Attention-deficit hyperactivity disorder (ADHD) is a common disorder in children and adults. Up to 8 percent of U.S. children have been diagnosed with the disorder, and one in seven adults have symptoms of ADHD. The cause is unknown; genetics likely plays a large role, but stressful family environments and maternal smoking during pregnancy may also be risk factors. ADHD is a serious condition that affects behavior, cognition, and emotions. In addition, ADHD puts children at risk for developing a variety of other disorders, including anxiety and substance-use disorders that can have influences into adulthood. Fortunately, many medicines are available for treatment.
Stimulants
Stimulants are the most commonly prescribed group of drugs for ADHD. About 75 percent of children prescribed stimulant medications will feel an improvement in their attention span, a decrease in their hyperactivity, and less impulsivity. In adults, stimulants are not quite as effective, but despite the lower rates of success, stimulants are still the most commonly prescribed medication for adults with ADHD. If one stimulant is prescribed and doesn't work, another stimulant may be more effective--it is worth trying different medications before deciding that the whole group of stimulants does not work.
Methylphenidate-containing stimulants include Concerta, Metadate, Methylin, Ritalin, Ritalin LA, Ritalin SR, Daytrana, Transdermal, Focalin, and Focalin XR.
Amphetamine-containing stimulants include Adderall, Dexedrine, Dextrostat, Adderall, and Adderall XR.
Both methylphenidate and amphetamine stimulants are short-acting (start working within 30 to 60 minutes and last around 2 to 5 hours). However, a newer class of longer-acting stimulants has made a big difference in the treatment of ADHD, because there is no need to re-administer the medicine in the middle of a school day for children, or the middle of a work day for adults.
Temporary side effects of stimulant medications include a lack of appetite, insomnia, feeling "on-edge," and upset stomach.
Strattera: A Specific Norephinephrine Reuptake Inhibitor
Atomexetine (Strattera) belongs to a new class of medicine called specific norephinephrine reuptake inhibitors (SNRIs); it is the only non-stimulant medication approved by the FDA for the treatment of ADHD. This medication works by increasing levels of a chemical in the brain called norephinephrine. In cases in which stimulants have been tried but have not helped the child with ADHD, Strattera may be a good alternative. In addition, Strattera is the first medication to be FDA approved specifically for treatment of ADHD in adults. It is generally a well-tolerated medication; however, an extremely rare but serious side effect is liver damage.
Antidepressants
While certain medicines used to treat depression may also work to treat ADHD in children and adults, there are two important points that should be noted: these are not the first choice for ADHD treatment in children, and only certain types of antidepressants are useful. For instance, a group of antidepressants called the tricyclic antidepressants may be effective in treating ADHD because they increase levels of certain chemicals in the brain, including norephinephrine. An antidepressant called bupropion (Wellbutrin) also does this, and may work to treat ADHD in both adults and children.
Antihypertensives
The blood pressure medications clonidine (Catapres) and guanfacine (Tenex) have been used to treat ADHD in children, and may be especially helpful in younger children, as well as to help deal with some of the specific symptoms of ADHD such as aggression. Clonidine is less sedating than guanfacine, but is shorter acting. In adults, antihypertensive medications have not been found to be as useful as in children.
References
- CURRENT Diagnosis and Treatment: Pediatrics"; William Hay et. al.; 2007
- MicroMedex "Atomoxetine Hydrochloride"
- "CURRENT Diagnosis & Treatment: Psychiatry"; Michael H. Ebert et. al.; 2008
