The role of General Practitioners in ADHD diagnosis and management
5. Treatment - Medication
The most successful forms of ADHD treatment has been shown to be a combination of medication and behavioural treatments.
- Stimulant drugs are the most common type of drugs used to treat ADHD. They do not cure, but manage the symptoms and are often a long term solution. People with ADHD may decide to stop taking their medication if they do not like how they feel whilst on it. However, when this happens symptoms are likely to reappear.
- Unfortunately medication often comes with side effects such as insomnia, appetite suppression, light-headedness, nausea, twitches or increased blood pressure. The advantages of taking medication often outweigh the side effects. While the side effects may be unpleasant, they are relatively low risk and it is important to understand the beneficial impact (interpersonal or professional) that medication can have on reducing future risks.
How medication works. What is it trying to address?
- Stimulant medication works by increasing dopamine levels in the brain. It makes more dopamine available by reducing reuptake at the synaptic cleft. Increased availability of dopamine helps modulate attention, motivation and movement. It can also boost concentration and focus while reducing hyperactive and impulsive behaviour.
- Non-stimulant medications work on norepinephrine pathways and are considered when stimulants have not worked or are causing intolerable side effects.
Research evidence has shown that prolonged use of stimulants does not lead to increase risk of addiction and can actually reduce it.
Type of medication: Stimulants can be short acting (immediate release) - take effect quickly, and can wear off quickly, too. They usually need to be taken several times a day. Or they can also be long acting, taken just once a day. e.g. Lisdexamphetamine, dexamphetamine and Methylphenidate.
Type of medication: Atomoxetine and in rare cases guanfacine and clonidine.
ADHD medication is not one-size-fits-all. It may take a while to figure out which medication works and at which dosage. This can vary across individuals.
How ADHD medication affects neurotransmitters
| Stimulants |
|---|
Main target: Dopamine, a neurotransmitter that plays a key role in motivation. It also helps control movement and emotional responses. Examples: Methylphenidates, (like Concerta, Focalin, Metadate and Ritalin), and amphetamines (like Elvanse). Usage: Stimulants are the most commonly prescribed type of ADHD medication. |
| Non-Stimulants |
|---|
Main target: Norepinephrine, a neurotransmitter that plays a key role in executive functions like impulse control and getting started on tasks. Examples: Atomoxetine (Strattera) and guanfacine (whose mode of action is not yet fully understood but appears to have an indirect effect on norepinephrine). Usage: Non-Stimulants tend to be used if individuals don't respond well to stimulants. They can be used or instead of stimulants. |