Attention Deficit Hyperactivity Disorder (ADHD): Stimulant Therapy
What is stimulant therapy?
Stimulant therapy is the most commonly used treatment for Attention-Deficit Disorder/ Hyperactivity Disorder, also known as 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 about 70% of adults and 70% to 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. Recent research, nevertheless, shows that individuals with ADHD had a lower incidence of substance use disorder if they were medically treated than if they were not treated.
Common stimulants for the treatment of 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)
- Daytrana® (long-acting patch)
- Dexedrine® (short-acting)
- Dexedrine® Spansule® (intermediate-acting)
- Focalin® (short-acting)
- Focalin XR® (long-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 2 or 3 times a day 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 to 12 hour duration), Ritalin LA (6 to 8 hours), Metadate CD (6 to 8 hours), and Adderall XR (10 to 12 hours), Vyvanse (up to 13 hours), Focalin XR (12 hours) and Daytrana (10 to12 hours).
Who should not take a stimulant drug?
- Patients with any of the following conditions or drug treatments should not take stimulant therapy: Allergy or sensitivity to stimulant medications.
- Patients with glaucoma (a condition that causes increased pressure in the eyes and can lead to blindness).
- Patients with severe anxiety, tension, agitation, or nervousness.
- Patients undergoing treatment with a type of medication called monoamine oxidase inhibitors (MAOIs), such as Nardil® (phenelzine) , Parnate® (tranylcypromine), Marplan® ( isocarboxazid), or Eldepryl® (selegeline) within 14 days of starting stimulant therapy.
- Patients with motor tics or a personal or family history of Tourette's Syndrome.
- Patients who have current psychotic episodes or a personal history of psychosis.
- Patients with overactive thyroid.
- Patients with coronary artery disease.
- Patients with heart or blood vessel disease.
- Patients with uncontrolled high blood pressure.
- Patients with certain types of irregular heart beat.
- Patients with a history of alcohol or substance abuse.
It is important to note that this is not an all inclusive list. Your physician will need to evaluate your complete medical history and regimen of medications, over-the-counter drugs, and dietary supplements to help determine if you would be able to take a certain stimulant.
How do they work?
Stimulants regulate impulsive behavior and improve attention span and focus by increasing the levels of certain chemicals in the brain, primarily dopamine, which transmit signals between nerves.
What should I tell my doctor before starting stimulant therapy?
When taking stimulant therapy for ADHD, be sure to tell your healthcare provider:
- If you are nursing, pregnant, or plan to become pregnant.
- If you are taking or plan to take any prescription drugs, dietary supplements, herbal medicines, or nonprescription medications.
- If you have any past or present medical problems, including high blood pressure, diabetes, 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 have a history of suicidal thoughts or if anyone in your family has tried to commit suicide.
What should I be aware of if my child is being given stimulants?
If you miss a dose, just go back to the regular prescribed dosage schedule - don’t 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 the medication 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.
Risks / Benefits
What are some common side effects of stimulant therapy?
These may 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 that can often be managed by taking the medication after meals or adding protein shakes or snacks to the diet.
- Sudden, repetitive movement or sounds known as tics.
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.
Visual disturbances such as blurred vision may occur with stimulant therapy.
Stimulant therapy may cause hallucinations or unusual thoughts.
Serious heart or blood vessel problems may be related to stimulant use.
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.
This is not a complete list of side effects.
If you notice any side effects that you think may be caused by stimulant medication, please contact a healthcare professional.