ADHD Medication Q&A for the Newly Diagnosed and Nervous

Is it safe? Does it work? What are the side effects? After an ADHD diagnosis, most patients have lots of questions about the best way to manage symptoms with medication. Our expert has answers.

Doctor writing prescription for patient with ADHD
Doctor writing prescription for patient with ADHD

When adults ask me questions about why they should try medication to manage their ADHD, my answer always comes down to two words: Medication works. When you find the right medicine, you can experience substantial improvements in your ADHD symptoms.

Adults who have been diagnosed with ADHD later in life have many questions about stimulants, just as parents do about giving them to their child. After all, adults may be taking ADHD medication for the rest of their life. Here are seven common queries, and my answers to them.

Q. Why don’t ADHD meds make me more antsy than I already am?

The term “stimulant” is misleading. Stimulant medications, like methylphenidate (Ritalin, Focalin, Concerta, and so on), do make people without ADHD more alert and awake; they stimulate activity in the frontal regions of the brain. The reason they don’t make hyperactive adults more restless is that these parts of the brain are underactive in those with ADHD. There is not enough norepinephrine and dopamine to send signals between neurons to stimulate the mind to pay attention or sit still.

Q. How long can I continue to take a stimulant without any long-term negative effects?

As far as we know, you can take it for as many years as you may need to manage your symptoms and reduce related impairments.

Q. Is there any evidence that Ritalin or other stimulants are safe or unsafe during pregnancy?

There is no evidence concerning the effects of any ADHD medications on pregnant mothers or their babies. At this time, manufacturers of such medications recommend that women discontinue taking ADHD medications when they become pregnant.

Q. Are generic versions as effective as brand-name stimulants?

Generic medications appear not to be manufactured with the same degree of precision as brand-name medications. The generics have had numerous reports of greater variability in controlling symptoms on a day-to-day basis and less success overall in managing symptoms.

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Q. Is it possible to build tolerance to stimulants? If so, how do I avoid this, or how do I handle it once I’m experiencing it?

Actual physical tolerance seems unlikely with the current ADHD medications, but some individuals report that their medication seems less effective about three to six months after starting their treatment. This usually requires an adjustment of the dose, or, sometimes, changing to a different delivery system or medication. Clinically, we sometimes see people complaining that their medicine isn’t working as well as before, but these people are usually going through an unusually stressful or demanding period in their lives that may exacerbate ADHD symptoms. They may need to temporarily change their dose or address the source of the stress at these times.

Q. I’ve heard that ADHD stimulants can make people more irritable or angry or increase muscle tension. Is this true?

In rare cases, a side effect of stimulants is that they make people more irritable or angry. This may depend on your personality, what other disorders you may have, and which executive functions have been most affected by ADHD. Some people do experience increased muscle tension — your body may feel tense, or you may experience a clenched jaw — especially if you are taking higher-than-typical doses.

Q. Can I drink alcohol or take other drugs when I am taking a stimulant?

Yes, but do so in moderation. The only drugs you should avoid are other stimulants. Caffeine and alcohol do not interact adversely with ADHD meds. Nicotine, though, can act as a stimulant, compounding the effects of ADHD medication on your heart rate and blood pressure. If you are a smoker, discuss it with your doctor.

Excerpted from Taking Charge of Adult ADHD, by RUSSELL A. BARKLEY, Ph.D., with Christine M. Benton. The Guilford Press, Copyright 2010.

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