Treatment of ADHD can involve many classes of medications. The best-known are the stimulants. Here it’s important to relay some concerns about stimulants containing amphetamine and methylphenidate: along with surging levels of ADHD diagnoses, are surging levels of stimulant production:

  • Stimulants are very effective at controlling symptoms of ADHD, but they can be horribly addictive drugs
    • They can, and do, ruin peoples’ lives just as much as cocaine and heroin
    • People with addictive personalities should not be given a second chance to take their stimulant as prescribed
    • Even people who’ve never been addicted to drugs, can become stimulant addicts
      • It’s a hell of a lot easier to justify tricking a psychiatrist into prescribing them if “Oh well. They went through medical school so that know what they’re doing.” And the pills come in a neat little legal bottle with one’s name on it
        • Furthermore, much of the time, the patient is likely only half-aware of deceiving their provider
    • Many patients think that their stimulant prescription is designed to produce euphoria or extreme motivation
    • This may lead to increasing the dose to chase these effects, a hallmark of drug addiction.
  • As the stimulant dose increases, the chance of negative side effects, such as psychosis, rises, even as the initial euphoria wears off
    • About 15% of people who become psychotic from stimulant use/abuse do not fully recover
      • Yes, even people who definitely have ADHD or narcolepsy, and who take stimulants as prescribed, can go psychotic
  • Lastly, stimulants are not brain food, despite how they feel
    • Both methylphenidate and amphetamine can be toxic to the brain
    • Amphetamine more so
  • For these general, interrelated reasons, high addiction potential, risk of extreme side effects, and toxicity if abused, these chemicals are Schedule II substances.
  • Stimulants are well-respected, effective medications if taken at the lowest dose possible by someone who actually needs them
    • And, when they actually need them, such as when going to college full-time, and/or having a busy work schedule
  • If someone can’t leave their room, is showing signs of trauma, or otherwise can’t function due to fear, they should not by any means take a stimulant, even if they have ADHD or narcolepsy

End rant…

http://test.askdrjones.com/wp-content/uploads/2007/10/Stimulant-dosing-chart.jpg

  • Stimulants
    • Effective about 30 minutes after ingestion
    • Most effective at relieving ADHD
    • Activate the reward system of the brain
    • Amphetamine-based
      • Many effects
        • Mostly indirect activity on the neurotransmitters norepinephrine and dopamine
          • Indirect agonism (activation of the receptors of these two chemicals)
        • A weak MAOI
        • Causes vesicles to leak neurotransmitters into cytoplasm, in turn releasing them into the synapse
        • Weak reuptake inhibitor of norepinephrine and dopamine
        • Little, but present, affect on serotonin
        • I find it an extremely intriguing chemical, so I wrote an essay on it!
      •  Adderall (mixed amphetamine salts)
        • Particularly useful for energy
      • Vyvanse (lisdexamphetamine)
        • A pro-drug, meaning that it only works when taken orally, and has much less abuse potential
        • Has a long duration of effect
        • Is still on patent, so is very expensive without insurance
      • Dexedrine (dextroamphetamine)
        • Similar to lisdexamphetamine, but comes in instant release tablets and extended release capsules
      • Desoxyn (dextromethamphetamine)
        • A particularly dangerous medication
          • Of all ADHD medications, has the greatest potential for abuse and subsequent brain damage
          • Should only be considered if all else fails
      • Amphetamine has been on the market since the 1930’s, speaking to its safety
    • Non-amphetamine stimulants
      • Ritalin and Concerta (methylphenidate)
        • A norepinephrine-dopamine reuptake inhibitor
        • Along with amphetamine-based medication, is about 60%-75% effective on symptoms
        • Less taxing on the brain and heart than amphetamine
        • Less abusable than amphetamine
        • In therpaeutic doses, may actually be healthy for the brain
        • Methylphenidate has been on the market since the 1950’s
      • Provigil and Nuvigil (modafinil and armodafinil)
        • Has a much less abuse potential than other stimulants
          • Demonstrated by Schedule IV status, whereas other stimulants are Schedule II
        • Not officially indicated for ADHD, but has shown promise
          • A rare side effect disqualified it for being officially licensed to treat ADHD
        • As the other stimulants, has use in narcolepsy
        • Is approved to treat shift work disorder
        • Perhaps best characterized as a eugoroic, or wakefulness-promoter
  • Strattera (atomoxetine)
    • Takes 3-4 weeks to work
    • Much less, if any, risk of toxicity and abuse
      • No significant activity in the nucleus accumbens, the brain region associated most havily with addiction
    • Norepinephrine reuptake inhibitor
  •  Antidepressants
    • Usually take a few weeks to work
    • MAOIs
      • Deprenyl, EMSAM (selegiline)
        • Stimulating without addicting
        • Shown to be very healthy for the brain
        • Also used in Alzheimers
        • EMSAM comes as a patch, and is extremely expensive without insurance
      • Other MAOIs may also be useful, but require a strict diet
        • Parnate (tranylcypromine), Nardil (phenelzine)
    • SNRIs
      • Effexor (venlafaxine)
      • Cymbalta (duoloxetine)
      • Pristiq (desvenlafaxine)
      • Also have use in many forms of anxiety
    • Tricyclics
      • Have norepinephrine reuptake inhibitor properties, like Ritalin, Straterra, SNRIs, and Wellbutrin do
      • Desipramine
      • Nortriptyline
    • Wellbutrin (bupropion)
      • Efficacy established by multiple studies on ADHD treatment
      • Also useful in stopping smoking
      • Has potential to relieve stimulant withdrawal
      • Works similarly to methylphenidate ( the norepinephrine-dopamine reuptake inhibitor)
  • Alpha-2 agonists
    • Kapvay (clonidine)
    • Intuiv (guanafacine)
      • An extended-release version is available
      • Less side-effect incidence than Kapvay

Sources: Condensed Psychopharmacology 2013: A Pocket Reference for Psychiatry and Psychotropic Medications, Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs, Abnormal Psychology: An Integrative Approach, Stahl’s Essential Psychopharmacology