ADHD Medication Treatments For Adults & Kids (Without Testing) - Pt 3
In Part 1 we talked about the signs of ADHD. In Part 2 we covered treatment without meds. And here we’ll have the complete guide to ADHD treatment with medications. *(press control-F to find a specific medication).
The Level 1 Gamer struggles with ADHD cause he never got it treated. He can’t complete anything he starts and he gets distracted from the smallest things. People think he’s lazy. He thinks he’s stupid. But he never knew otherwise cause he never got it treated.
The Level 100 Gamer has a complete ADHD treatment plan designed by a psychiatrist. His ADHD is completely controlled and doesn’t affect his life anymore. He finishes all of his work on time. He doesn’t spend money on stupid stuff like Steam sales or junk food. He’s able to set goals and actually achieve them. He gets up when he wants to, not cause he can’t ever sit still.
ADHD meds get a bad rap. Some people think they’re “cheating,” especially when it helps someone with school or projects. Others think we’re all just drug addicts snorting our meds. It doesn’t help there’s recent controversy about the ADHD med shortage due to pill mill companies overprescribing these meds.
Yet I’ve had many clients with life-changing results from these medications. One guy quit binge eating and stopped failing his college classes after we found him the right dose of Vyvanse. Another man was able to finally graduate high school and get his drivers license after years of gaming in his parents’ attic. Over the years I’ve had many clients confused about their ADHD treatment. If that’s you, keep reading.
ADHD meds are broken down into various categories. Here they are with no BS:
Stimulants
This is the bread and butter. These medications have some of the best effectiveness in all of psychiatry. If we recall, ADHD is caused by low epinephrine (NE) and dopamine (DA) causing poor connectivity in the brain. These meds increase both of these neurotransmitters in our frontal lobes. They’re broken into 2 classes:
1) Methylphenidate: Ritalin, Concerta, Focalin, Metadate CD etc.
2) Amphetamine: Adderall, Vyvanse, Dexedrine etc.
The biggest benefit of these meds is clients notice the effects immediately. This is great cause it lets us adjust your medication dosage very quickly (unlike antidepressants) so we find your perfect dose fast.
They come in tablets, capsules, liquids (some) and patches (some), which can be handy for kids. They also have immediate release and extended release formulations (basically lasting different amounts in our bodies) to best suit our individual needs.
Most common side effects: appetite suppression, nausea, insomnia (difficulty falling asleep) and tachycardia (high heart rate). These are generally dose dependent and go away within a week. Having your meds early in the day and with meals helps a lot.
These are the ones that are bought/sold illicitly. They also have the most addictive potential since they work immediately. But that gets mediated by using an extended-release or long-acting formulation. And by far these are the best meds for ADHD, so they should always get tried first.
Non-Stimulants
Let me be blunt. They’re are not as effective as stimulants. They take way longer to work.
However these have a few advantages: No addictive potential. They work differently so they’re effective for people who don’t respond well to stimulants. They can treat co-occuring anxiety and depression. They’re usually dosed once daily. They also have different side effects so they’re better for specific clients.
1) Atomoxetine (Strattera) or Viloxazine (Qelbree):
These increase NE in our frontal lobes, working similar to SSRI antidepressants. These take about 4 weeks to start fully working. Clients also often notice improvements in anxiety and depression with these meds.
Side Effects: Increased blood pressure, increased heart rate, nausea, sweating, dry mouth, headache, insomnia
2) Bupropion (Wellbutrin):
An antidepressant that’s found to have benefit with ADHD. This increases DA in our frontal lobes. Also takes a few weeks to start fully working.
Side Effects: Increased heart rate, sweating, weight loss, nausea, constipation
*Notable: Can increase risk of seiures if you’re prone to them. Tell your doc if you have a history of these.
Others
These ones aren’t as good for ADHD. But they can be helpful for patients who don’t do well with the above options.
3) Venlafaxine (Effexor):
Another antidepressant. This one increases NE and serotonin. Can take up to 6 weeks to see full benefits. This is a really good antidepressant and anxiety med, but a so-so ADHD med.
Side effects: Sweating, weight loss, nausea, dry mouth, insomnia, fatigue, increased blood pressure
4) Guanfacine (Intuniv):
Technically a blood pressure medication, but its been found to have benefit with ADHD (mainly in kids/teens). Works primarily for hyperactivity / impulsivity symptoms. I think of this med as “chilling everything out.” It calms down the sympathetic nervous system (“fight/flight.”)
Side effects: Dry mouth, fatigue, constipation, headache, lower blood pressure
5) Clonidine (Catapres)
Similar to guanfacine. This one tends to be more sedating, so usually given at bedtime. Also mainly for hyperactivity / impulsivity
Side effects: Dry mouth, dizziness, drowsiness, fatigue, constipation, lower blood pressure
*With clonidine and guanfacine, do not increase them or stop them suddenly without talking with your doc. That could drop or skyrocket your blood pressure. These 2 need to be increased or decreased gradually.
6) Tricyclic Antidepressants (TCAs): Desipramine, Nortriptyline, Amitriptyline
These are old AF antidepressants. They have a lot of NE activity so they have been found helpful with ADHD. But they tend to not be well tolerated due to higher likelihood of side effects. But they’re an option for treatment resistant ADHD patients or patients who also have depression and/or anxiety. We just make sure to adjust your dose slowly.
Side effects: Increased heart rate, arrhythmias (weird heart rhythms), low blood pressure, sleep issues, balance issues, tremor etc
*Tell your doc if you have any existing heart conditions and you’re taking this class of meds.
Conclusion
Feeling stuck with ADHD is common, but it doesn’t have to be permanent. It’s one of the most treatable psych conditions out there, both with meds and without meds.
ADHD Meds Ranking: Stimulants (methylphenidate / amphetamine) > atomoxetine & bupropion > venlafaxine, guanfacine, clonidine > TCAs
Imagine a life where we can get whatever we want done, where no one calls us lazy. Where we make great decisions by thinking them through rather than impulsively and regretting it later. Where we can stay sitting through class and meetings instead of constantly having to get up. This life is possible.
I’m a psychiatrist who specializes in treating Young Men & Gamers with Depression, Anxiety, ADHD and Video Game Addiction. CLICK HERE to book your free consult call.
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Real life’s the video game.
So let’s level up.
Agam
FAQs
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No. There’s been a lot of studies on this. While there has been some evidence they can slightly slow down a child’s growth, their END height ends up being the same. And it was only a minimal slowing effect.
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No. While some of the stimulant class can be addictive, its relatively rare. Most people report feeling like they can finally think clearly again, rather than getting a “high” from the meds.
I often tell parents that untreated ADHD is worse because those impulsive kids often turn to substances instead. Which obviously have a much higher rate of addiction.
If addiction is that serious of a concern, we can use Vyvanse (a very low-addictive stimulant) or a non-stimulant option.
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Yes. People with ADHD notoriously vape because nicotine is a mini stimulant. People with ADHD tell me they feel so clear when they vape, cause its briefly helping their ADHD. But unfortunately that’s what makes them so prone to being addicted to it.
So by treating the ADHD, you or your kid are much less likely to vape.
