A Doctor's View on ADHD Medication
Finding the right medication to get symptoms of adult attention-deficit/hyperactivity disorder (ADHD) under control can be a challenge, but ultimately, as you work with your psychiatrist, you’ll find the best option for you. Psychiatrist David Brendel, MD, Ph.D., shares how he guides his adult patients through choosing ADHD medications to get their symptoms managed.
1. Q: Is medication necessary for adults with ADHD?
A: Adults with ADHD struggle with symptoms that impact all aspects of their lives. They can’t stay focused on their work, they’re distracted, they have trouble prioritizing tasks and sticking to deadlines—people lose confidence in their ability to get daily things done and it can lead to a very reduced quality of life. These symptoms are caused by poor communication between mechanisms in the brain, and the problems won’t just go away on their own. We’re fortunate that we have many medications and therapeutic strategies available to boost the brain’s ability to function and make up for deficiencies.
Of course, it’s up to each individual patient whether or not he or she wants to go on medication. There can sometimes be a stigma about adult ADHD in which people think taking medication is a shortcut. But I’ve treated people whose lives are completely transformed for the better when they start treating. It’s like night and day. One of my patients was out of work, stressed out, depressed, self-critical, and completely down on himself for not being better able to function at work and with his family. We determined that he had ADHD, got him on a stimulant medication, and six months later he had a great job and was spending more time enjoying his family and being a good father. He got control of his life because he was able to overcome his ADHD with medication and counseling. Of course, like any medication, there’s the potential for side effects, and it might take a little while to find the right one. But I feel really good about my work because I’ve seen some people get much better. It’s not about helping people get through school or their jobs—it’s about transforming their lives so they feel empowered and able to live up to their full potential.
2. Q: How do you decide what adult ADHD treatment to prescribe?
A: The most effective medications for adult ADHD are called stimulants. There are a lot of different options to try, and there’s no textbook algorithm for how to choose the right one. There are many factors to consider when making this decision. Although stimulant medications are similar, the way each one affects the body varies. Some drugs are short-acting and work for 4 to 6 hours, requiring another dose later in the day. Some, called extended-release medications, work for 10 to 12 hours and are released into the body gradually throughout the day. I’ll work with a patient to determine what type of medication would benefit him or her the most. We’ll typically start out with one medication and then may end up switching a few times before we find the right one.
When I first see a patient, I’ll determine if he or she has any problems that might prevent me from prescribing a specific medication. Stimulant medications can lead to tolerance, dependency, and addiction, so doctors must make sure patients are aware of these serious risks and assess a patient's use of the medication carefully over time. If someone has an active substance abuse disorder or is taking a medication that may interact with a stimulant, like an opiate, a stimulant is generally not the right way to go. I’ll also need to determine if the patient is dealing with any other mental health problems, like anxiety or depression. Often, the frustrations of adult ADHD can lead to an increase in anxiety and depression, so I’ll consider treating those conditions as well as ADHD symptoms.
If I determine a patient would benefit from a stimulant, I’ll ask if anyone in his or her family takes a stimulant already. Often, family members respond to the same types of stimulants, so if one drug is working for a relative, it’s more likely to work well for my patient.
If I’m starting from scratch with a patient, I’ll typically first prescribe the amphetamine salt Adderall, and go from there. I’ll ask the patient to report any side effects or symptoms to me immediately so we can figure out if the drug and dosage is right. Stimulants can have several side effects, including decreased appetite, insomnia, tremors, and increased anxiety. Sometimes, these side effects are tolerable and worth it for patients, but sometimes, patients want to switch to another drug to see if their bodies will respond better.
Ultimately, it might take some trial and error to find the right medication and dosage, but we end up finding a solution that works.
3. Q: Is medication the only treatment for adult ADHD?
A: Medication effectively treats adult ADHD, but the effects are stronger if a patient goes through talk therapy and coaching as well. Talk therapy can help patients deal with the shame and frustration of living with adult ADHD, and it can also ease symptoms of related mental health conditions like anxiety or depression. ADHD coaching is a form of counseling that’s not focused on exploring a patient’s past or looking at emotional factors in their lives; instead, it’s about developing practical life skills. It’s focused on helping people organize their schedules, set priorities, and put accountability structures into place.
Practicing mindfulness strategies is also beneficial for adults with ADHD. These approaches can help people settle their minds and bodies so they can be more effective at their jobs and at home. If you’re calm and able to stop and reflect before making decisions, you’re more likely to succeed in your daily life, and you’ll also get more benefit from the medications.