ADHD Medication (Stimulants and Non Stimulants)

Updated: Mar 4


What causes ADHD?

Humans have forebrain which is involved in planning, concentration, impulse regulation and executive function. It aims to gives you top-down control of the more primitive/reptilian parts of the brain.


There is a narrow band where 2 important hormones called dopamine and noradrenaline at required to operate at the right level. Doing so will help manage the forebrain’s control of the midbrain and other more primitive regions.





In ADHD, it is believed that there is decreased levels of dopamine and noradrenaline in the prefrontal cortex circuits. All ADHD medication aim to increases the levels of the hormones.


There is a goldilocks zones where the increase in dopamine and noradrenaline will be “just right.” This is what we try to achieve when we titrate and adjust the dose of ADHD medication.


What should ADHD medication do?

By increasing the levels of dopamine and noradrenaline we should improve concentration, attention, impulse control, working memory and energy.


What are the 2 types of ADHD medication?

  • Stimulants (increases both dopamine and noradrenaline). On average these medications are effective for 80% of people.

  • Nonstimulants (increases noradrenaline). On average these medications are effective for 70% of people.

More about the Diagnosis and the Symptoms:



ADHD - A Guide for Adults Diagnosed with ADHD
.pdf
Download PDF • 723KB

ADHD Behaviour Symptom Checklist
.pdf
Download PDF • 69KB

Stimulants:

The two main types of Stimulants are called Methylpenidate and Dexamphetamines. Usually we trial Vyanse (Lisdexamphetamine) first, as long acting stimulants are considered first line. Long acting stimulants assist a person with ADHD to focus and manage well throughout the day. They also have the benefit of requiring less frequency dosing, meaning you do not have to take medication with you when you are out and about. Usually this will be effective, however if it is not or is poorly tolerated, we may switch to standard Dexamphetamines.






Examples:

  • Amphetamine:

  • Vyvanse (Lisdexamphetamine).

Vyanse CMI
.pdf
Download PDF • 139KB

How to take VYVANSE
.pdf
Download PDF • 412KB

Things to know about Vyvanse
.pdf
Download PDF • 7.31MB

  • Dexamphetamines:


Dexamphetamine CMI
.pdf
Download PDF • 215KB

  • Methylphenidate:

  • Ritalin (Methylphenidate Immediate Release)


Ritalin CMI
.pdf
Download PDF • 114KB

  • Ritalin LA (Methylphenidate Long Acting)

  • Concerta (Methylphenidate Slow Release)


Concerta cmi
.pdf
Download PDF • 90KB


How do we dose stimulants?

  • Initially we will need to commence you on a low dose. The main reasons for this is to ensure your body gradually adjusts the medication and reduces your risk of serious side effects. You will be given a plan for how to increase the dose gradually when you receive your prescription. It can be tricky finding the correct dose for you. We may need to increase or decrease your dose several times before reaching your final regime.


What is the “goldilocks” dosing range for stimulants?

  • If your dose is too low:

  • You may find that your medication effects run out quickly than expected, resulting in in poor concentration, focus and impulse control. You may also experience increased distractibility and fatigue

  • If your dose is too high:

  • You may feeling irritable, highly energetic, wired, emotionally numb, rigid in your thoughts

  • If your dose is just right:

  • Focussed, Flexible, Clear in your thoughts.





Side effects:


Common side effects (>1%):

  • Nausea, diarrhoea, dry mouth, loss of appetite, weight loss, anxiety, irritability, insomnia, headache, dizziness, aggression, tachycardia, palpitations, changes in BP (usually increases in adults)

  • Decreased appetite and insomnia are generally temporary in nature and resolved after approximately a fortnight. If you experience these two particular side effects please attempt to persist for at least 1-2 weeks.



Serious side effects (<1%): The risks of these side effects worsen if stimulants are taken in excess and at doses which are against the advice of your psychiatrist.

  • Psychosis

  • This includes paranoia, delusions, auditory or visual hallucination, disordered thoughts and behaviour

  • If you experience this symptom, please contact call 000 or present to your nearest emergency department

  • Mania

  • This includes risk-taking behaviour, grandiose thoughts, increased energy, pressured speech and decreased need for sleep

  • If you experience this symptom, please contact call 000 or present to your nearest emergency department.

  • Agitation/Aggression

  • If you experience this symptom, please contact your doctor as soon as possible and cease your stimulant medication.

  • Suicidal thoughts

  • If you experience this symptom, please contact call 000 or present to your nearest emergency department.

  • Liver dysfunction

  • Tics: often tics may improve with medication. However occasionally they may worsen them.


Infrequent side effects (0.1–1%)

  • movement disorders, tics (but see Precautions above), rash, growth retardation


Rebound side effects:

  • When the effects of the stimulants begin to wear off, you may find that your pre-existing ADHD symptoms return more intense than before. To manage this side effects, we will need to adjust the dose and frequency of your medication.

Cardiac side effects:

  • Before commencing stimulants. a cardiac physical examination and ECG is required. The reason for this is because stimulants can cause increases in your heart rate and blood pressure. Rarely, you may also experience increased palpitations, rapid heart rate, dizziness, or syncope. If this is the case, please immediately cease your medication and see your doctor as soon as possible.

  • Stimulants are contraindicated with patients with a history of confirmed hypertension. If you have a history of occasional high blood pressure readings, your doctor may ask you to get weekly blood pressure readings from your local pharmacy or through a home-based automatic blood pressure monitor.


Foods and medication to avoid:

  • Caffeine: please avoid excessive consumption of caffeinated beverages. These may cause your heart rate, blood pressure and anxiety to increase.

  • Pseudoephedrine: please avoid cold and flu tablets that contain pseudoephedrine. These may cause your heart rate, blood pressure and anxiety to increase.


How long will I need take this medication?

  • It is likely you will need to take this medication long term (years). Often people will develop alternative skills to manage their attention deficit and impulsivity. In such case, we will be able to wean you off stimulants or consider alternative medication.


Are stimulants addictive?

  • If stimulants are taken in excess, then patients may become addicted. To ensure this does not occur, the WA Health government mandates annual urine drug screen. Stimulants are also a schedule 8 medication. This means they are highly regulated and there are many rules in places in relation to their prescription. For full details, please visit: https://ww2.health.wa.gov.au/Articles/S_T/Stimulant-medicines


Am I able to change to dose myself?

  • No, it is imperative that you do not change the dose without permission from your psychiatrist. There are a number of legal and safety reasons why this is the case. If evidence of this occurs, further prescribing will be ceased.


What happens if my script is lost or stolen?

  • Unfortunately if your script is lost or stolen, you will not be given a repeat script. You will also not able to have your next prescription early. Stimulants are highly regulated by the WA Health department and as such there are stringent rules in place. Please be very careful when handling your scripts. We recommend you keep all scripts on file with your local pharmacist.


Non Stimulants


Non stimulants work by increasing the noradrenaline levels. They are usually better tolerated than stimulants, albeit with a slightly lower efficacy. Non stimulants are the recommended choice in patients with a history of addiction, poor response to stimulants or are highly anxious.


Examples:

  • Strattera (Atomoxetine)


Stratera CMI
.pdf
Download PDF • 103KB

  • Guanfacine

  • Clonidine

  • Buproprion


ADHD WA coaching

ADHD WA coaching involves the teaching of psychological techniques to improves productivity, focus and reduce impulsivity.

  1. Grace Da Camara (teens and adults)

  2. Dr Andrew Sheridan (teens and adults)

  3. Karen Breeze (parents and adults)


Email: hello@adhdwa.org, or phone 6457 7544



Other resources:


Websites:

SolvingProcrastination.com - excellent list of strategies if you are finding yourself constantly procrastinating

http://www.adhdwa.org

http://add.org

http://adhdandyou.com/

http://adhdtogether.com/


Books:

ADHD Answer Book by Susan Ashley

ADHD Handbook by Munden and Arcelus


Support groups:

ADHD WA - Facebook group