Focus on Stimulant Drugs
Stimulants come in a variety of forms and brands. Stimulant medications are considered safe when taken under medical supervision. Used as prescribed, they do not make adults with ADHD feel high.
Although the majority — 60 to 80 percent — of adults with ADHD enjoy a dramatic decrease in symptoms when taking medication, some only receive a small benefit while others reap none at all.
Others suffer from side effects that are so severe that they must go off the drugs.
How Stimulants Work in the Brain
Stimulant medications are believed to directly affect the brain neurotransmitters dopamine and norepinephrine, which are responsible for transmitting messages between different parts of the brain.
Dopamine controls the power of the signals coming into your brain and regulates areas of the brain that control filtering and screening. Norepinephrine controls your level of alertness, clarity, and wakefulness. Both neurotransmitters have an impact on motivation and are also believed to affect attention and behavioral symptoms, although how this works remains unknown.
Seventy-five percent of adults with ADHD also have co-existing conditions. However, there are no controlled studies on the most effective ways to treat adults with overlapping conditions, so physicians must rely on their previous clinical experience and continual feedback from patients to find a treatment plan that works for each patient.
Generic stimulants are usually inexpensive, although many longer acting stimulants can be quite expensive if your insurance doesn't cover medication costs.
Forms of Stimulant Medication
Stimulant medications come in pills, capsules, liquids, and skin patches. Some medications also come in short-acting, long-acting, or extended release varieties. The active ingredient is the same in each of these varieties, but it is released differently in the body.
Long-acting or extended release forms (“ER” or “XR”) often work best for adults who need continuous relief during daytime and evening hours and who may be too forgetful or distracted to remember to take second and third doses. They are also prescribed to people for whom substance abuse is a concern.
The Half-Life of Medication
The half-life of a drug refers to the amount of time it takes a drug to reach 50 percent of its peak effectiveness after you take a dose. The longer the half-life of a drug, the longer it takes for the drug to reach its full effect, and the more important it is to take it on time to maintain a steady level of medication in your bloodstream.
Neglecting to take drugs with a short half-life on time may result in a condition called discontinuation syndrome. Symptoms include irritability, insomnia, dizziness, light-headedness, and flu-like symptoms, and may persist for weeks.
Commonly Prescribed Stimulants
There are many different kinds of stimulant drugs your physician may prescribe. Although they all work in a similar fashion, the differ in how quickly they begin to work, how long they remain in your bloodstream, the degree of relief they provide, and their side effects. Through trial-and-error, you and your physician will be able to determine which medication(s) work best for you.
Marketed as Ritalin, Concerta, Metadate, and Focalin, methylphenidate is one of the most widely prescribed drugs for adult ADHD and is available in a wide range of forms. Different brands use different delivery systems to get the medication into your system, and there are also differences among brands in how long the drugs take to reach their half-life and peak, how long they remain in the bloodstream, and their side effects. Methylphenidate is available in a variety of forms, including short-acting, long-acting, and sustained-release.
Dexedrine is one of the oldest drugs used to treat adult ADHD and is still considered one of the best. It is offered in both short-acting and sustained-released forms.
Adderall (Salts of D- and L-Amphetamine)
Similar to Dexedrine, this medication is believed to have more impact on norepinephrine than Dexedrine. It is available in short-and long-acting forms.
This newer medication is similar to Adderall in its chemical composition. It is believed to have less potential for substance abuse than most stimulants because snorting it or injecting it will not cause a user to get high. Before it can become effective, the body must convert it from its oral form to a stimulant form. It may result in a smoother onset and result in less restlessness than Adderall.
Biologically identical to the methamphetamine manufactured in illegal drug labs, Dexoxyn has gotten an undeserved bad rap. The legal, prescription form of Dexoxyn is not only one of the most beneficial medications for many adults with ADHD, but one of the least expensive medications.
This medication causes the release of dopamine but not nor-epinephrine. Because the drug has been associated with liver damage, it is only prescribed after other stimulants have failed. People who take Cylert are generally advised to get regular liver function tests.
Although this drug is approved for the treatment of narcolepsy, research indicates it may have some benefit in adults with ADHD, although the drug does not appear to increase the levels of dopamine and norepinephrine.
Side Effects of Stimulants
The most common adverse reactions in double-blind clinical trails were decreased appetite, headache, dry mouth, nausea, insomnia, anxiety, dizziness, weight loss, and irritability. The most common adverse reactions associated with discontinuation from adult clinical trials were anxiety, irritability, insomnia, and increases in blood pressure. However, it should be noted that most side effects are minor and disappear over time or if the dosage level is lowered.
Dealing with Stimulant-Related Sleep Problems
If you can't fall asleep, ask your doctor about prescribing a lower dose of the medication or a shorter-acting form for use in the afternoon or early evening. You might also ask about taking the medication earlier in the day, or stopping the afternoon or evening dose.
A low dose of certain antidepressants or a blood pressure medication called Clonidine may also help alleviate sleep problems. Maintaining a good sleep schedule is also important, so make sure you go to bed and get up at the same time every day, end the day with relaxing activities, and establish a relaxing sleep environment. Using black-out eye shades, ear plugs, and white-noise machines can help eliminate distractions like bright lights and noise.