In my previous post, I explained how an ADHD brain functions and what the medication aims to achieve. If you haven’t read it yet, I recommend giving it a read before diving into this one, as it will help provide essential context for understanding how these medications work.
Now, let's zoom out for a moment. Did you know that in the UK, 5 out of every 1000 people are prescribed Central Nervous System (CNS) medications for ADHD? Over the past year, there's been an 18% increase in prescriptions, with the majority of patients being women. (1)
In this post, we'll take a closer look at the most commonly prescribed ADHD medications for both children and adults, their pros and cons, and some important side effects to be aware of. Ready? Let’s go!
Common ADHD Medications
Amphetamine Medications
Adderall
Adderall is an amphetamine-based medication that consists of two components: dextroamphetamine (D) and levoamphetamine (L) in a 3:2 ratio. These two components have different effects on the body—D is more potent and affects the brain, while L impacts the body by increasing heart rate and blood pressure.
Adderall works by increasing dopamine and adrenaline levels, two neurotransmitters that regulate brain activity. Although it may seem counterintuitive to give a hyperactive person a stimulant, the goal is to help their brain focus by enhancing the activity in areas responsible for attention and concentration.
Vyvanse
Vyvanse is a modified version of Adderall. It combines dextroamphetamine with lysine, an amino acid, to create a slow-release effect. This helps reduce the risk of addiction, although it's not without its own challenges, as the dextroamphetamine component remains powerful.
Ritalin
Ritalin (methylphenidate) works similarly to Adderall by affecting the dopamine and adrenaline systems in the brain. However, it is not as strong as Adderall when it comes to impacting both neurotransmitters, with its primary effect being on dopamine.
Non-Amphetamine Medications
Modafinil
Modafinil, a non-stimulant, is not typically prescribed for ADHD in the UK but is used to treat conditions like narcolepsy. It works by weakly inhibiting dopamine reuptake, allowing more dopamine to transfer between brain cells. It also affects the body's wakefulness system by increasing histamine levels.
Atomoxetine (Strattera)
Unlike the stimulant medications above, Atomoxetine is a norepinephrine reuptake inhibitor (NRI). This means it prevents the brain from reabsorbing adrenaline, keeping more of it available in the brain to help manage ADHD symptoms.
Themes to Consider: Pros and Cons
Before diving into the pros and cons of these medications, it’s essential to consider your personal profile. Everyone’s sensitivity to medication differs, so what works for one person may not work for another. Here, I’ll break down the key themes you should be thinking about when it comes to ADHD medications.
Sleep Impact
ADHD medications can significantly affect sleep, given their impact on mood, focus, and energy levels.
- Ritalin is short-acting, with a 4-hour window, making it a preferred choice for those who don’t want medication affecting their sleep.
- Vyvanse is designed for slow release but may still disrupt sleep.
- Adderall can affect sleep due to its 6-8 hour duration.
- Modafinil is specifically used to promote wakefulness and can severely affect sleep if not timed properly.
- Atomoxetine may cause drowsiness during the day, which can also disrupt your sleep cycle.
Risk of Addiction
Stimulant medications, especially amphetamines, carry the risk of addiction.
- Adderall has been found to create dependency, with some patients requiring higher doses over time.
- Vyvanse was created to minimise this risk, though it’s still possible to develop a tolerance.
- Ritalin is classified as a Schedule II controlled substance, which means it has a high potential for abuse.
- Modafinil has a lower risk of addiction but can be dangerous when mixed with alcohol.
- Atomoxetine can create dependency as the brain becomes reliant on the medication to regulate neurotransmitters.
Dosage and Timing
The timing and dosage of these medications are key to their effectiveness and minimising side effects. Each medication has different active windows, and it’s important to tailor your medication schedule to your lifestyle. Exercise and avoiding alcohol can also help manage the side effects of these medications. (2)
Other Key Considerations
Side Effects
Side effects of ADHD medications are often similar across the board. Some of the most common include:
- Anxiety
- Impulsiveness
- Insomnia
- Panic attacks
- Hostility
However, psychosis and other more severe side effects, while rare, should be monitored, especially in those with a family history of mental health conditions.
Long-Term Effects
Long-term studies on ADHD medications are still ongoing, but most research has focused on Ritalin. Early findings suggest that prolonged use may increase serotonin levels and affect the cardiovascular system. (3)
Drug Holidays: Should You Take Breaks?
There is ongoing debate over whether ADHD medications should be taken daily. Originally, some research suggested that drug holidays—such as skipping medication on weekends or during school breaks—could be beneficial. Before deciding, it's important to consult your healthcare provider and weigh the risks and benefits for your situation.
Conclusion
The goal of this post is not to sway you in one direction or the other but to provide an overview of the landscape of ADHD medications. In future posts, I’ll explore how these medications impact gut health and nutrition, so stay tuned!
If you have any questions or want to dive deeper into specific medications, feel free to reach out.
References
https://www.additudemag.com/short-acting-stimulants-long-acting-stimulants/
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2811812).
Andrew Huberman Podcast:
Share this post