Everyone gets a little nervous when the doctor reaches for his prescription pad and rips off a sheet to prescribe ADHD medication. So many questions, and so little time.
Are ADHD medicines safe? How long will you have to take it? How will you know that it is working? What about side effects? Will you feel like a zombie, or will it put a spring in your step and give you the ability to manage symptoms? Asking those questions about your child raises your worries to a serious level. Here are straightforward answers about ADHD medication. Settle back and be informed.
Will Meds Work for Me?
How can you know, or at what point do you know, that you are part of the 20 percent of people for whom meds don't work?
The first-line stimulant medications for ADHD are among the most effective treatments in all of medicine. Unfortunately, as many as one in five people do not respond to the two standard stimulants, methylphenidate and amphetamine.
We measure effectiveness through a statistical calculation called effect size. Just about every medicine falls within an effect size of 0.4 (barely but consistently detectable) to 1.0 (robust therapeutic response). The effect size of the optimal molecule and optimal dose of stimulant can be as high as 2.1. Simply put, the benefits of medication will be nothing short of life-changing. The most common problem in achieving the optimal dose is that physicians stop increasing the dosage at the first sign of positive benefit in their patients, fearing that the development of side effects at higher doses will cause the patient to stop taking the medication altogether.
If you have tried both methylphenidate and amphetamine at adequate dosages, and have seen neither benefits nor side effects, it is possible that you are in the 3 percent of people who just do not absorb these medications orally. The formulation to try at this point is the transdermal delivery system, Daytrana,* also known as the patch.
ODD and ADHD
My son has been diagnosed with ADHD, but he seems to have oppositional defiant disorder (ODD). Will stimulants help ODD?
Oppositional defiant disorder (ODD) coexists with ADHD in up to 40 percent of males. ODD is almost unheard-of in people who do not have ADHD. For decades, the medication of choice for the treatment of ODD has been either methylphenidate or amphetamine, with more than 26 studies demonstrating that the stimulants reduce symptoms of ODD by up to 50 percent if taken in therapeutic dosages.
Having ODD, a child is hardwired to defeat the authority figure — typically, a parent. I find that kids with ODD tuck the ADHD medication in their cheek and spit it out later. That's why I prefer the amphetamine Vyvanse, which can be dissolved in water. A liquid form of methylphenidate, Quillivant XR, which came out in January and is approved by the FDA, is another way to get medication into a recalcitrant child.
The Problems with Vitamin C
I heard that vitamin C affects stimulant medication adversely.
You shouldn't take ascorbic acid or vitamin C an hour before and after you take medication. ADHD stimulants are strongly alkaline and cannot be absorbed into the bloodstream if these organic acids are present at the same time. High doses of vitamin C (1000 mg.), in pill or juice form, can also accelerate the excretion of amphetamine in the urine and act like an "off" switch on the med.
Are There Withdrawal Symptoms?
Will you notice withdrawal side effects from Concerta after missing several doses? Also, is a flat, dull expression common?
There is little cumulative effect from the stimulant medications. If you stop taking them, the benefits dissipate quickly, usually in a matter of hours rather than days. Luckily, these medications work for a lifetime without the development of tolerance, but they need to be taken reasonably consistently in order to get full benefits.
A flat, dull, unemotional expression, known as "Zombie Syndrome," almost always suggests that the medication dose is too high. Talk with your doctor about lowering the dosage.
When Do Side Effects Decrease?
Don't some of the initial side effects from ADHD medication smooth out after a short period? Is there an adjustment period? How long should I endure side effects before I change meds?
Most side effects of stimulant medications should resolve in three to five days (with the exception of appetite suppression). Side effects that the patient finds intolerable, or those that last longer than three to five days, warrant a call to your clinician. It is vital that neither the patient nor the parent has a bad experience when starting ADHD medication in order to ensure long-term use and success. As a result, I always recommend that side effects be addressed and managed promptly.
*FDA is warning that permanent loss of skin color may occur with use of the Daytrana patch (methylphenidate transdermal system) for Attention Deficit Hyperactivity Disorder (ADHD). FDA added a new warning to the drug label to describe this skin condition, which is known as chemical leukoderma. See the FDA Drug Safety Communication for more information.