National Institutes of Health Landmark Study
Adult ADHD and depression often go hand-in-hand, and a multi-treatment approach often works best to alleviate symptoms of the disorder. Results of a 2006 landmark study funded by the NIH showed that using a variety of antidepressants may also help relieve depression in adults.
In the study, one out of three people suffering from chronic depression found relief from symptoms after adding a second medication, and one in four became symptom-free after switching to a different antidepressant. The medications included sertraline (Zoloft), bupropion-SR (Wellbutrin), and venlaxafine-XR (Effexor), three different types of antidepressants.
Essential
To date, no psychostimulants routinely prescribed for adult ADHD have been approved by the FDA specifically for the treatment of the disorder. For this reason, these drugs are often prescribed “off label,” or used for reasons other than the standard prescribed use.
The research also showed that the best course of action if your first treatment or medication isn't successful is to work with your physician to change or add another medication until you find a combination that works. Studies have shown that stimulant medication is a safe, long-term solution for adult ADHD.
Challenges in Medicating Adults with ADHD
Research funded by NIMH indicates that medication is most effective when treatment is routinely monitored by a physician. Adults may also benefit from a change in dose or scheduling. Long-acting medications that are taken once a day, rather than in multiple doses, seem to work best for most adults.
Short duration stimulants may wear off quickly. Since many adult patients have problems with forgetfulness, taking multiple doses during the day can leave them unprotected if they forget to take the second and third doses. Adults who are tempted to take stimulants at night to help them calm down may wind up feeling so relaxed they can't focus on household chores, homework, completing projects for work, paying bills, or even driving.
The Problem with Substance Abuse
Research shows that 60 to 80 percent of adults with ADHD experience a dramatic reduction of symptoms after taking stimulant drugs. While using stimulants to treat adult ADHD may seem paradoxical, studies show mild stimulants have a dramatic calming effect on the brains and nerves of adults with ADHD and also reduce the incidence of substance abuse among treated adults. However, because many adults with ADHD have a history of substance abuse, and because stimulant drugs are schedule II controlled substances, some believe there's a chance they may be tempted to use their ADHD medication for recreational purposes.
Fact
Research shows that adults with ADHD being treated with stimulants have a lower incidence of substance abuse that other adults, and are also less likely to self-medicate with illegal substances than adults with undiagnosed adult ADHD. Recent studies showed that the majority of adults taking Ritalin gradually lower their dose of stimulants across time rather than increasing the dose.
For people with a recent history of substance use but no current use, deciding to use stimulant medication should be dealt with on a case-by-case basis. Certain extended release preparations are less likely to be abused. One example is Concerta, which can't be crushed and used other than as prescribed orally.
In general, medications with a gradual onset of effect and long durations of effect are likely to work most smoothly, avoiding emotional ups and downs. These are also the best formulations for people with a history of substance abuse because they avoid the “hit” and “buzz” of recreational stimulants.
Vyvanse, a new medication for adult ADHD, is a “pro-drug.” After you ingest the medication, the body converts it to a stimulant, which lessens the potential for abuse.
Differences in Treating Children and Adults
While many of the medications are the same as those used for children and adolescents, there are several general differences to consider. Although adults are generally larger than children, they may need less medication per pound of body weight because the drug may remain in their system longer if they don't have healthy liver and kidney function.
In addition, adults are more likely to be taking medications for other conditions, some of which may interact with ADHD drugs and interfere with their potency. Many medications taken by adults for coexisting conditions may also cause lethargy, anxiety, and insomnia or exacerbate adult ADHD symptoms.
The Practice of Polypharmacy
Polypharmacy, or prescribing several psychiatric medications at the same time, is often used to treat coexisting conditions in adults with ADHD. For instance, if an adult has ADHD as well as clinical anxiety, she may need to take medication for both conditions. If done in the right way, polypharmacy can result in a simultaneous reduction of symptoms for both conditions. But if medications are prescribed without taking into account their various side effects, a patient could suffer serious medical consequences or even experience an increase in symptoms.
