In the first article of this series, you learned that there are several classes of drugs used to treat ADD/ADHD: Stimulants; Antidepressants; and Serotonin Reuptake Inhibitors. We are going to start our overview with the class of Stimlulants.
Stimulants are drugs that work in the central nervous system to help the brain increase the circulation levels of those chemicals thought to be at a low level in persons with ADHD. Stimulants are thoguth to help children and adults concentrate more easily and to help control other symptoms of ADHD. While most people can take these drugs without difficulty, others have pretty serious side effects. These can range from minor problems such as decreased appetite and delayed sleep onset, to more troubling symptoms such as tics and even hallucinations.
One major concern parents have about stimulants is that since these drugs can be habit-forming in adults, they might have the same effects on children, or that children might become drug addicts in later years. The research is sketchy on this, but most agree that addiction in the pediatric population is not a major concern.
Stimulants work differently in children than adults. Most of the drugs have to be ggiven more than twice a day. However, there are newer forms that only require once-a-day dosing which makes it easier to give to a school-age child. These drugs work well with “drug holidays,” a period of time (weekends, school breaks, summers) where the drugs are not needed, where the child does not have to be so focused, or when it is not necessary to control hyperactivity.
Do not let yourself become confused or overwhelemd by the names or types of drugs. What you should be aware of, however, is how these drugs affect the brain and ultimately the person with ADD or ADHD.
Also, a common question parents will ask is, “If my kid had ADHD, why would I give him stimulants?” For some reason, when you give a stimulant to a child or adult with ADHD, he is thought to get on the right track. His brain seems to shift into a different gear that makes paying attention easier. He can absorb and integrate informaiton such that he can focus more effectivley.
METHYLPHENIDATE is the first category of stimulants and is a drug that you have undoubtedly heard of in one place or another. Methyphenidates include Ritalin, Focalin, Ritalin SR, Metadate ER, and Concerta.
Ritalin and Focalin are short acting medicines with one dose lasting about 3 to 4 hours. These are helpful drugs when a rapid onset of symptoms management is needed in a short amount of time. While they work quickly and are thought to be effective in about 70% of patients, they should be used cautiously if there is a lot of anxiety, tics, a family history of Tourette’s syndrome, or a history of substance abuse. Side effects of Ritalin include insomnia, decreased appetite, weight loss, headaches, irritability, stomachaches, and a rebound agitation or exaggeration of pre-medication symptoms as it is wearing off. Focalin has the same side effects except it doesn’t seem to disturb sleep or appetite as much.
Ritalin SR (sustained release) and Metadate ER (extended release) have a longer onset for about 60 to 90 minutes. Duration of these drugs is thougt to be 6 to 8 hours depending on the individual. They wear off more gradually so the risk for abuse is low. Side effects are about the same.
Concerta begins working in 30 to 60 minutes and its duration is about 10 to 14 hours. While it has the same side effects, the risk for abuse is low.
Even though many of these drugs are considered “miracle drugs” for many cases of ADD/ADHD, it is not always the case. Consider MIchael who was diagnosed with ADHD in high school. Although his parents were against medication, he started taking Ritalin when he went to college and sought help for himself. Whiel the first week seemed like a dream come true, his symptoms began to change. Michaelr eports sleep disturbance, increased anxiety and irritability that would not go away. His doctor tried to change the dose, but nothing helped. It was then that Michael decided to stop the medicine and seek behavioral therapy for his symptom management. he said that within a day of stopping medication, he was back to his old self.
Many doctors and drug companies want you to use medicine as a quick fix for many ailments including ADD/ADHD. As you begin to research the issue of whether medicine is right for you or your child, make sure you are getting your information form unbiased sources. If a drug company has financed a study or has written the review of a medication, just keep in mind that they may be motivated by more than just providing education. Pharmaceuticals are a big business – so buyer beware!
