What Medications Are Used To Manage ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects both children and adults, causing difficulties with attention, impulse control, and hyperactivity.

While there are various approaches to managing ADHD, including behavioral therapies and lifestyle changes, medication is often a key component of treatment plans.

ADHD medication falls into two groups. Stimulants such as methylphenidate and amphetamines are the first-line choice. Non-stimulants such as atomoxetine, guanfacine, and clonidine are used when stimulants do not suit. This article covers how they work, how well they work, and their side effects.

Please note that this information is not intended as medical advice, and readers should always consult with a qualified healthcare professional for personalized guidance.

Types of ADHD Medications

There are two main categories of medications used to treat ADHD: stimulants and non-stimulants.

Stimulants

Stimulant medications are the most commonly prescribed treatments for ADHD.

They work by increasing the levels of certain neurotransmitters, such as dopamine and norepinephrine, in the brain.

Dopamine drives motivation and reward, while norepinephrine modulates attention and arousal. Raising both helps improve focus, attention, and impulse control.

Examples of stimulant medications include:

• Methylphenidate (Ritalin, Concerta)
• Amphetamine (Adderall)
• Dextroamphetamine (Dexedrine)
• Lisdexamfetamine (Vyvanse)

Stimulants are available in both short-acting and long-acting formulations. Short-acting medications typically last 4-6 hours. Long-acting formulations can provide symptom control for 8-12 hours.

Non-stimulants

Non-stimulant medications are an alternative for individuals who do not respond well to stimulants or experience intolerable side effects. These medications work differently than stimulants, but still aim to improve attention and reduce impulsivity.

Examples of non-stimulant ADHD medications include:

• Atomoxetine (Strattera)
• Guanfacine (Intuniv)
• Clonidine (Kapvay)

Non-stimulants may take longer to show therapeutic effects compared to stimulants, often requiring several weeks of consistent use before improvements are noticed.

Atomoxetine blocks the reuptake of norepinephrine, so more of it stays active in the brain. Guanfacine and clonidine belong to a different class, the alpha-2 agonists. Bupropion (Wellbutrin) is also prescribed off-label. Off-label means used outside its formal approval for ADHD.

Doctors may prefer non-stimulants when anxiety or tics co-occur with ADHD, or when stimulants are unsuitable.

Effectiveness of ADHD Medications

Numerous studies have demonstrated the efficacy of both stimulant and non-stimulant medications in managing ADHD symptoms.

Medication may do more than ease symptoms. A systematic review and meta-analysis of 40 studies examined functional outcomes among people taking ADHD medication.

Most showed a protective effect on mood disorders, suicidality, criminality, substance use disorders, accidents and injuries, traumatic brain injuries, motor vehicle crashes, and educational outcomes.

Pooled analyses of 21 of these studies confirmed a protective effect on academic outcomes, accidents and injuries, and mood disorders.

The data came from registries and large databases. So they show association, not proof of cause.

A network meta-analysis pooled 133 double-blind randomized controlled trials of ADHD medications (Cortese et al., 2018). This method ranks treatments never tested head to head. Of the trials, 81 involved children and adolescents and 51 involved adults.

In children and adolescents, every drug beat placebo on clinicians’ ratings after about 12 weeks. Amphetamines led, followed by methylphenidate and atomoxetine. Their standardized mean differences were -1.02, -0.78, and -0.56, where negative means fewer symptoms.

In adults, amphetamines (-0.79), methylphenidate, bupropion, and atomoxetine beat placebo. Modafinil did not.

Side effects are the trade-off. Amphetamines were less well tolerated than placebo in both age groups, judged by dropout because of side effects.

Weighing benefit against tolerability, the authors recommended methylphenidate first for children and adolescents and amphetamines first for adults, for short-term treatment.

The evidence has a clear limit. Robust data covered only about 12 weeks, and the authors stress that long-term efficacy is still inadequately studied.

Effectiveness in Children and Adolescents

ADHD medication use has risen steadily in Finland.

Between 2008 and 2018, the share of boys aged 6-12 taking it grew from 1.26% to 4.42% (Vuori et al., 2020). For girls, it grew from 0.21% to 0.99%.

A Cochrane review pooled 212 randomized trials of methylphenidate in children and adolescents (Storebø et al., 2023). Teachers rated ADHD symptoms as lower on methylphenidate than on placebo or no treatment (standardized mean difference -0.74).

The certainty of the evidence was very low. Trials averaged just 29 days, and 191 of 212 were at high risk of bias.

The review found no clear effect on quality of life, and more non-serious side effects, such as sleep problems and decreased appetite.

A cross-sectional evaluation suggests that ADHD medication was associated with fewer suicidal thoughts in children with substantial externalizing symptoms.

Teachers’ ratings were more cautious. In the network meta-analysis described above, only methylphenidate and modafinil clearly outperformed placebo on teacher ratings (Cortese et al., 2018).

Medication is not a one-size-fits-all solution. Its effects vary from person to person. Working closely with a healthcare provider is crucial for finding the right medication and dosage.

Potential Side Effects

As with any medication, ADHD treatments can cause side effects. Common side effects of stimulant medications include (Smith et al. 2019):

• Decreased appetite
• Sleep difficulties
• Headaches
• Stomachaches
• Irritability
• Increased heart rate and blood pressure

Non-stimulant medications may cause side effects such as:

• Fatigue
• Nausea
• Dry mouth
• Constipation
• Dizziness
• Mood changes

Most side effects are mild and tend to subside over time.

However, if side effects persist or become severe, tell the prescribing healthcare provider. Adjustments to the medication or dosage may be necessary.

Heart rate and blood pressure need particular attention. A meta-analysis of 18 trials in children and adolescents found small but statistically significant rises in systolic blood pressure (Hennissen et al., 2017). This applied to methylphenidate, amphetamines, and atomoxetine.

Amphetamines and atomoxetine also raised heart rate. In the trials, only 2% of patients stopped treatment because of a cardiovascular effect, but the authors advise regular monitoring of heart rate and blood pressure.

Questions to Ask an ADHD Specialist

When considering ADHD medication, it’s essential to consult with an ADHD specialist or experienced psychiatrist. Here are some questions to ask during your appointment:

1. What are the potential benefits and risks of ADHD medication for my specific situation?
2. How will you determine the most appropriate medication and dosage?
3. What non-medication treatments do you recommend in conjunction with or instead of medication?
4. How long does it typically take to see improvements in symptoms with medication?
5. What side effects should I watch out for, and how can they be managed?
6. How often will you monitor progress and adjust treatment if needed?
7. What are the long-term implications of taking ADHD medication?
8. Are there any lifestyle changes or behavioral strategies that can enhance the effectiveness of medication?

Is Medication Right for Me?

Deciding whether to take ADHD medication is a personal choice that should be made in collaboration with your healthcare provider. Consider the following factors when making your decision:

1. Severity of symptoms: If your ADHD symptoms significantly impact your daily functioning, relationships, or work/school performance, medication may be a helpful treatment option.
2. Non-medication treatments: Have you tried other interventions, such as behavioral therapy, lifestyle changes, or accommodations at school or work? If these approaches haven’t provided sufficient relief, medication may be the next step.
3. Personal preferences: Some people may prefer to manage their symptoms without medication, while others feel that the benefits outweigh any potential side effects. Consider your values and goals when making your decision.
4. Family history: If close family members have had positive experiences with ADHD medication, this may influence your choice.
5. Comorbid conditions: If you have other mental health or physical conditions, your healthcare provider can help you determine if ADHD medication is safe and appropriate for your specific situation.

Remember, medication is not the only treatment option for ADHD, and it’s not a magic solution.

Accommodations help too. Even modest changes at home, school, or work can substantially improve quality of life. ADHD is increasingly framed in terms of what lets this brain work well.

Strengths matter too. According to Sedgwick et al. (2019), interviews with successful adults with ADHD revealed cognitive dynamism, energy, courage, resilience, and self-acceptance. They also revealed divergent thinking and hyper-focus, meaning intense absorption in a task the person finds engaging.

They described using these traits to compensate for their difficulties, and even to harness them. These adults were a selected group. They do not speak for everyone with ADHD.

Work closely with your healthcare provider to find a treatment plan that suits you. It may combine medication, therapy, and lifestyle modifications.

Considerations and Alternative Treatments

A holistic approach works best. It looks beyond the core symptoms to overall well-being and quality of life.

While medication can be highly effective, it’s not the only path to managing ADHD. Psychotherapies such as cognitive behavioral therapy (CBT) should also be considered.

The landmark MTA trial tested this combination directly. It randomized 579 children aged 7 to 9.9 with combined-type ADHD to 14 months of medication management, intensive behavioral treatment, both, or routine community care (MTA Cooperative Group, 1999).

Carefully managed medication beat behavioral treatment alone and community care for core symptoms. Adding behavioral treatment gave modest extra benefits for oppositional behavior, social skills, parent-child relations, and reading, and could allow lower medication doses. The medication advantage faded at later follow-up.

Likewise, self-help strategies can be powerful tools in conjunction with or as an alternative to medication. These include:

1. Establishing routines and organization systems: Using planners, calendars, and to-do lists can help individuals with ADHD stay on track and minimize forgetfulness.
2. Managing time effectively: Breaking tasks into smaller, manageable steps and using techniques like the Pomodoro method can improve focus and productivity.
3. Creating a supportive environment: Minimizing distractions, decluttering workspaces, and seeking support from friends and family can foster a more conducive atmosphere for managing ADHD symptoms.
4. Implementing healthy lifestyle habits: Regular exercise, balanced nutrition, and adequate sleep can significantly impact overall functioning and symptom management.
5. Practicing mindfulness and relaxation techniques: Mindfulness, deep breathing, and meditation can help reduce impulsivity, improve emotional regulation, and alleviate stress and anxiety often associated with ADHD.

While self-help strategies can be highly beneficial, it’s important to recognize that they may not be sufficient for everyone.

If symptoms persist or affect daily functioning, consult a qualified healthcare professional. They can help you explore other treatment options, such as therapy, medication, or both.

Conclusion

Medication can be a highly effective tool. It can help many people improve focus, impulse control, and overall functioning.

Stimulant medications are the most commonly prescribed treatments, but non-stimulant options are available for those who do not respond well to stimulants or experience intolerable side effects.

Short-term trials show that ADHD medications reduce core symptoms in children, adolescents, and adults. Long-term evidence is thinner. Large registry studies link treatment to better functional outcomes, but they cannot prove cause.

However, medication needs careful monitoring. Work closely with a healthcare provider to find the most appropriate medication and dosage, and to watch for side effects.

Medication works best as part of a wider plan. That plan may include behavioral therapies, educational support, and lifestyle modifications.

Remember, this article is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional for personalized guidance on managing ADHD.

References

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Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., Atkinson, L. Z., Tessari, L., Banaschewski, T., Coghill, D., Hollis, C., Simonoff, E., Zuddas, A., Barbui, C., Purgato, M., Steinhausen, H.-C., Shokraneh, F., Xia, J., & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 5(9), 727-738. https://doi.org/10.1016/S2215-0366(18)30269-4

Hennissen, L., Bakker, M. J., Banaschewski, T., Carucci, S., Coghill, D., Danckaerts, M., … & ADDUCE consortium. (2017). Cardiovascular effects of stimulant and non-stimulant medication for children and adolescents with ADHD: a systematic review and meta-analysis of trials of methylphenidate, amphetamines and atomoxetine. CNS drugs, 31, 199-215. https://doi.org/10.1007/s40263-017-0410-7

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Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet Psychiatry, 5(2), 175-186. https://doi.org/10.1016/S2215-0366(17)30167-0

Sedgwick, J. A., Merwood, A., & Asherson, P. (2019). The positive aspects of attention deficit hyperactivity disorder: A qualitative investigation of successful adults with ADHD. Attention Deficit and Hyperactivity Disorders, 11(3), 241-253. https://doi.org/10.1007/s12402-018-0277-6

Shoval, G., Visoki, E., Moore, T. M., DiDomenico, G. E., Argabright, S. T., Huffnagle, N. J., … & Barzilay, R. (2021). Evaluation of attention-deficit/hyperactivity disorder medications, externalizing symptoms, and suicidality in children. JAMA network open, 4(6), Article e2111342. https://doi.org/10.1001/jamanetworkopen.2021.11342

Smith, B. H., Reid, E. K., Sajovec, P., & Namerow, L. (2019). Pharmacological treatment of attention-deficit/hyperactivity disorder. In S. M. Evans & K. M. Carpenter (Eds.), APA handbook of psychopharmacology (pp. 347–371). American Psychological Association. https://doi.org/10.1037/0000133-016

Storebø, O. J., Storm, M. R. O., Pereira Ribeiro, J., Skoog, M., Groth, C., Callesen, H. E., Schaug, J. P., Darling Rasmussen, P., Huus, C.-M. L., Zwi, M., Kirubakaran, R., Simonsen, E., & Gluud, C. (2023). Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database of Systematic Reviews, 2023(3), Article CD009885. https://doi.org/10.1002/14651858.CD009885.pub3

Vuori, M., Koski-Pirilä, A., Martikainen, J. E., & Saastamoinen, L. (2020). Gender- and age-stratified analyses of ADHD medication use in children and adolescents in Finland using population-based longitudinal data, 2008-2018. Scandinavian Journal of Public Health, 48(3), 303-307. https://doi.org/10.1177/1403494820901426

Further information

Guidelines for the Pharmacological Management of Attention Deficit Hyperactivity Disorder (ADHD) in Children, Young People and Adults

ADHD Medications: A Guide For Healthcare Professionals

ADHD Medications Approved By The FDA: CHADD.org