Attention-deficit hyperactivity disorder (ADHD) is a common disorder diagnosed in up to 8 percent of U.S. children, with one in seven adults having symptoms as well. Genetics is an important potential cause for ADHD, but other factors may contribute. ADHD puts children at risk for developing other disorders such as substance-use problems, and can greatly impact adult life as well. Despite the potential for bad outcomes, many medications may help.
Stimulant Medications
Stimulants continue to be the most commonly-prescribed drugs in the treatment of children and adults with ADHD. There are many formulations available; some contain the stimulant methylphenidate and others contain ampthetamine. According to the medical textbook, "Current Diagnosis and Treatment: Pediatrics," if one type of stimulant does not result in improvement, another stimulant may still be effective.
The list of methylphenidate-containing stimulants is a long one and includes the well-known Ritalin, along with Concerta, Metadate, Methylin, Ritalin LA, Ritalin SR, Daytrana, Transdermal, Focalin, and Focalin XR.
Amphetamine-containing medicines include Adderall, Dexedrine, Dextrostat, Adderall, and Adderall XR.
Both methylphenidate and amphetamine stimulants are short-acting--they begin to work within an hour of taking the medicine and last up to five hours. Newer versions of stimulants have been formulated that last for up to 8 hours, so the need to take medicine in the middle of a school (or work) day is eliminated.
Stimulants as a whole are safe and well-tolerated. Side effects are generally mild and temporary, and may include a lack of appetite, insomnia, feeling "on-edge" and upset stomach.
Antidepressant Medications
Several specific antidepressants may be helpful in treating either adults or children with ADHD, though these are not generally the first type of medications tried. The tricyclic antidepressants may be effective in treating ADHD because they increase levels of certain chemicals in the brain, including norephinephrine. Also, an antidepressant called bupropion (Wellbutrin) works in a similar way and may work to treat ADHD in both adults and children.
Atomexetine
Atomexetine (Strattera) belongs to a new class of medicine called specific norephinephrine reuptake inhibitors (SNRIs). 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. Strattera is both the first non-stimulant medication to be approved by the U.S. Food and Drug Administration (FDA) for ADHD treatment and the first medication to be FDA-approved specifically for treating adult ADHD. It is generally a well-tolerated medication; however, an extremely rare but serious side effect is liver damage. Additionally, in 2005, the FDA issued an important warning that Strattera may increase the risk for suicidal thoughts and behaviors in children and adolescents taking the medication.
Blood Pressure Medications
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, and to help deal with some of the specific symptoms of ADHD such as aggression. Clonidine is less sedating than guanfacine, but is shorter acting. For treating adults with ADHD, the effects of antihypertensive medications are not as clear, so it is preferable to treat with other medications.
References
- "CURRENT Diagnosis and Treatment: Pediatrics"; William Hay et. al.; 2007
- "Up To Date"; Denise Basow; 2010
- "CURRENT Diagnosis & Treatment: Psychiatry"; Michael Ebert et. al.; 2008
- "Public Health Advisory: Suicidal thinking in children and adolescents being treated with strattera (atomoxetine)"; U.S. Food and Drug Administration; 2005
