Medication for ADHD

Medication

The Pros and Cons

As a support group we respect parent's decisions to either medicate or not medicate as they believe best.  We wish to encourage both groups in pursuing the course of action they have chosen, without fear of criticism.  Currently all parties including doctors, professionals and parents are facing the problem without strong medical information as to the best course of action.  As such we find ourselves guessing what each child or adult needs, and finding that no one solution works in all cases.  We hope that this site is able however to provide parents with the information they need to make an informed decision as to whether or not to medicate.

Below are details of the different medications currently on offer globally which can allow parents to inform themselves fully on whether they are benefit their child, and know how to recognise any unwanted side effects.

The following details are based on the published information given by Paul T. Elliott M.D. who has worked with ADHD people for over 30 years.


General Information
When discussing medication for Autistic Spectrum Conditions such as ADHD (Attention Deficit and Hyperactivity Disorder) it must be remembered that the drugs do not treat the core disorder.  Rather they assist with the symptoms faced by the patient such as anxiety, agitation, and obsessive-compulsive types of behaviour, and often moderate explosive tendencies.  Unfortunately they do not appear to assist with the core issues of the conditions.

Stimulant Medication
Many studies support the common belief among physicians that stimulants provide the best treatment for Autistic Spectrum Conditions.  The benefit gained is most noticeably seen when dosage is small, however more significant dosage can exasperate the symptoms and therefore see an increase in anxiety, agitation, and obsessive-compulsive types of behaviour.  This is however awkward as dosage sizes are not available in such small amounts, leaving some patients to be on as much as four to ten times the amount the should be on.

Safety
With the exception of Cylert, the drugs used by doctors for treating ADHD are among the safest around.

Cylert (Magnesium Pemoline)
Known to cause liver damage.  Normally avoided by doctors.

Methylphenidate (Ritalin & RitalinSR)
Ritalin has been on the market for over 30 years and has proven to be very reliable.  Unfortunately however it does not last more than 4 hours, and many takes not more than 3 hours.  RitalinSR was therefore produced and marketed to last 8 hours, however often lasts less than 6 hours.  The benefit may also fluctuate throughout the day and from day to day.  This often causes a 'rebound' effect, in which their symptoms return and sometimes more severely.  This leads some doctors to question whether the overall benefit is good or bad.

The Guardian newspaper release a report stating:
"Nine UK children have died after being prescribed Ritalin for Hyperactivity. The safety of Ritalin, known as "the chemical cosh" is under review following sudden deaths in the US.  Ritalin and other drugs used to treat ADHD were linked to the deaths of 51 Americans in one year. Dozens of others suffered serious heart problems.  It's prescribed for children as young as six. Some US experts suggest that it should carry the highest health-warning"

 
Struggling with ADHD

We believe that anyone taking any form of medication should always consult a doctor if they experience any medical symptoms, especially if they feel that they are a side affect of prescribed drugs.  Reactions to medications are widely known for all types of medicines, and are normally unique to the individual.  This said the US and UK have medical oversight of all drugs and when a pattern begins to form investigations are carried out.  If you are concerned about Ritalin and possible side affects do not take your child off Ritalin, but rather consult medical advice from your doctor.

MetadateIR, MetadateSR, MetadateER
The Metadate brand has three forms.  The first 'IR' that lasts for 4 hours, the second SR which lasts for six to eight hours, and finally ER which lasts twelve hours.  The Metadate provides a stable reliable blood level for the duration.

Concerta 18, 36 and 54mg
Concerta was first release in 2000. This differs from other methylphenidate products in that it provides an initial release and a slow release mechanism.  The initial release medication is weaker than the slow release medication.  The helps reduce the 'rebound' effect seen with the use of other medications.  The mechanism also helps patients get to sleep more easily.

Dextroamphetamine S04 (Dexedrine Capsules 5, 10 & 15mg; Tablets 5mg)
The Dexedrine capsules last 12 hours due to the bead based design.  The different strengths of capsules contain different numbers of beads based on the dosage.  As such this allows for a manual, but careful, reduction of beads allowing more easily for the correct dosage to be calculated for Autistic Spectrum Conditions, such as Attention Deficit and Hyper Activity Disorder and Asperger's Syndrome.

Mixed Amphetamine Salts (Adderall Tablets 5, 7.5, 10 15, 20 and 30mg)
Adderall XR is a twelve hour sustained-release form, and has begun use in the USA.   It's advantage over Dexedrine is that it is less likely to cause a persistent feeling over overstimulation (e.g. described as 'a pressure sensation', 'agitation' or 'edginess').  It is a little less likely to suppress the appetite than Dexedrine, but i little more likely than methylphenidate.  It is also less likely to trigger the 'rebound' effect seen with Dexedrine or Ritalin, however more likely to than Concerta.

Methamphetamine (Desoxyn Tablets 5mg)
This is also a twelve hour sustained-release base drug.  The key disadvantage of this drug is the extremely high cost, which has risen to the point that few can afford it.

Strattera
In Feb 2006 the Daily Mail had an article on the potential dangers of Strattera, following the suicide of 2 children and 200 others reporting serious side affects of the drug which was only released in 2004.  The MHRA report released under the Freedom of Information Act also revealed that 20 children & adults have killed themselves & 63 tried to commit suicide around the world.  We do not know of any further information at this time.

Trapped in Anxiety
 

Anti-Anxiety Medications
These medications can be beneficial on an occasional basis, or if the patient has a chronic, residual level of anxiety or agitation related to a co-existing mood or personality disorder.

Benzodiazepines

  • Xanax
    This lasts for six to eight hours, and causes very little drowsiness.  It is therefore not a valuable sleeping aid unless the anxiety is the key cause of lack of sleep.
  • Klonopin
    This a little more prone to cause drowsiness and therefore is a good sleeping aid, lasting between eight and twelve hours.
  • Ativan
    This only works for four to six hours, however is prone to cause memory problems (even in the oral form).

Sleeping Medications
Sleep disturbances are common with ADHD and Asperger's Syndrome, and persist even when the symptoms are well controlled.  This said most non-persistent difficulties are found in the first few weeks of taking medication, and therefore the following two drugs can be helpful.

Sonata (5 & 10mg)
This is especially useful for those who have trouble getting to sleep.  Sleep will occur within approx 20 to 30 minutes, however beneficially only last 2-3 hours.  It therefore rarely leaves the 'hang over' feeling left by other drugs.  Additionally if the patient wakes during the night and has at least three more hours of night remaining then another dosage can be taken.  This medication does not cause drowsiness like most sleeping medication, but rather the patient must lie down and close their eyes, at which point sleep will ensue.  This said, if the patient waits until they are sleepy they can bypass the period of effectiveness of the drug.

Ambien (5 & 10mg)
This medication lasts five to six hours, and again rarely leaves the patient with a 'hangover' feeling in the morning.  Additionally it does not build up in the patients system, which in turn reduces the possibility of memory loss and a sense of drowsiness during the day, experienced with many other drugs.

"Hybrid" Medications
This covers drugs which doctors prescribe however have not officially been approved for the specific use of treatment of ADHD (this information may be unique to the USA, or may have now changed).

Risperadal (1, 2 & 3mg)
This has proven beneficial in the treatment of Attention Deficit and Hyperactivity Disorder andAS.  Initial dosages for children are between 0.25 & 0.5mg (once then twice a day should be tried).  Teenagers and Adults may however require higher dosages.  Gradual increase in dosage will allow the avoidance of symptoms caused by too much medication.  Initial use causes drowsiness, and therefore recommended to initially be taken at bedtime.  Dosage is normally best taken evenly over the day in two equal amounts, however may vary from patient to patient.

Other Drugs
Zyprexa, Neurontin, Carbatrol and Depakote have also been used by doctors.  We are unable to confirm what benefits are offered or issues relating to their use.

Antidepressants
These drugs have been proven to assist with reducing anxiety and tendencies towards obsessive compulsive disorders (OCD), often moderating patients explosive tendencies and depression.  As with all drugs recommended for adults, this may be used for children as young as 12 years old.  This said, some doctors have used them on younger children, claiming beneficial results.

Zoloft (25, 50 & 100mg)
This appears to work best with anxiety and OCD symptoms.  Initial usage is best from half of a 25mg tablet (12.5mg) and then increasing in similar amounts, if necessary.  Increases are best made after three to four week intervals.  Faster increases can cause interfering side effects, as the patient adjusts to the change in medication.

Other antidepressants, although function to some degree, are not apparently as beneficial as Zoloft.  It is recommended that the same procedure be followed when using other antidepressants to maximise their benefits.

Over the Counter Medications
A number of medications available over the counter (under US regulations) are claimed to provide similar benefits to the control drugs being subscribed.  These include:

  • Caffeine
  • Decongestants
  • Nasal Decongestants (e.g. Afrin, NeoSynephrine, Otravin, Dristan)
  • Phenylephrine HC1 (NeoSynephrine)
  • Pseudophedrine HC1 (Sudaphed)
  • Ephedrine (e.g. MiniThins)
  • Ma Huang (aka Ephedra)
 
Over the counter medication for ADHD

Our volunteer worker, Stephen, confirms that he has had definite benefit from caffeine, 'Sudaphed' and decongestants.  Those with ADHD often have allergies which are often benefited by these medications, and in turn seem to provide relief from anxiety and agitation etc.  He does however point out that Asthma can be negatively affected by caffeine, so should be avoided during times when Asthma is not fully under control.  He himself turns to Sudaphed or a decongestant during these periods.  This said, he confirms that caffeine has been by far the most effective, however one needs to be careful not to have too much and then stop immediately as this can cause the 'rebound' effect.  Stephen confirms that he finds Nescafe Gold Blend the most effective, with the least negative effects.  Please note that coffee can cause the removal of vitamins and minerals from the body, particularly if large quantities are drunk.

Additional Questions
If you have any further questions on these or other medications currently be prescribed please let us know at steve@adhdplus.support.

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