TREATMENT OF ADHD WITH MEDICATION
Stimulants medications are widely used to treat the symptoms of ADHD. However, Stimulant medications DO NOT treat the underlying cause of ADHD, they will simply help to relieve the symptoms. Once a medication is stopped, the symptoms tend to come back, creating the need to take medications indefinitely. Additionally, each person responds differently to medications. Some experience significant improvement while others show only little gains.When cognitive behavioral therapy, counseling, parental and social skills training, as well as practical support are used together for the treatment of ADHD, it can help children with ADHD and their families’ better cope with everyday problems. This method addresses the underlying cause of ADHD and provides useful and sustainable skills to manage the symptoms, without the need for medications for the rest of one’s life.
Stimulant and nonstimulant medications are approved by the FDA to treat the symptoms of ADHD and improve functioning in children as young as six years of age. Most ADHD medications increase the amount of two brain chemicals that are used by brain cells to communicate with each other (dopamine and/or norepinephrine). These chemicals related to attention, desire, and drive. ADHD meds are formalized and offered in short, intermediate, and long-acting forms in pharmacies.
In cases, where stimulants do not work or cause intolerable side effects, non-stimulant medications might help. The first nonstimulant medication approved by the FDA was Atomoxetine (Strattera). It is now used in children, adolescents, and adults. Then the FDA approved a second nonstimulant drug, guanfacine (Intuniv), for children and teens (6-17) and recently approved the non-stimulant clonidine (Kapvay) for use alone or with a stimulant in combination to boost efficiency. These meds can all improve attention, hyperactivity, and impulse control. Stimulant medications are considered the most effective treatment for ADHD. However, the degree of improvement in symptoms and functioning might surprise patients and families, especially when medications are combined with other treatment modalities instead of used alone.
To help families make important decisions about treatment, the National Institute of Mental Health (NIMH) began a study in 1992 called the Multi-modal Treatment Study of Children with ADHD (MTA study). Results from this 14-month study showed that stimulant medications are the most effective treatment in addressing ADHD symptoms. The study also stated that the outcome results were the best when the medication doses were adjusted according to needs of each child specifically –either alone or in combination with behavioral therapy.
The MTA study provided evidence that stimulant medications reduce hyperactivity and impulsivity, improve attention, and increase the ability to get along with others. Therefore, these medications are still the top choice when treating individuals with ADHD. However, gold standard treatment should include a comprehensive diagnostic evaluation, work-up tests, individualized treatment plan and a risk-benefit analysis of all treatment options with the patient and family by experienced clinicians.
Stimulant Medications for ADHD
Stimulants can be significantly effective in 70-80% of individuals with ADHD. Stimulants such as methylphenidate and amphetamines are the most commonly prescribed types for treating ADHD. Although it may seem odd to treat hyperactivity with a stimulant, these meds, in reality, activate brain paths that support attention and focused behavior, thus reducing hyperactivity. They may be helpful in children, adolescents, and adults who are experiencing trouble with ADHD symptoms at school, work, home or social life.
Potential Side Effects of Stimulant Medications
Most children taking ADHD meds experience some side effects, but mostly temporary and minor. These may include reduced appetite, weight loss, problems with sleeping, headaches, and stomach pain. Some children may have a delay in their height growth during the first two years of treatment, but then growth continues at an average rate. Preschoolers are more prone to have side effects especially with methylphenidate group compared to older children, and adverse events may include: emotional outbursts, irritability, difficulty falling asleep, repetitive behaviors/thoughts, appetite decrease, and slower growth rate.
Although rare, ADHD meds can have serious side effects, too. Also severe psychiatric conditions can be seen related to use of ADHD meds, like depression, anxiety, motor or vocal tics or auditory and visual hallucinations (hearing voices or seeing things that are not present).
It was believed that some stimulants may pose a threat of increased risk of cardiovascular problems. On the other hand, FDA communicated that stimulant medications do not increase the risk of serious cardiovascular events based on a comprehensive study published in New England Journal of Medicine.
Potential Side Effects of Non-Stimulant Medications
Common side effects experienced with the non-stimulant medications clonidine and guanfacine may include a decrease in heart rate and blood pressure, fainting, dizziness, drowsiness, fatigue, irritability, constipation, and dry mouth. Some less common ones are itching, appetite and weight changes, and depression. Though there is a potential for a rapid rise in blood pressure and risk of stroke if these medications are stopped suddenly, this problem has not been reported with their extended release forms.
Another non-stimulant, atomoxetine (Strattera), has been associated with the following common side effects: nausea, vomiting, tiredness, upset stomach, headaches, weight loss in younger children, and sexual dysfunction in adults. Atomoxetine contains FDA black box warning of increased suicidal thinking in children and adolescents and increased risk of liver damage in rare cases.
Side effects mostly are not dangerous, but they should all be reported to the prescribing doctor—especially if they cause distress or interfere with everyday activities of a patient. Side effects can be reduced by adjusting the dose, time of day the drug is taken, using another form of the med, or switching to a different med.
Do ADHD Medications Cause Addiction?
Parents may be hesitant to give stimulant medications to their children who suffer from ADHD symptoms because stimulants medications are classified as ‘Controlled Substances’ by Drug Enforcement Administration (DEA). On the other hand, research studies have shown that treatment of ADHD reduces the risk and delays the onset of substance abuse through adolescence.
Wilens et al., examined the effects of early stimulant treatment on subsequent risk for cigarette smoking and substance use disorders (SUDs) in 104 adolescents with attention-deficit/hyperactivity disorder (ADHD). They demonstrated that stimulant therapy does not increase but rather reduces the risk for cigarette smoking and SUDs in adolescents with ADHD.
In Summary
ADHD research is working to find a more comprehensive approach to the treatment of ADHD than just medications alone. The goal is to provide patients and families with information and options for treatment since one size does not fit all. The research has demonstrated that while medications can be effective and helpful for many, it may not be for some. The use of a multi-modal treatment approach to address not only the symptoms but the source of the problems are the most effective way to treat ADHD and sustain lasting results. It also provides those who do not want to maintain a lifelong medication regimen options to help them successfully manage their ADHD.