Published on ADDitudeMag.com
Your ADHD Medication Questions, Answered!
When it comes to treating attention deficit, good information is the best medicine. An expert answers all your ADHD medication questions.
by William Dodson, M.D.
Everyone gets a little nervous when the
doctor prescribes ADHD medication. So many questions, so little time. Is the
medication 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
escalates your worries even more. Here are straightforward answers about ADHD
Will Meds Work for Me?
The first-line stimulant medications for
ADHD are among the most effective treatment in all of medicine. Unfortunately,
as many as one in five people do not respond to the two standard stimulants,
methylphenidate and amphetamine.
If you have tried both stimulants at optimal
dosages, and haven’t seen benefits or side effects, you may be part of the 3%
of people who do not absorb these medications orally. The formulation to try
next is the transdermal delivery system, Daytrana, also known as the patch.
How Do You Determine the Correct Dose?
Start with the lowest dose of stimulant
medication, increasing it periodically. Continue to increase the dose, as long
as the target symptoms improve without side effects. At some point, however,
you'll increase the dose and won't see further improvement. At that point, the
previous dose is the optimal dose.
When working with small children who have
difficulty giving feedback, clinicians use scales (the Connor global index
scale, for instance), which compare the ADHD patient to non-ADHD children of
the same gender and age.
What Is the Optimal Dose?
Stimulant medications have a "therapeutic
window." Doses that are too low or too high are ineffective. Since there
is no factor that predicts either the optimal class of medication or the
optimal dose in a given individual, dosing needs to be determined on the basis
of target symptoms — determining the impairments the person is experiencing
that they would like medication to manage. Each person will have his or her own
How Long Does it Take for Meds to Work?
The stimulant medications are effective as
soon as they cross the blood-brain barrier, which takes 45 to 60 minutes.
Consequently, in adults, it is possible to change the dose of stimulant meds
every day to determine the optimal dose in less than a week.
Children often lack the ability to tell the
clinician how the medication is affecting their functioning and mood. For
patients under the age of 15, the medication dose can be raised only once a
week, to allow time for parents and teachers to assess the effect on symptoms.
Is a Flat Expression Common for Individuals Taking ADHD Meds?
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.
Do ADHD Medication Side Effects Go Away?
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. I always
recommend that side effects be addressed and managed promptly.
Does Appetite Suppression Suggest Too High a Dose?
Not necessarily. Appetite suppression is
the only side effect of stimulants that is not necessarily dose-related. More
predictive of appetite suppression is the child who is already thin and a picky
eater. You can try a lower dose of stimulant medication while you're waiting
for the next appointment with the pediatrician, but this usually results in
loss of benefits for your child's ADHD.
Although no one likes to take several
medications, additional medication is often required for children who have
appetite suppression lasting longer than two months, or who continue to lose
weight. Talk with your doctor.
Are There Withdrawal Symptoms When You Stop Taking ADHD Meds?
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.
Does Vitamin C Affect ADHD Meds?
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.
Do Stimulants Help ODD?
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
My ODD Son Refuses ADHD Meds—Now What?
A child with ODD is hardwired to defeat an
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.
How Do You Treat ADHD Plus a Mood Disorder?
Seventy percent of ADHDers will have
another major psychiatric condition at some time in their life. Mood disorders,
major depression, dysthymia, and bipolar mood disorder are the most common
conditions that coexist with ADHD.
Most clinicians determine which condition
is of most concern to the patient and proceed to treat that condition first. If
the patient has suicidal thoughts, is unable to get out of bed, or is manic,
the clinician will treat depression first and then reassess the symptoms of
ADHD. If there is no urgency to treat depression, most clinicians will treat
the ADHD first.
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