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.

Questions, Questions!

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 medication.

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 list.

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 therapeutic dosages.

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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