+ ADHD: A Doctor Explains Medications

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Dr Larry B. Silver, in an article published in the May/June 2009 LDA Newsbriefs, explains, lists and describes various medications that may be prescribed for attention deficit hyperactivity disorder (ADHD). 

Attention deficit hyperactivity disorder (ADHD) is a neurological disorder resulting from a deficiency of a specific neurotransmitter in specific areas of the brain.  This transmitter is norepinephrine or one of its building blocks, dopamine or dopa.  Any medication that increases the level of this neurotransmitter in the areas of the brain involved with ADHD will significantly reduce the behaviors associated with ADHD.

The article reviews the medications currently available.

“Stimulants”

A group of medications called “stimulants” are most successful in treating ADHD, writes Silver.  He explains they are called “stimulants” not because they stimulate or arouse the person, but because they stimulate nerve cells to produce more of the deficient neurotransmitter.

(There are a few non-stimulant medications that might be used if stimulants are not successful.)

Specific Stimulant Medications

So many medications are advertised that parents can easily become confused, says Silver. 

Three main medications within this group of stimulants are

  • methylphenidate (Ritalin)
  • dextroamphetamine (Dexadrine)
  • a mixture of several amphetamine salts (Adderall)

Each comes in several strengths and several release mechanisms.

The confusion for parents is that each new product is given what is called a trade name, which suggests it is a new medication.  And the fact that each parmaceutical company says in its ads that their product is the best treatment.

Each medication may be available as a four-hour tablet, an eight-hour tablet, and an eight-hour capsule. One comes in a twelve-hour capsule.   Each of these may be given a different name by the company making it. And there are generic forms of each medication, each of which may have its own name.

Methylphenidate is also available as a transdermal patch called Datrana.  Adderall is also available in a form that modifies how it’s absorbed and activated: Vyvance.

Polarization Characteristics

Yet another confusion is related to what is referred to as the “polarization characteristics” of each medication.

When crystals of a medication are looked at through polarized light, two different images are seen.  The right image is called the dextro form, and the left image is called the levo form of the medication.

For example, explains Dr.  Silver, when the amphetamine medications were studied, it was found that the dextro  form was potent, and that the levo form had little effectiveness.  Thus, dextro-amphetamine became the medication of choice.

Later, a pharmaceutical company decided to mix dextro and levo forms of amphetamine with other salts, creating Adderall.  (It is unclear, he says, if Adderall is indeed more effective than dextro-amphetamine.)

Another example:  methylphenidate (Ritalin) was analyzed with polarized light and the dextro form was found to be potent and the levo form was found much less potent.  So, a pharmaceutical company patented dextro-methylphenidate as a new product called Focalin.

In the complete article, Dr. Silver goes on to describe many other factors and details about dosage information.

Using the Stimulant Medications Effectively

Dr. Silver notes that there is no one medication that should be used first.  Every physician may have his or her own preference.

Once medication is started, there are three steps in the process of finalizing the medication treament plan.

  1. Which dosage is right for any individual?  Unlike many medications, these dosages are not based on age or body weight.  It seems to be related to how quickly it is absorbed into the blood stream, and how quickly it passes through the blood-brain barrier into the brain.  Usually, the individual is started at the lowest dose.  After five to seven days, the dose might be increased until the maximum benefits are noted.
  2. How long does the medication last?  Depending on the form used, each dose should last the time noted for the product.  However, the length of effectiveness might vary with individuals; it might last a shorter or longer time.  Based on such observations, the periods of the day to be covered is determined.  (For example, an individual might take an eight-hour capsule before going to school and a four-hour tablet about 4:00 pm to cover the afternoon and evening.)
  3. Are there side effects that need addressing?   These stimulant medications might cause a reduction in appetite or difficulty falling asleep at night.  Each negative effect can be addressed.  The individual should not be expected to live with either of these problems.  If someone has (or has a predisposition to) difficulties with anxiety, depression, anger control, obsessive-compulsive disorder (OCD) or tic disorder, the 6 stimulant medications might exacerbate them.  Make sure to address the problems.

Ideally the right medication and dosage is worked out and any side effects are addressed.  The goal is for an individual to function well in all settings. 

If there are problems achieving this ideal level, consult with someone who specializes in ADHD: a Child and Adolescent Psychiatric Behavioral Pediatrician.

REMEMBER

Medication alone is not the treatment of choice, says Dr. Silver.  Along with medication, behavioral counseling may help the individual.  Family education and counseling may help parents understand and support their child.  Adults might benefit from help provided by an ADHD Organizational Coach.

For the complete article, you can find it in LDA Newsbriefs, May/June 2009, “Medications for ADHD,” by Larry B Silver MD.  The LDA site is www.ldaamerica.org; email info@ldaamerica.org .

Silver recommends these sites as resources: www.chadd.org; and www.Additudemag.com

tutoring in Columbus OH:   Adrienne Edwards  614-579-6021  or email  aedwardstutor@columbus.rr.com   

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