The best medication for an adults with ADHD depends on a number of critical factors, like the type and severity of an individual's symptoms, medical and health history, and risk of potential side effects. So while you’re probably looking for a specific medication that’s best for you, it is really impossible to give an answer without first assessing you to find out all the things that make you unique. Before we dig any deeper, I want to reiterate that I do not believe in a medication-only treatment approach for anything, including ADHD.
Key Takeaways:
The best medication for adults with ADHD is dependent on each individual's needs, symptoms, and goals. Treating ADHD holistically has the best outcomes.
There are two main classes of ADHD medications, stimulants and non-stimulants. Each tackle ADHD from different angles.
ADHD medications can have side effects, though they are not all that common. These side effects can include unintended behavioral changes, activation of underlying mental health issues like anxiety, thyroid problems with long-term use, and blood pressure issues.
Treatment plans should always be holistic and include things like behavioral modifications to reduce things like procrastination, routine optimization, nutritional counseling, exercise planning, and potentially other interventions. Just something to keep in mind as we discuss medication for ADHD here.
Whenever we are talking about medication, even for something like ADHD, it is super important to talk with a provider who can evaluate each individual's goals for treatment, symptoms, and medical history before prescribing medication. I think working with an integrative provider is best – because integrative providers view treatment through a holistic lens, which means care is highly individualized. An integrative provider can recommend appropriate medication and dosage based on the individual's genetics, needs, goals, and monitor their progress.
ADHD might sound straight forward in terms of prescribing, but there are lots of variables that must be considered for treatment to be effective. From an integrative perspective, we look at an individual’s presentation of symptoms as a starting point. Each individual’s goals really are the driver of treatment, especially with ADHD. Then we come up with a comprehensive gameplan after investigating prior history, lab work, genetic screenings, medical considerations, and more. All of this dramatically increases overall treatment effectiveness.
Medications for ADHD
So, now we’re ready to talk about medication for ADHD. Some common medications prescribed for ADHD in adults include stimulants like methylphenidate and amphetamines, as well as non-stimulant medications like atomoxetine and guanfacine.
Stimulant medications for ADHD
Stimulants are overwhelmingly effective, even with the first dose. More or less, stimulant medications for ADHD are thought to work by increasing the levels of dopamine and norepinephrine, two neurotransmitters that are responsible for regulating attention, focus, and motivation.
Remember, in people with ADHD, the levels of dopamine and norepinephrine are often lower than normal, leading to difficulties with attention, concentration, and impulsivity. So when we use a stimulant for ADHD, the increased levels of available dopamine and norepinephrine ultimately help reduce inattention, impulsivity, and improve overall focus and concentration.
Stimulant medications come in two main forms: methylphenidate and amphetamine. Methylphenidate-based medications include Ritalin, Concerta, and Focalin, while amphetamine-based medications include Adderall and Vyvanse. These medications can be taken in a variety of forms, including tablets, capsules, and extended-release formulations.
Stimulant medications are generally considered safe and effective for treating ADHD, but they can have side effects such as insomnia, decreased appetite, and irritability, as well as anxiety. This makes it all the more important to use the correct dose. Another consideration is availability. There are shortages of stimulants across the board, making treatment of ADHD challenging at times. Hopefully supply chains are able to work out the shortages as the DEA cracks down on pill mills and predatory prescribing.
Non-stimulant medications for ADHD
Non-stimulant medications for ADHD work differently than stimulant medications. Instead of increasing the release of dopamine and norepinephrine levels in the brain, non-stimulant medications target neurotransmitters in a different fashion. Non-stimulants tend to take 4-6 weeks before effectiveness is noticed, but this varies with each individual.
One common type of non-stimulant medication for ADHD is atomoxetine (brand name Strattera). Atomoxetine is a selective norepinephrine reuptake inhibitor, meaning that it increases the amount of norepinephrine in the brain by blocking its reabsorption into nerve cells, thus increasing the available norepinephrine. This can help improve attention, impulse control, and hyperactivity in people with ADHD.
Another non-stimulant medication for ADHD is guanfacine (brand name Intuniv), which is an alpha-2A adrenergic agonist. We think this works by increasing blood flow to key areas of the brain involved with executive functioning, again helping increase those same neurotransmitters. However, we don’t have as firm theory with how guanfacine works, we just know folks with ADHD tend to notice solid benefits from taking it. Guanfacine helps reduce hyperactivity, impulsivity, distractibility, and general executive functioning in people with ADHD.
Non-stimulant medications for ADHD can be helpful for people who cannot tolerate or do not respond well to stimulant medications. They may also be used in combination with stimulant medications to enhance their effectiveness. Again, finding the right dose and combination is really an art and should be done by working closely with a skilled provider.
It is essential to note that medication is not the only treatment option for ADHD. For ADHD, behavior therapy, lifestyle changes, and optimizing exercise and nutrition play a huge role in effectively managing ADHD long-term.
Now that you have a better idea of some of the medications for ADHD are, I’ll answer some of the most common questions people ask:
Will ADHD medications change my personality?
Ahh, you’re unique, why would we want to change you? Well, we don’t! ADHD medications are designed to help manage the symptoms of ADHD, such as difficulty with focus, attention, and impulse control. They are not intended to change a person's personality or alter their core characteristics.
However, some people may notice changes in their behavior or mood when they start taking ADHD medications. For example, they may feel more focused, alert, and calm, which could lead to changes in how they interact with others or approach certain situations.
Also, these changes are typically a result of the medication's positive effects on brain chemistry and are not necessarily permanent or indicative of a change in personality. Some people may experience this, but this is generally mild and may go away over time. This is definitely something to chat about with your provider. Sharing your concerns is extremely helpful in shaping the course of treatment.
Can ADHD medication cause or help anxiety?
ADHD medication can sometimes cause anxiety as a side effect, but this certainly doesn’t happen to everyone. Some individuals with ADHD may already be prone to anxiety or may have an underlying anxiety disorder, and the stimulant medication can exacerbate these symptoms.
As we discussed, the stimulant medications used to treat ADHD work by increasing the levels of dopamine and norepinephrine in the brain, which can improve focus, attention, and impulse control. However, these medications can also affect other parts of the brain and body, leading to side effects such as increased heart rate, jitteriness, and restlessness, which may contribute to feelings of anxiety.
If you are taking ADHD medication and are experiencing symptoms of anxiety, it's important to talk to your provider. Your provider (hopefully an integrative one) can evaluate your symptoms and come up with a holistic gameplan to help manage your anxiety and ADHD symptoms.
In some cases, non-stimulant medications may be a better choice for people with ADHD who also experience anxiety or have an anxiety disorder. Because these medications work differently than stimulant medications, they tend to have fewer side effects related to anxiety. In fact, guanfacine, has been shown to be effective in managing anxiety even in individuals without ADHD.
Can ADHD medication cause or help depression?
ADHD medication is not known to cause depression as a side effect, and in fact, many people with ADHD who take medication report improvements in mood and overall well-being. Interestingly, we sometimes prescribe stimulants to those who have depression that is difficult to treat. That being said, some people with ADHD may also have underlying mood disorders, such as depression, and the medication may not effectively treat these conditions. So while their ADHD symptoms may subside, their feelings of depression linger, making it appear like the ADHD medication caused the depression.
Now, everyone is different. So it's also possible that ADHD medication could exacerbate symptoms of depression in some people. Stimulant medications used to treat ADHD can sometimes cause side effects such as irritability, agitation, and insomnia, which can contribute to feelings of depression.
If you are taking ADHD medication and are experiencing symptoms of depression, it's important to talk to your provider. The goal is to treat ADHD without causing other problems in its place.
Can ADHD medication cause weight gain or weight loss in adults?
ADHD medication can cause both weight gain and weight loss in adults, depending on the medication and the individual's response to it.
Stimulant medications for ADHD, like methylphenidate and amphetamines are known to suppress appetite, which can lead to weight loss in some people. Though less common, these medications can also increase metabolism, which can lead to weight gain in others. Non-stimulant medications, atomoxetine and guanfacine, are less likely to cause weight changes, but they can still affect appetite and metabolism in some individuals.
Weight changes are not a universal side effect of ADHD medication and may not occur in everyone. If this is a concern, make sure to talk with your provider. As we talked about earlier, any good ADHD treatment plan will also include nutrition counseling. This becomes even more important when we take into account potential weight-related side effects.
Can ADHD medications cause high blood pressure?
ADHD medications, especially stimulants, can increase blood pressure in some people. The risk of developing high blood pressure as a result of ADHD medication use is generally low. Everyone’s response is different. Not every stimulant type will cause an increase in blood pressure. Also, the increase in blood pressure is usually not significant enough to cause health problems.
It's important to note that the risk of developing high blood pressure due to ADHD medication use may be higher for people who already have hypertension or other cardiovascular issues. This is why it is really critical for people with a history of high blood pressure, heart disease, or other cardiovascular problems to have a chat with their team of providers before starting any ADHD medication.
It's a good idea to monitor blood pressure and other vital signs regularly when prescribing ADHD medication to help identify any potential side effects. If high blood pressure does occur, that doesn’t mean game over with ADHD medications. It may adjust the medication dosage or switch to a different medication to help manage the issue.
Can ADHD medication cause thyroid problems?
There is some evidence that suggests that long-term use of certain ADHD medications, particularly those containing amphetamine, may be associated with an increased risk of developing thyroid problems in some people. However, the overall risk appears to be small and more research is needed to fully understand the relationship between ADHD medication and thyroid function. Moreover, there may be an underlying link between thyroid function and ADHD, making it difficult to parse out the exact source of any particular thyroid issue in those with ADHD.
The mechanism by which ADHD medication might affect thyroid function is not well understood, but it is thought to be related to the medication's effects on the sympathetic nervous system. The sympathetic nervous system is responsible for regulating the body's "fight or flight" response and can affect the function of many organs, including the thyroid gland. If you are taking or plan to take ADHD medication and are concerned about the potential risk of thyroid problems, I recommend you have a chat about your concerns with your provider to help find a solution that is right for you.
Summary: ADHD medications
Whew, we covered a lot of ground here. Just to recap, the best ADHD medication for adults really depends on a number of variables. An integrative approach based on an individual’s symptoms and goals are typically the most effective treatments plans long term. With respect to medication, there are a number of options for ADHD, including stimulants and non-stimulants, each with their own advantages.
As an integrative provider, I always approach treatment from a holistic perspective, even for ADHD. I believe that medication-only treatment plans are just not best practice. There are side effects of ADHD medications, so it is important to discuss any concerns with a knowledgeable provider. Remember, side effects don’t happen to everyone but some of the side effects include the potential for changes in behaviors, activation of underlying anxiety or mood disorders, thyroid problems, weight fluctuations, and blood pressure.
If you have any additional questions about ADHD medications or integrative psychiatry in general, shoot me an email or reach out through my website. If you're looking for a provider and you're in the Washington, DC area, I'd love to help you on your treatment journey!