Benefits and Risks of ADHD Medications

Analysis of benefits and risks of ADHD medications plus side-effects of medications for ADHD. And why using medications to treat ADHD is controversial.

Important Points

• Medications are NOT the only treatment for ADHD.
• The decision to use medications for treatment of ADHD requires knowledge and consideration.
• Other interventions (such as psychotherapy, educational accommodations, etc.) should always accompany the use of medications for ADHD.
• Periodic re-evaluation of ADHD medication use is essential, as a person's response and need can change over time.

What is ADD / ADHD?

Attention-Deficit/Hyperactivity Disorder (AD/HD, or ADHD) is characterized by two or more of the following:

• poor attention
• impulsivity
• hyperactivity.

The condition may take different forms: either inattentive or hyperactive/impulsive. Children are more often the ones diagnosed with ADHD, but many adults also maintain the attention impairments (ADD).

It is currently believed that ADHD is a neurobiological condition caused by genetics, conditions in utero, or possibly by relational trauma.

Why are medications often used for the treatment of ADHD?

Although the causes of ADHD are somewhat speculative, the source is generally believed to be a problem with either the structure or functioning of the brain. The most common view is that ADHD is a biochemical problem, related to an imbalance of the neurotransmitters in the brain. Thus, the use of medications is to regulate this presumed imbalance. Stimulants are the most frequently utilized type of medications for ADHD. Gabor Maté, M.D., author of Scattered: How Attention Deficit Disorder Originates and What You Can Do About It, offers this explanation and analogy:

• Even though ADHD individuals are generally hyperactive, their brain waves are slower at a time when they would be expected to be faster (when reading or other tasks are attempted).
• The brain's prefrontal cortex is supposed to sort out and organize sensations and impulses coming from the body and the environment, and to inhibit those that are not useful in a given situation. When this task is successful, there is order, as with a policeman directing traffic at a busy intersection.
• In an ADHD person, the prefrontal cortex is underactive, like a policeman asleep on the job, thus not prioritizing and selecting or inhibiting input. The result is a flood of data bits that keep the mind and body unfocused and in turmoil. Traffic is gridlocked.
• Stimulant medications wake the policeman and allow the prefrontal cortex to perform traffic direction more efficiently.

What are the medications for treating ADHD?

Stimulants

The most common medications for treating ADHD are stimulants. Stimulants have been the longest in use for treatment of ADHD, and have the most research studies on their effects. Although some have been used on children as young as age 3, most are recommended for age 6 or older. Long-term studies on the use of stimulants for the treatment of ADHD lean toward the discontinuation during adolescence, due to possible growth inhibition.

Stimulants for the treatment of ADHD may be shorter or longer acting formulations. Short/intermediate acting stimulants require dosages 2-3 times a day, while long acting stimulants last 8-12 hours, and can be taken once a day, thus not requiring a dose at school.

There are four main types of stimulants used for treatment of ADHD:

• amphetamines (Adderall)
• methylphenidate (Ritalin, Concerta, Metadate)
• dextroamphetamine (Dexedrine, Dextrostat)
• pemoline (Cylert - less commonly prescribed because can cause liver damage)

Non-stimulant

The newest medication for treatment of ADHD is Strattera. This medication is a reuptake inhibitor that acts on the neurotransmitter norepinephrine (which affects blood pressure and blood flow) in the same way that antidepressants act on the neurotransmitter seratonin, allowing the natural chemical to remain longer in the brain before being drawn back up. Because it is a non-stimulant, it may be less objectionable to some families. Nevertheless, it has similar side effects as other medications used for ADHD.

Antidepressants and anti-anxiety medications

In some cases, Antidepressants or anti-anxiety medications may be prescribed either in addition to or instead of stimulants for the treatment of ADHD. Most often, this determination is based on other symptoms, beyond those typical of ADHD alone. Antidepressants most commonly affect the neurotransmitters seratonin or norepinephrine. (the FDA advises that anyone on antidepressants should be watched for increases in suicidal thoughts and behaviors. Monitoring is especially important if this is the child or adult's first time on depression medication or if the dose has recently been changed. If the depression appears to be getting worse, an evaluation by a mental health professional should be scheduled as soon as possible).

Antipsychotic or mood-stabilizing medications

For certain conditions that include symptoms of ADHD, other medications may be prescribed. With a few exceptions for seizure disorders, antipsychotic medications are not prescribed for children and most mood stabilizers are not recommended for children or adolescents.

What are the side effects of medications for ADHD?

Persistent and negative side effects of stimulants have been documented, including sleep disturbances, reduced appetite, and suppressed growth, which might have important health implications for the millions of children who are currently taking medication for ADHD. Source: Centers for Disease Control and Prevention

Side effects most commonly include:

• decreased appetite or weight loss
• headaches
• upset stomach, nausea or vomiting
• insomnia or sleep difficulties
• jitteriness, nervousness, or irritability
• lethargy, dizziness, or drowsiness
• social withdrawal

All medications have side effects, and sometimes a change in dosage, brand or type of medication will allow for the usefulness of the medication while reducing the side effects. One problem with medications for ADHD is that they are most often prescribed for young children, who usually will not be able to accurately report side effects. This is one of the concerns about prescribing any medications for children.

Why is the use of medications for ADHD controversial?

The introduction of medications for the treatment of ADHD initially seemed like a miracle cure. Many believe that the benefits in terms of academic achievement and social behavior warrant the possible risks. However, there are also many concerns about the use of medications for ADHD, and as studies continue to monitor their effects, the controversy grows. Some of the most often-expressed concerns are:

Overuse

As cultures become more fast-paced with increasing time pressures on parents, children, and teachers, the use of ADHD medications seems a fast fix for a complex problem. Long-range effects on the developing brain are not known. Even when medications are advised, they should never be used as the exclusive treatment for ADHD. Additional interventions (such as behavior management, parenting skills, and classroom accommodations) must also be incorporated.

Age of children

Originally, ADHD medications were prescribed for school-age children, and use was generally discontinued at adolescence. In recent years, these medications have been prescribed at younger ages, and have been extended through adolescence and into adulthood. In some cases, doctors are diagnosing ADHD and prescribing medications for children as young as age 2, even though the controlled studies on these medications were not done on pre-school children. Understanding of normal child development and family behavioral management skills might be a more appropriate intervention for such young children.

Misdiagnosis of ADHD

ADHD is defined by behavioral symptoms. There is no specific test for ADHD. Behaviors that are common to ADHD may be caused by a variety of other sources, such as domestic violence, alcoholism in the family, inadequate parenting, ineffective behavior management, poor attachment to a stable caregiver, or a number of other medical conditions. The symptoms of ADHD are on a continuum that could be interpreted differently by any particular parent, teacher or physician. What one person would consider normally active for a child might be seen by someone else as hyperactive. What one adult can tolerate or handle might be seen by another adult as impossible behavior.

Sources:

• DSM-IV-TR, The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.
• ADHD, Wikipedia
• Attention Deficit Hyperactivity Disorder publication by NIMH, June 2006.
• FDA Warning on Antidepressants
• The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit hyperactivity disorder (ADHD). Archives of General Psychiatry, 1999;56:1073-1086.

next: Guidelines for Use of ADHD Medication For Children
~ adhd library articles
~ all add/adhd articles