug be helpful in a person who is  already hyperactive?  It is theorized that by making certain parts of the brain more excited, stimulants paradoxically calm people down and help them stay focused.  Part of the problem in ADHD is that the individual’s environment doesn’t stimulate their brain sufficiently, as it does in people without the disorder. As a result ADHD-sufferers often feel bored and look for ways to feel more excited – mainly by rapidly shifting their attention to something new, engaging in thrill-seeking or being constantly on the move.  By providing the missing stimulation to the brain, these medicines help people calm down and stay focused.

Dextroamphetamine (Adderall, Adderall XR, Dextrostat, Dexedrine) – This is another psychostimulant.  Adderall is a combination of four different amphetamine molecules.  Adderall XR is the extended release form of the drug.  Whereas Adderall is usually taken twice or three times a day, Adderall XR usually only needs to be taken once a day.

Vyvanse is a stimulant that is formed by adding the amino acid lysine to dextroamphetamine.  It is similar in function to the others.  It's duration is generally around 6-8 hours (between that of regular Adderall and Adderall XR.)  It experienced by some as smoother than other amphetamines.  The downside is that it does not have as predictable an onset, ranging anywhere from 20-90 minutes.


*A note about Adderall XR: while most people have the understanding that Adderall XR is released continuously throughout the day, this is not the case.  Adderall XR is a capsule that contains two kinds of micro-beads.  One is Adderall that is released immediately, like a regular Adderall.  The other contains a coating that causes release after 4 hours.  So, taking Adderall XR 20 mg, for instance, is the same as taking regular Adderall 10 mg, then taking another 10 mg four hours later.

Both Methylphenidate (Ritalin) and Dextroamphetamine (Adderall) work equally well in the general population.  However, on an individual level some people may respond better to one or the other.   If you have tried one medication and have not seen your ADHD symptoms get better, you shouldn't conclude that these are not the right medications for you.  It may just be that you haven’t found the right one yet or gotten on the right dose.

Generic vs. Brand name stimulants: For most people these two work equally well.  There are certain generics that patients tend to respond to poorly.  They include CorePharma and Eon brands.  (Many patients who receive these generics describe feeling jittery and sleepless, but not more focused.)  If a patient receives one of these as their first medication after being diagnosed, they may think stimulants don't work for them.  In fact, they simply need to switch to brand-name Adderall or at least a different generic.  For more on generics, see this page.

Non-stimulants

 

Bupropion (Wellbutrin) – Bupropion is an antidepressant that is also useful in ADHD.  Its effects are similar to the psychostimulants.  However, most people find it somewhat less effective than these medications.  The side-effects are also similar: occasional difficulty with sleep, decrease in appetite, potential for increased blood pressure. A side-effect that is more common to Bupropion is the potential for inducing seizures. This is an even greater risk in patients with certain eating disorders, a seizure history, alcohol abuse, or a history of head trauma.

Atomoxetine (Strattera) – Although this medication is marketed as effective for ADHD, most patients and clinicians have been disappointed with its results.  In addition to its lack of efficacy, it has an unpleasant side effect profile, leading many patients to discontinue use.  However, it can be an option in patients in patients getting only partial benefit from stimulants or those who, for one reason or another, can not take stimulant medication. Additionally, it may be a good choice in patients who have ADHD on combination with anxiety.

Modafinil (Provigil) - This drug initially used as a treatment for narcolepsy, a sleep disorder.  It stimulates the part of the brain responsible for increasing wakefulness.  Because it has this stimulating effect, it has been used to treat ADHD.  The research on efficacy remains inconclusive.  My patients have generally reported that it increases there alertness, but have gotten mixed results with regard to their focus.  At this point use of Modafinil in ADHD patients can only recommended on a case-by-case basis.

Guanfacine (Tenex, Intuniv) – Guanfacine affects the adrenergic system.  Because of it's effects on adrenalin and related receptors, it was originally tested as a blood pressure medication.  However, it appears to have some efficacy in treating ADHD symptoms, as well.  One advantage of Guanfacine as an ADHD drug is that it tends to induce a greater sense of calm and relaxation.  While patients rarely find that the effects on focus are as pronounced as those produced by stimulants, the greater sense of calm sometimes alleviates the occasional irritability or jitteriness that can accompany stimulant use, making it a good add-on medication.

Tricyclic antidepressants (Desipramine, primarily) – Desipramine is an older antidepressants that also can treat ADHD symptoms.  Because of difficult side effects desipramine is not used as much any more.  However, it may be a good treatment option when other approaches have failed or when the person also has depression.

 

This page last updated 12/1/17