ADHD Medication Q&A: Side Effects, Dosages, Precautions & More
ADHD medication is safe, effective, and sometimes confusing. Here, ADHD specialist William Dodson, M.D., answers the 12 most common questions about ADHD medication side effects, effective dosages, precautions, and making adjustments for optimal treatment outcomes.
ADHD Medication: Side Effects, Types, and Dosages Explained
ADHD medications are among the safest and most effective of all psychiatric treatments. Decades of research confirms that the benefits of both stimulant and nonstimulant medications for ADHD far outweigh their risks. Still, valid and important questions abound when a patient or caregiver is prescribed ADHD medication for the first time or when a clinician recommends a new drug or dosage:
- What are common ADHD medication side effects?
- What is the best medication for ADHD?
- How do we find the right dosage?
- How do we know the ADHD medication is working as it should?
- Does ADHD medication change your personality?
- Who should not take ADHD medication?
- How long will you have to take it?
Here, ADHD specialist William Dodson, M.D., answers 14 of the most common questions about ADHD medication from caregivers and from adults with ADD.
1. How Do ADHD Medications Work?
Stimulant ADHD medications are among the most effective treatments in all of medicine. They literally “stimulate” the brain to produce more norepinephrine and dopamine — the key neurotransmitters deficient in patients with ADHD.
The FDA has approved 29 stimulant medications for treating ADHD in the U.S. All of them are just different ways of delivering only two molecules: methylphenidate and amphetamine. The methylphenidate-based stimulants include Ritalin, Concerta, Qullivant, Quillichew, Jornay PM, and Adhansia XR. The amphetamine-based stimulants include Adderall, Vyvanse, and Evekeo.
Roughly 85% of children and adults with ADHD will respond to one of these standard stimulants. If you have tried both stimulants at optimal dosages, and haven’t seen benefits or side effects, you may be part of the 3 percent 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.
When all deliveries of stimulant ADHD medication fail, doctors should turn to the nonstimulant ADHD medications atomoxetine, guanfacine, clonidine, and the new viloxazine branded as Qelbree. They take longer to deliver results than do stimulant medications for ADHD, which is one reason they are considered a second-line treatment.
2. What Is the Best ADHD Medication?
Choosing the best ADHD medication is often a lengthy trial-and-error process that requires the careful adjusting of dosage and timing. It is impacted by a patient’s history, genetics, experienced side effects, and unique metabolism. ADHD medication is often accompanied by behavioral therapy in children and by other non-pharmacological treatments in both children and adults. What ADHD medications do is give you a chance so that behavior management or cognitive behavioral therapy has a chance of working.
Stimulant ADHD medications — amphetamine and methylphenidate — are considered the first-line treatment for ADHD. Nonstimulant ADHD medications are often prescribed to patients who don’t tolerate or see benefits from stimulant medications.
3. What Is the Optimal Dose of ADHD Medication?
There is no such thing as a universal “optimal dosage” of any ADHD medication; the best dose is highly personal. Stimulant ADHD 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.
4. How Should We Adjust the ADHD Medication Dosage?
Start with the lowest dose of a stimulant ADHD medication, increasing it periodically with your clinician’s oversight and guidance. 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 patient to children of the same gender and age who don’t have ADHD.
5. How Long Does It Take for ADHD Medication to Work?
Stimulant ADHD 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.
6. What Are Common ADHD Medication Side Effects?
Common side effects of ADHD medications in children and adults include the following:
- Diminished appetite
- Sleep problems
- Headaches and stomachaches
- Moodiness and irritability – particularly as the medication wears off
- Delayed growth
- Dry mouth
For solutions to these and other common side effects, read “ADHD Medication Side Effects No One Should Tolerate” and “The 5 Most Common ADHD Medication Side Effects — and Their Fixes.”
7. Will ADHD Medication Turn My Child Into a Zombie?
A flat, dull, unemotional expression, known as “Zombie Syndrome,” almost always suggests that the ADHD medication dose is too high. Talk with your doctor about lowering the dosage.
8. Do ADHD Medication Side Effects Go Away?
Most side effects of stimulant ADHD 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.
9. Does Appetite Suppression Suggest the Dose Is Too High?
Not necessarily. Appetite suppression is the only side effect of ADHD stimulants that is not necessarily dose-related. Appetite suppression appears more common in 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 symptoms. Though 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 body mass. Talk with your doctor.
10. What Happens When You Stop Taking ADHD Medication?
There is little cumulative effect from the stimulant ADHD 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.
11. Does Vitamin C Affect ADHD Meds?
Yes. Don’t take ascorbic acid or vitamin C an hour before and after you take ADHD medication. 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.
12. Do Stimulants Help ODD?
Oppositional Defiant Disorder (ODD) coexists with ADHD in up to 40 percent of children. 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.
There’s no medication that’s FDA-approved for either ODD or conduct disorder. The American Academy of Child and Adolescent Psychiatry, however, in their practice guidelines say, “It is important to note that there is very little gold standard, double-blind research on medications other than stimulants for ODD.” Nonetheless, that’s what clinicians use because the medications work. It’s a very practical approach.
13. My Child with ODD 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, is another way to get medication into a recalcitrant child.
14. How Do You Treat ADHD Plus a Mood Disorder?
Seventy percent of people with ADHD will have another major psychiatric condition at some time in their life. Mood disorders 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 the mood disorder first and then reassess the symptoms of ADHD. If there is no urgency to treat the mood disorder, most clinicians will treat the ADHD first.
ADHD Medication Side Effects and Other Questions: Next Steps
- Download: What to Ask Before Starting ADHD Medication
- Learn: 9 Questions to Ask Your Doctor Before Taking ADHD Medication
- Watch: 5 Common Side Effects of ADHD Medications — and Fixes
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