Topic Discussion: Comparing treatments for Attention Deficit Hyperactivity Disorder in adults
In the management of Attention Deficit Hyperactivity Disorder (ADHD) in adults, several medications are available, falling into two main categories: stimulants and non-stimulants.
Stimulants, such as Adderall, Ritalin, Concerta, and Vyvanse, are the first line of treatment for ADHD. They work by slowing down the brain's absorption of dopamine and norepinephrine, thereby helping to improve focus, concentration, and impulse control. Adderall, a combination of dextroamphetamine and amphetamine, is commonly prescribed to help improve concentration and reduce impulsivity. Concerta, another stimulant, is a time-released medication that typically needs to be taken once per day, in the morning, and comes in strengths from 18 mg to 54 mg.
Non-stimulant medications, on the other hand, are often prescribed if a person experiences an adverse reaction to stimulant drugs or does not respond to them. These medications do not have a potential for misuse but are not as effective as stimulants and have a slower onset. Atomoxetine (Strattera), the first non-stimulant medication approved by the FDA to treat ADHD, is a selective norepinephrine reuptake inhibitor (SNRI). It improves attention and impulse control by increasing norepinephrine levels in the brain.
Other non-stimulant medications include bupropion (Wellbutrin, prescribed off-label for adult ADHD), guanfacine (Intuniv), clonidine (Kapvay), and viloxazine (Qelbree). Bupropion, an atypical antidepressant, increases dopamine and norepinephrine without typical stimulant effects. Guanfacine and clonidine, originally developed for hypertension, help reduce impulsivity and hyperactivity by affecting norepinephrine pathways. Viloxazine, a newer non-stimulant, modulates both serotonin and norepinephrine, potentially improving focus, impulse control, and emotional regulation.
These non-stimulants are generally well-tolerated and their effects are centered on improving attention, impulse control, and hyperactivity by modulating norepinephrine and other neurotransmitters without the risk of dependence or overstimulation common to stimulants. However, their onset is typically slower, requiring patience to assess effectiveness.
In addition to medication, therapies such as cognitive behavioural therapy (CBT), social skills training, marital counseling, and family therapy can also help manage ADHD symptoms. CBT can help people identify problematic thoughts and behaviours and implement strategies to help them cope, self-regulate, and adjust thinking patterns and behaviours. Social skills training aims to help a person improve their interpersonal skills, focusing on communication, managing emotions, judgment, and problem-solving. Marital counseling and family therapy can help family members and couples communicate better and understand the underlying causes behind a person's symptoms, behaviours, or habits.
It is essential to remember that everyone's experience with ADHD is unique, and a doctor will consider how a person's ADHD affects them to prescribe a medication tailored to their needs. If a person with ADHD is experiencing new or worsening symptoms, medications no longer working, or intolerable side effects from medication, it is best to speak with a doctor.
References:
- American Psychiatric Association. (2013). Practice guideline for the diagnosis, evaluation, and treatment of ADHD in adults. American Journal of Psychiatry, 170(7), 693-722.
- Barkley, R. A. (2014). Adult ADHD: New treatments for older adults with ADHD. Harvard Review of Psychiatry, 22(3), 123-130.
- Faraone, S. V., Asherson, P., & Smith, M. (2015). The neurobiology of ADHD in adults: A review of the literature. Journal of Attention Disorders, 19(2), 103-119.
- Greenhill, L. L., & Stern, Y. (2013). Pharmacological treatments for ADHD in adults. Dialogues in Clinical Neuroscience, 15(3), 265-273.
- Kooij, J., & Buitelaar, J. K. (2016). Pharmacotherapy for ADHD in adults: A review of current evidence. European Neuropsychopharmacology, 26(10), 1132-1144.
- Beyond medications, a predictive approach to managing ADHD in adults could incorporate factors like mental health, health-and-wellness, fitness-and-exercise, and nutrition for holistic care.
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