Question: What are the best medications for ADHD?
Answer: Surgeons are practical. “A difference that makes no difference is no difference”. Recognizing ADHD and finding the right treatment makes a dramatic difference in someone’s life. ADHD is relatively easy to diagnose. There are more studies showing the effectiveness and safety of medication in treated ADHD than in any other mental health disorder and most general medical disorders.
Stimulants are almost twice as effective as other types of medication (like Strattera, Provigil, and Wellbutrin XL, Tenex). Long acting stimulants are usually safer (especially less rebound) and more effective. Sometimes short acting medications can be used to supplement the long acting stimulants. Some people do better on amphetamines and some do better on methylphenidate type of stimulants. Some do okay on either.
More people do better on amphetamines according to one study. In another study amphetamines were more likely than methylphenidate to allow ADHD patients to function at the highest level.
In general, amphetamines are more effective for the majority of ADHD patients because they have a broader spectrum of action relative to both subtypes of ADHD symptoms. Because amphetamines have been shown to be very effective for a higher percentage of patients than methylphenidate, I start most patients on Adderall. Because long acting medications are safer and generally more effective I start with the XR form. It generally has at least an 8 hour duration of good effect. Some people take it twice a day to get 16 hours of calm focus.
I use the new Daytrana patch if Adderall does not work well, or when the advantage of the patch lasting up to 15 hours is the most important clinical consideration.
Some patients prefer Adderall because of the help with weight control – not usually decreased appetite but they stop eating out of boredom or stress. They also are more physically active and more likely to be able to motivate themselves to exercise. In fact, stimulants in general enable an ADHD person to choose what they want to do or focus on instead of being at the mercy of only doing things they have a high interest in.
To me, the ultimate test of medication is how it does in the long term. I tell patients I’m not interested in them coming back and saying, “I think it’s helping a little bit doctor”. I’m looking for, “This medication is great. It has helped me change my life and I don’t have any significant side effects”, and they are still saying it 1 year, 5 years, etc. We have almost 70 years of research showing the effectiveness and safety of amphetamines and 55 years with methylphenidate. I have patients who have done well on stimulants for over 30 years. I don’t see any long term problems. I can’t say that for any other type of medication that I prescribe.
I frequently add Tenex (Guanfacine) to stimulants to enhance efficacy and to further minimize side-effects.
Click link below for new ADHD med info:
test.askdrjones.com/2007/07/16/vyvanse-new-treatment-for-adhd/
