Making ADD/ADHD medication decisions can be difficult, but doing your homework helps. The first thing to understand is exactly what the medications for ADD and ADHD can and can’t do. ADHD medication may help improve the ability to concentrate, control impulses, plan ahead, and follow through with tasks. However, it isn’t a magic pill that will fix all of your or your child’s problems. Even when the medication is working, a child with ADD/ADHD might still struggle with forgetfulness, emotional problems, and social awkwardness, or an adult with disorganization, distractibility, and relationship difficulties. That’s why it’s so important to also make lifestyle changes that include regular exercise, a healthy diet, and sufficient sleep.
Medication doesn’t cure ADD/ADHD. It can relieve symptoms while it’s being taken, but once medication stops, those symptoms come back. Also, ADD/ADHD medication works better for some than for others. Some people experience dramatic improvement while others experience only modest gains. Because each person responds differently and unpredictably to medication for ADHD, its use should always be personalized to the individual and closely monitored by a doctor. When medication for ADD/ADHD is not carefully monitored, it is less effective and more risky.
Generic vs. Brand-Name Drugs
Generic drugs have the same use, dosage, side effects, risks, safety profile, and potency as the original brand-name drug. The main reason why generic drugs are cheaper than brand-name drugs is that the generic drug manufacturer does not need to recoup huge expenses for developing and marketing a drug. Once the patent for the original drug has expired, other manufacturers can produce the same drug with the same ingredients at a markedly lower cost.
Occasionally, brand-name drugs have different coatings or color dyes to change their appearance. In rare cases, these extra ingredients will make the generic form of the drug less tolerable, so if your condition worsens after switching from a brand-name to a generic drug, consult your doctor. In most cases, however, generic drugs are just as safe and effective as brand-name drugs.
Stimulants are the most common type of medication prescribed for attention deficit disorder. They have the longest track record for treating ADD/ADHD and the most research to back up their effectiveness. The stimulant class of medication includes widely used drugs such as Ritalin, Adderall, and Dexedrine.
Stimulants are believed to work by increasing dopamine levels in the brain. Dopamine is a neurotransmitter associated with motivation, pleasure, attention, and movement. For many people with ADD or ADHD, stimulant medications boost concentration and focus while reducing hyperactive and impulsive behaviors.
Short-acting vs. long-acting stimulants for ADD / ADHD
Stimulants for ADD/ADHD come in both short- and long-acting dosages. Short-acting stimulants peak after several hours, and must be taken 2-3 times a day. Long-acting or extended-release stimulants last 8-12 hours, and are usually taken just once a day.
The long-acting versions of ADD/ADHD medication are often preferred, since people with ADHD often have trouble remembering to take their pills. Taking just one dose a day is much easier and more convenient.
Common side effects of stimulants for ADD & ADHD:
Stimulant medications may also cause personality changes. Some people become withdrawn, listless, rigid, or less spontaneous and talkative. Others develop obsessive-compulsive symptoms. Since stimulants raise blood pressure and heart rate, many experts worry about the dangers of taking these ADD/ADHD drugs for extended periods.
Stimulant Medication Red Flags
Call your doctor right away if you or your child experience any of the following symptoms while taking stimulant medication for ADD or ADHD:
- chest pain
- shortness of breath
- seeing or hearing things that aren’t real
- suspicion or paranoia
Beyond the potential side effects, there are a number of safety concerns associated with the stimulant medications for ADD/ADHD.
- Effect on the developing brain — The long-term impact of ADD/ADHD medication on the youthful, developing brain is not yet known. Some researchers are concerned that the use of drugs such as Ritalin in children and teens might interfere with normal brain development.
- Heart-related problems — ADD/ADHD stimulant medications have been found to cause sudden death in children and adults with heart conditions. The American Heart Association recommends that all individuals, including children, have a cardiac evaluation prior to starting a stimulant. An electrocardiogram is recommended if the person has a history of heart problems.
- Psychiatric problems — Stimulants for ADD/ADHD can trigger or exacerbate symptoms of hostility, aggression, anxiety, depression, and paranoia. People with a personal or family history of suicide, depression, or bipolar disorder are at a particularly high risk, and should be carefully monitored when taking stimulants.
- Potential for abuse — Stimulant abuse is a growing problem, particularly among teens and young adults. College students take them for a boost when cramming for exams or pulling all-nighters. Others abuse stimulant meds for their weight-loss properties. If your child is taking stimulants, make sure he or she isn’t sharing the pills or selling them.
ADD / ADHD stimulants are not recommended for those with:
In addition to the traditional stimulant drugs, there are several other medications used to treat ADD/ADHD, including Strattera, atypical antidepressants, and certain blood pressure medications. In most cases, non-stimulant medications are considered when stimulants haven’t worked or have caused intolerable side effects.
Strattera Suicide Risk in Children
Strattera may cause an increase in suicidal thoughts and actions in some children and teenagers, especially if your child has bipolar disorder or depression in addition to ADD/ADHD.
Call the doctor immediately if your child shows agitation, irritability, suicidal thinking or behaviors, and unusual changes in behavior.
Strattera, also known by its generic name atomoxetine, is the only non-stimulant medication approved by the FDA for ADD/ADHD treatment. Unlike stimulants, which affect dopamine, Strattera boosts the levels of norepinephrine, a different brain chemical.
Strattera is longer-acting than the stimulant drugs. Its effects last over 24 hours—making it a good option for those who have trouble getting going in the morning. Since it has some antidepressant properties, it’s also a top choice for those with co-existing anxiety or depression. Another plus is that it doesn’t exacerbate tics or Tourette’s Syndrome.
On the other hand, Strattera doesn’t appear to be as effective as the stimulant medications for treating symptoms of hyperactivity.
Common side effects of Strattera include:
Straterra can also cause insomnia and appetite suppression, but these side effects are more common in stimulants.
Other ADD & ADHD medication options
The following medications are sometimes used “off-label” in the treatment of attention deficit disorder, although they are not FDA approved for this purpose. They should only be considered when stimulants or Strattera aren’t viable options.
- High blood pressure medication for ADD/ADHD – Certain blood pressure medications can be used to treat ADD/ADHD. Options include clonidine (Catapres) and guanfacine (Tenex). But while these medications can be effective for hyperactivity, impulsivity, and aggression, they are less helpful when it comes to attention problems.
- Antidepressants for ADD/ADHD – For people suffering from both ADHD and depression, certain antidepressants, which target multiple neurotransmitters in the brain, may be prescribed. Wellbutrin, also known by the generic name bupropion, is most widely used. Wellbutrin targets both norepinephrine and dopamine. Another option is the use of tricyclic antidepressants.
Even when armed with all the facts, deciding whether or not to let your child take ADD/ADHD medication isn't always easy. If you're unsure, don't rush the decision. Sometimes other medical conditions–or even normal childhood behavior–can be mistaken for ADD/ADHD symptoms, so be sure to eliminate all other possible causes before considering medication for your child. Take your time to weigh the options and get your child's input in the decision-making process.
Most importantly, trust your instincts and do what feels right to you. Don't let anyone–be it your physician or the principal at your child's school–pressure your child into medication if you're not comfortable with it. Remember: medication isn't the only treatment option. For young children especially, medication should be viewed as a last resort, not the first course of treatment to try.
Questions to ask an ADD / ADHD specialist
Consulting with an ADD/ADHD specialist or an experienced psychiatrist can help you understand the pros and cons of medication. Here are some questions to ask:
- What ADD/ADHD treatments do you recommend?
- Can my child's symptoms be managed without medication?
- What medications do you recommend and what are the side effects?
- How effective is medication for my child's ADD/ADHD?
- How long will my child have to take medication?
- How will the decision be made to stop medication?
For Parents: Helpful questions about ADHD medication and your child
When deciding whether or not to put your child on medication, Jerome Schultz, Ph.D., ADHD expert, says to first consider the following questions:
- Has my child been helped by non-medication approaches? Self-calming techniques, deep breathing, and yoga often can help children with ADHD.
- Has the school tried to teach my child to be more attentive and less active?
- Is the decision to put my child on medication the result of behavioral observations over time and in different settings, such as in school and at home?
- When is my child at his or her best? Fishing with his uncle or playing video games? Help the physician understand how pervasive or selective the problem is.
- Does my child have other conditions that can be mistaken for hyperactivity? Children exposed to toxic chemicals or who have undiagnosed learning disabilities and low-level anxiety disorder may produce similar behaviors.
Source: Family Education Network
Talking to your child about ADD / ADHD medication
Many kids and teens with ADD/ADHD don't take their medication correctly–or stop taking it without talking to their parents or doctor–so if your child is on ADD meds, make sure that he or she understands how to take the medication correctly and why following prescription guidelines are important.
Encourage your child to come to you with any medication-related concerns so you can work together to solve the problem or find another treatment option. It's also important to remember that ADD/ADHD medication should never have a numbing effect on a child's energy, curiosity or enthusiasm. A child still needs to behave like a child.
Monitoring Medication's Effects on Your Child
Here is a list of questions you should ask when your child begins medication therapy, changes dosage, or starts taking a different medication.
- Is the medication having a positive impact on your child's mood and/or behavior?
- Do you think the dosage or medication is working?
- Does your child think the dosage or medication is working?
- Does the dose need to be increased or decreased?
- What was the change in a specific behavior or set of behaviors that caused you to conclude that the medication needed to be evaluated?
- Is your child experiencing any side effects, such as headaches, stomachaches, fatigue or sleeplessness, (or suicidal thoughts if taking Strattera)?
- What is the likelihood those side effects will last? (Ask your doctor)
- Do any lasting side effects (if any) outweigh the medication's benefits?
- Do you or your child think a medication or dosage level has stopped working?
Source: From Chaos to Calm: Effective Parenting of Challenging Children with ADHD and Other Behavioral Problems, by Janet E. Heininger and Sharon K. Weiss.
Need Help with ADD/ADHD?
Helpguide's Bring Your Life into Balance mindfulness toolkit can help.
Treatment for attention deficit disorder isn’t just about seeing doctors or taking medication. There is a lot you can do to help yourself or your child tackle the challenges of ADD/ADHD and lead a calmer, more productive life. With the right tips and tools, you can manage many of the symptoms of your ADD/ADHD on your own. Even if you choose to take medication, healthy lifestyle habits and other self-help strategies may enable you to take a lower dose.
- Exercise regularly. Exercising is one of the most effective ways to reduce the symptoms of ADD/ADHD. Physical activity boosts the brain’s dopamine, norepinephrine, and serotonin levels—all of which affect focus and attention. Try walking, skateboarding, hiking, dancing or playing a favorite sport. Encourage your child to put down the video games and play outside.
- Eat a healthy diet. While diet doesn’t cause ADD/ADHD, it does have an effect on mood, energy levels, and symptoms. Set regular snack and meal times. Add more omega-3 fatty acids to your diet and make sure you’re getting enough zinc, iron and magnesium.
- Get plenty of sleep. Regular quality sleep can lead to vast improvement in the symptoms of ADD/ADHD. Simple changes to daytime habits go a long way toward resting well at night. Have a set bedtime and stick to it. Avoid caffeine later in the day.
- Try therapy. ADD/ADHD professionals can help you or your child learn new skills to cope with symptoms and change habits that are causing problems. Some therapies focus on managing stress and anger or controlling impulsive behaviors, while others teach you how to manage time, improve organizational skills, and persist toward goals.
- Maintain a positive attitude. A positive attitude and common sense are your best assets for treating ADD/ADHD. When you are in a good frame of mind, you are more likely to be able to connect with your own needs or your child’s.
If you decide to take medication for ADD/ADHD, it’s important to take the drug as directed. Following your doctor and pharmacist’s instructions will help you maximize the effectiveness of medication for ADD/ADHD and minimize the side effects and risks. Here are some guidelines for safe use:
- Learn about the prescribed medication. Find out everything you can about the ADD/ADHD medication you or your child is taking, including potential side effects, how often to take it, special warnings, and other substances that should be avoided, such as over-the-counter cold medication.
- Be patient. Finding the right medication and dose is a trial-and-error process. It will take some experimenting, as well as open, honest communication with your doctor.
- Start small. It’s always best to start with a low dose and work up from there. The goal is to find the lowest possible dose that relieves you or your child’s symptoms.
- Monitor the drug’s effects. Pay close attention to the effect the medication is having on your or your child’s emotions and behavior. Keep track of any side effects and monitor how well the medication is working to reduce symptoms.
- Taper off slowly. If you or your child wants to stop taking medication, call the doctor for guidance on gradually decreasing the dose. Abruptly stopping medication can lead to unpleasant withdrawal symptoms such as irritability, fatigue, depression, and headache.
Most children and adults taking medication for ADD/ADHD will experience at least a few side effects. Sometimes, side effects go away after the first few weeks on the medication. You may also be able to eliminate or reduce unpleasant side effects with a few simple strategies.
Tips for minimizing side effects
- Loss of appetite – To deal with reduced appetite, eat healthy snacks throughout the day and push dinner to a later time when the medication has worn off.
- Insomnia – If getting to sleep is a problem, try taking the stimulant earlier in the day. If you or your child is taking an extended-release stimulant, you can also try switching to the short-acting form. Also avoid caffeinated beverages, especially in the afternoon or evening.
- Stomach upset or headaches – Don’t take the medication on an empty stomach, which can cause nausea, stomach pain, and headaches. Headaches can also be triggered by medication that’s wearing off, so switching to a long-acting drug may help.
- Dizziness – First, have you or your child’s blood pressure checked. If it’s normal, you may want to reduce your dose or switch to a long-acting stimulant. Also make sure you’re drinking enough fluids.
- Mood changes – If medication is causing irritability, depression, agitation, or other emotional side effects, try lowering the dose. Moodiness may also be caused by the rebound effect, in which case it may help to overlap the doses or switch to an extended-release medication.
If troublesome side effects persist despite your best efforts to manage them, talk to your doctor about adjusting the dose or trying a different drug. Many people respond better to the long-acting or extended release formulations of ADHD medication, which build gradually in the bloodstream and then wear off slowly. This minimizes the ups and downs caused by fluctuating medication levels and causes less of a rebound effect, where symptoms return, often worse than before, as the drug wears off.
ADD / ADHD Treatment
ADD / ADHD in Adults
ADD / ADHD in Children
Resources & References
General information about ADD / ADHD medications
Attention-Deficit Hyperactivity Disorder: Medications – Covers common ADD/ADHD medications for children and adults, including side effects, long-term complications, and concerns for abuse. (University of Maryland Medical Center)
ADHD Treatment: Your Guide to Common ADD Drugs – Find answers to parents' top 10 questions about common ADD/ADHD medications. (ADDitude)
Stimulant Medication and ADHD – In-depth article on stimulants for ADD/ADHD, including side effects, treatment guidelines, and effectiveness. (Northern County Psychiatric Associates)
ADHD Medications – Article written for kids about ADD/ADHD medications and their safety. (Nemours Foundation)
Side Effects and Safety Concerns of ADD / ADHD Medication
FDA Asks Attention-Deficit Hyperactivity Disorder (ADHD) Drug Manufacturers to Develop Patient Medication Guides – Overview of the FDA’s requirement for ADD/ADHD drug labels, with links to each specific medication. (U.S. Food and Drug Administration)
Early Ritalin Exposure May Cause Long-Term Effects on the Brain – A new study suggests that the misdiagnosis of ADD/ADHD combined with prescription drug use in children may lead to a higher risk of developing depressive symptoms in adulthood. (McLean Hospital)
ADD / ADHD Medication Guidelines
ADD Drugs 101: Stimulant Strategies – Guidelines for taking ADD/ADHD stimulant medications safely and effectively. (ADDitude)
ADD Drugs: Say No to Side Effects – Guide to finding the right ADD/ADHD medication for you or you child and minimizing side effects. (ADDitude)
What If Einstein Had Taken Ritalin? – Examines the effects of Ritalin and other ADD/ADHD drugs on active kids and questions what effects these drugs might have had if some famous people had taken them. (Overmatter.com - reprint of Wall Street Journal article)