Attention deficit-hyperactivity disorder (ADHD) is a diagnosis characterized by a persistent pattern of inattention, impulsivity and occasional hyperactivity or restlessness. These symptoms must be continuous and cause impairment in multiple areas of functioning (such as school, work, social relationships and self-esteem) before the diagnosis can be made. The cause is unknown, and treatment is centered on stimulant medications.
Stimulants
The two main stimulant medications that patients with ADHD utilize are methylphenidate and Adderall. Methylphenidate is the most commonly prescribed medication for ADHD and is available under the brand name Ritalin. It is a nervous system stimulant and has more of an effect on mental function than motor activities. It can be administered both orally and through a transdermal skin patch. Side effects include nasal congestion, nervousness, insomnia, abdominal pain, headache and uncontrolled tic. Adderall is the brand name for a medication that is a combination of amphetamine and dextroamphetamine in a ratio of 1:3. It is a nervous system stimulant and produces a decreased sense of fatigue, increases in motor alertness and motor activity and mild euphoria. Common side effects include decreased appetite, insomnia, headache, dry mouth, dizziness and weight loss; symptoms are typically more common initially and mostly disappear after a few weeks of continued use.
Non-Stimulants
Atomoxetine, which is marketed under the brand name Strattera, is the only non-stimulant medication that is FDA-approved for ADHD treatment. Its effects take two to six weeks to fully reach peak efficacy, and it also results in more sustained symptom control. It is taken orally and is primarily excreted in the urine. Common side effects include dizziness, insomnia, decrease in appetite, upset stomach, abdominal pain, nausea, vomiting, weight loss and urinary hesitancy.
Second-Line Medications
Other medications for ADHD treatment are not first-line for a variety of reasons, including efficacy or side effects. Bupropion is an antidepressant that is effective in treating ADHD and is typically used as second-line drug or as an adjunct to existing treatment. Common side effects are decreased appetite, insomnia and irritable mood. It also has beneficial effects on nicotine addiction and coexisting depression and is often utilized in patients with these issues who also have coexisting ADHD. Clonidine is also typically used as a second-line treatment or as an adjunct to existing treatment. It is not as effective as stimulant therapy, but it is helpful in ADHD patients with coexisting aggression or tics. Clonidine can take four to six weeks for therapy to show a benefit, and it is given frequently because of its short-acting properties. Side effects of clonidine therapy include low blood pressure and sedation. Patients must take care when weaning off the medication, because of the risk of hypertension upon sudden cessation.
References
- "Massachusetts General Hospital Comprehensive Clinical Psychiatry, 1st Edition;" Stern; 2008
- "Psychiatric Clinics of North America;" Review of Pediatric Attention-Deficit/Hyperactivity Disorder for the General Psychiatrist; C. Kratochvil, Volume 32, March 2009
- "Psychiatric Secrets, 2nd Edition;" Jacobson; 2001
