What do ADHD medications do?

Medication is prescribed to support concentration, reduce hyperactivity, improve impulsivity and help the emotional dysregulation which can characterise ADHD. It may also support improved executive function.

Medication does not cure ADHD – it can only reduce the challenges it causes. It can help to control the core symptoms of ADHD and help children to be more focused and concentrate better. Similarly, due to the complexity of the condition, medication on its own is unlikely to treat ADHD fully.

How does the medication work?

In simple terms, they adjust the levels of dopamine and noradrenaline, two brain chemicals (or neurotransmitters) associated with ADHD. These brain chemicals get released in the spaces between brain cells, and then get carried back into the brain cells by transporters once they have done their job.  Once the level of brain chemicals are adjusted, the brain functions more efficiently, and the individual becomes less hyperactive, inattentive, and/or impulsive.

There are two types of medication that can be used either stimulants or non-stimulants. 

Watch our useful video which is a 10 minute introduction to Medication with Dr Peter Hill.  For a more in-depth and longer discussion on medication refer to the webinar of Dr Maite Ferrin. Dr Peter Hill has also written a recent book “The parents’ guide to ADHD medication”, which can be found here. We also held a webinar with Dr Hill discussing medication more in-depth.

Ben’s story (Aged 11)

“I was always getting into trouble at school. The teacher used to tell me off for not sitting still, I’d try to sit down but it was hard – I would just want to get up and walk around. I was always getting into trouble for talking. The other children in my class would sit still and finish their work but I found this hard. Mum and Dad said I had a lot of energy. Sometimes my friends would tell me I was over the top. Mum says she couldn’t take me anywhere when I was younger because I was so noisy and always on the go. In the end, Mum and Dad took me to a clinic for children who have problems. They said I have ADHD and talked to my parents and teachers about how to help me. They gave me some medication – Ritalin. My Mum and Dad think it helps. I don’t seem to get told off so much and can do my school work better.”

What different medications are used to treat ADHD?

Stimulants:

Methylphenidate is most commonly used in the UK to treat ADHD. Brand names include Medikanet, Ritalin, Equasym, Concerta, Matoride, Delmosart and Xenidate.  For children having difficulty swallowing capsules, Medikinet XL and Equasym XL capsules can be carefully opened and the medication inside carefully sprinkled onto something slightly sticky, like a spoonful of yoghurt.

Dexamfetamine (brand names include Dexedrine) is also a stimulant and similar in its actions to methylphenidate. It sometimes works when methylphenidate does not.

Elvanse capsules contain the active ingredient lisdexamfetamine dimesylate. Lisdexamfetamine is converted into dexamfetamine.  Lisdexamfetamine capsules can be opened and mixed in with a small amount of water for children who struggle to swallow.

Non-stimulants:

Intuniv is a long-acting form of guanfacine. It is a non-stimulant. It is often prescribed for children who cannot tolerate stimulants, or for parents who prefer not to use stimulants. It’s believed that Intuniv strengthens receptors in the brain, improving memory and attention, reducing distractions, and controlling impulses. It can help reduce symptoms of ADHD.

Atomoxetine (which goes by the brand name of Strattera) is a non- stimulant drug. It is available in liquid form but only on an application to the pharmacy board as an exception.

Combinations of medications are rarely needed, and seldom used. The combination of guanfacine and methylphenidate can be used

There is a limited range of other types of medication that are sometimes used in specialist practice, including Clonidine, certain antidepressants and mood stabilisers.

How long do the benefits of the medication last?

Most of the methylphenidate medications work on improvements lasting from around 4 hours through to around 12 hours, depending on the brand. Lisdexamfetamine lasts around 13 hours. Both guanfacine and atomoxetine take around 6 weeks to show benefits, but once it is effective the benefits last 24 hours. Everyone is different, and some young people do find the medication doesn’t last as long as expected.

With stimulant medications (methylphenidate and lisdexamfetamine) patients often elect not to take medication during weekends or the school holidays and then resume again in school term time. This would usually be to help improve appetite over the weekends / holidays. There are a few young people who do find consistency more helpful who benefit from taking it everyday, including weekends but this would be something to discuss with your doctor.

Are any of the medications for ADHD addictive?

The medication used to treat ADHD are controlled drugs and therefore need to be prescribed as it can impact the individual if other medical conditions (heart conditions or mental health issues) are prevalent. However, the low and steady doses used to treat ADHD do not lead to dependence. Research suggests that children with ADHD are somewhat more likely to use illegal drugs, but that the risk actually falls if they are treated with stimulants. Anecdotal evidence suggests that the use of illegal drugs is more prevalent due to risk-taking nature of ADHD.

The medication has been used over many years and the first Methylphenidate that was licenced in 1955 was Ritalin.

What are the side effects of ADHD medication?

Despite media coverage, side effects for ADHD medication are not usually problematic. The commonest being a loss of appetite. However, your doctor will need to know any side effects your child experiences and they will need to be assessed and managed.

Side effects of stimulant medication for ADHD can include restlessness, difficulty sleeping, irritability and mood swings, depression, loss of appetite, headaches, upset stomach, dizziness, high blood pressure, racing heartbeat and tics. Side effects of non stimulants include restlessness, difficulty sleeping, irritability and mood swings, depression, loss of appetite, headaches, upset stomach, dizziness, low blood pressure and a slowed heartbeat.

Significant side effects typically arise when the selected medication is not suitable to the individual or if the doses is not correct. For these reasons, ADHD medication should only be prescribed to children and young people who have been professionally assessed and diagnosed by an expert, and should be reviewed regularly.