Attention Deficit Hyperactivity Disorder (cont.)
ADHD in Children Medications
The medications used to treat ADHD are psychoactive. This means they affect the chemistry, and thus the functioning, of the brain.
Psychostimulants are by far the most widely used medications in
treating ADHD. When used appropriately, approximately 80% of individuals with ADHD show a very good to excellent response in reduction of symptoms. These medications stimulate and increase activity of areas of the brain with neurotransmitter imbalances.
The exact mechanism of how these drugs relieve symptoms in ADHD is unknown, but these medicines are linked to increases in brain levels of the neurotransmitters dopamine and norepinephrine. Low levels of these neurotransmitters are linked to ADHD.
- The most common adverse effects occur over the short term. They
include loss of appetite, sleep disturbances, rebound (for example, agitation,
anger, lethargy as the last dose starts to wear off), and mild anxiety. Most individuals who take psychostimulants for ADHD build up tolerance to adverse effects within a few weeks.
- Individuals with certain coexistent psychiatric
disorders (for example, psychosis, bipolar disorder, some disorders of anxiety or depression) are particularly vulnerable to adverse effects if they do not receive appropriate concurrent treatment for the coexistent condition.
The psychostimulants most often used in ADHD include the following:
Atomoxetine (Strattera) is a non-stimulant used to treat ADHD. This medication has been used for
fewer years than the stimulants, and less is known about its long-term side effects. This drug has several benefits over stimulants,
but its use may also carry several negative aspects.
- It is not a controlled substance and is not
considered a drug of potential abuse by the U.S. Food and Drug Administration
(FDA). Since it is not a controlled substance, pharmacies may accept phone-requested medical refills.
- It is usually taken only once a day for full 24-hour
- It is much less likely than stimulants to disrupt
eating or sleeping.
- For some children, atomoxetine is not enough to control their ADHD symptoms. Many other children do very well on this medicine alone.
- Specialists treating individuals with ADHD have found Strattera seems to best help improve the problems associated with a disruption in executive function skills. Inattention and hyperactivity symptoms are less responsive.
- When starting Strattera therapy, a gradually increasing dosage schedule is recommended. It may take up to three weeks before full therapeutic benefit is achieved. For this reason, patients may need to remain on previously prescribed stimulant medication during the "build up" phase. In addition, Strattera must be taken daily; short-term "medication holidays" (for
example, school vacations and weekends) will limit Strattera's efficacy.
- Studies have indicated a higher than expected incidence of suicide ideation during early treatment. This occurred in patients with pure ADHD as well as in those patients with ADHD accompanied by other emotional disorders (for
example, depression, anxiety, bipolar disorder).
Some medications originally developed to treat depression
(antidepressants) also have important roles in treating some individuals with
ADHD. Since these medicines have been used for many years to treat other mental-health conditions, their adverse effects are well understood.
- Imipramine (Tofranil): an antidepressant that
increases levels of neurotransmitters norepinephrine and/or serotonin in the
- Bupropion (Wellbutrin):
an antidepressant that
increases levels of neurotransmitters in the brain, especially dopamine
- Desipramine (Norpramin):
an antidepressant that increases levels of the neurotransmitter norepinephrine in the brain
Other medicines that were originally developed to treat high
blood pressure (alpha agonists) may also be useful in the treatment of those having ADHD. Again, due to widespread and long-term use, their side effects are well known to doctors.
- Clonidine (Catapres): an
alpha-2 agonist that stimulates certain receptors in the
brain stem; the overall effect is to "turn down the volume" of hyperactive
movement and speech
- Guanfacine (Tenex,
Intuniv): Recently, the U.S. FDA has licensed the use of guanfacine as a non-stimulant medication effective in treating ADHD when used in conjunction with other stimulant medications. It is not felt to be nearly as effective when used as a sole agent. Both a short-term preparation (Tenex) and a long-term preparation (Intuniv) are available. Unfortunately, 18% of Intuniv users discontinued use of their medication due to side effects, including drowsiness (35%), headache (25%), and fatigue (14%).
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