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Pharmaceutical Therapy for ADHD

Medication has long been considered the gold standard for treating ADHD and consequently there are many options to choose from. ADHD medications come in two basic categories: stimulants and antidepressants, with stimulants being prescribed as the first course of treatment. Unfortunately many of these medications have some serious side effects.

Central Nervous System (CNS) Stimulants

The main drug prescribed for ADHD is Methylphenidate which belongs to a group of drugs known as central nervous system (CNS) stimulants. Methylphenidate drugs include Concerta, Ritalin LA, Focalin XR, or Metadate CD and increase the level of neurotransmitters in the brain called dopamine and norepinephrine. Neurotransmitters are chemicals that assist in sending messages between nerve cells in the brain. In addition to pills, methylphenidate is also available as Daytrana, a patch that allows the medicine to be absorbed by the skin. Amphetamines, such as Adderall, Adderall XR, Vyvanse, Dextrostat, and Dexedrine, also treat ADHD in ways similar to methylphenidate medications.

Antidepressants

Antidepressants are a second-line therapy used when stimulants don't work. It is believed that the brains of people with ADHD have a lower than normal supply of neurotransmitters such as dopamine and norepinephrine. Tricyclic antidepressants prevent the nerves from absorbing these chemicals so there's a greater supply for the brain. They also enable dopamine and norepinephrine to remain in the blood for longer periods of time so they can be used by the body more productively.Two tricyclic antidepressants frequently prescribed are Imipramine and Desipramine. But both have some side effects including fast heart rate, blurred vision, urinary difficulty urinating, dry mouth, constipation, weight gain or loss, and low blood pressure when standing.

There are other medications prescribed for ADHD but they are not currently approved by the FDA for this use. They include Bupropion, Clonidine, and Guanfacine and each may have some side effects. With Bupropion, some patients experience agitation, dry mouth, insomnia, headache, nausea, constipation, and tremor. While Clonidine can cause tiredness, lethargy, drowsiness, constipation, and dry mouth. It may also cause headache, dizziness, fatigue, and weakness. The most common side effects experienced with Guanfacine are dizziness, drowsiness, headache, constipation, gas pains, diarrhea, and loss of appetite, fatigue, and nasal congestion.

Multi-Modal Treatment

As noted earlier, a combination of therapies or a multi-modal treatment which includes medication, parent/school counseling, and EEG biofeedback is often used for the long term management of ADHD. EEG biofeedback in particular seems to provide a sustained effect even when used without pharmaceutical therapy. Patients using other forms of complementary and alternative therapy have also enjoyed some success.

Merln Hurd PhD; BCN, QEEGT

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PVKelsey, LICSW

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Center for Personal Growth

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