ADHD + Medication: Positives

If a treatment has a 70-80% success rate why are people so reluctant to try it?

The impact of ADHD without support - pills AND skills - can lead to kids failing in school and college, adults being unable to inhibit impulsive, dopamine seeking behaviour that impacts their financial, emotional and physical health - but in the middle of yet another ADHD medication crisis in the UK, I still meet people who swear they would never give their child medication. It’s all a matter of choice but often it’s based on misunderstandings of what it does and what the results can be.

What does ADHD medication actually do?

There are two main kinds of medication prescribed for ADHD - stimulant and non-stimulant. The first kind is the most common and people know it as Ritalin, Adderall, Elvanse etc. They are ‘stimulant’ medications that increase activity in those parts of the brain most affected by ADHD - usually increasing the amount of dopamine that circulates so that even with our higher number of dopamine transporter cells, we reach a more ‘average’ level of dopamine. This is why many starting medication as adults report being able to just choose to start on the task they want to do, instead of that grinding feeling of resistance and procrastination; or find they are able to resist their habitual snack/smoke/drink because their immediate impulse is no longer louder than their long term priority.

With young people in school or college, it might mean they can choose to focus on work a bit longer - be less distracted in class, or resist ‘playing up’ i.e. finding stimulation one way or another in a difficult environment.

Non-stimulant medication can have a similar effect but works on different mechanisms - for example atomoxetine is a selective noradrenaline reuptake inhibitor (SNRI), which means it increases the amount of a chemical in the brain called noradrenaline.

This chemical passes messages between brain cells, and increasing it can aid concentration and help control impulses. There are others which work on different messengers or neurotransmitters, including guanfacine and clonidine.

Why is it so successful for many - and why doesn’t always work for 20-30%?

The simplest answer is that ADHD is a structural, brain based neurological difference so when we address the difference - by increasing dopamine or noradrenaline for example - our brains function in a way that feels better and allows us to get work AND play done, to focus on conversations with friends, to be able to choose which thought we listen to instead of having a ‘box of toys’ bouncing around in our heads.

Unfortunately there are some who get NO relief with any medication - and that includes well known writer and psychologist Dr Edward Hallowell and Coach and author Tracy Otsuka. The only way to know which percentage you are part of is to try them and see.

Side effects should be taken seriously

At the same time, there are serious physical and psychological risks to taking ADHD medication that need to be taken seriously: they range from increased blood pressure and heart rate, lack of appetite (which can be dangerous especially for growing children) to persistent low mood, increased anxiety and even some suicial ideation.

This is why medication should never be taken by someone who has not had a thorough assessment and has a clear line of communication with their prescribing physician, so that these can be addressed quickly. The positive is that ADHD medication does not stay active in our system for too long, especially the fast acting stimulants - although atomoxetine and other non-traditional ADHD medications can take up to 2 weeks to build up and also leave.

What’s the future for ADHD medication?

The good news is that new treatments are being looked at all the time - most recently a medication that addresses three kinds of neurotransmitter simultaneously, or a ‘triple reuptake inhibitor’. It’s in Phase 3 clinical trials and although it appears to have fewer side effects that some current medications, it may also be slightly less effective than the very popular lisdexamphetamine (or Elvanse): “Centanafadine showed a better safety/tolerability profile than lisdexamfetamine, atomoxetine, and viloxazine ER, as evidenced by a significantly lower incidence of several adverse side effects,” the researchers noted. “Efficacy was lower than lisdexamfetamine and non-different compared to atomoxetine and viloxazine ER”.

Most importantly, we have to take an approach to ADHD that uses medication, behavioural support and education as well as lifestyle ‘scaffolding’ and modification to address our whole being - as we can see when the medication runs out, we don’t want to be left without anything to soften the blow of being untreated again.

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Warmly,

Katherine

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