What Do Adults Take for ADHD?

Research suggests that adults with attention deficit hyperactivity disorder (ADHD) often respond extremely well to stimulants and at times antidepressants. Treatment options and successes are similar to those in childhood ADHD.

Counseling, also called psychotherapy, can play an important role in treatment by helping to develop increased awareness of ineffective habits. Therapy can also be a way to develop activities to build organizational and planning skills. However, no current research has demonstrated that counseling alone will eliminate the actual symptoms of ADHD; rather, counseling can become more effective once an effective medication is found. Medication will "start the engine" but not necessarily provide a way to "steer." In other words, counseling may help with issues of marital instability or poor interpersonal skills but by itself will not end inattention, impulsivity, or feelings of restlessness.

The medications available for managing attention deficit hyperactivity disorder (ADHD) can have slightly different effects from individual to individual, and currently no method exists to tell which will work best. Medications indicated for ADHD are thought to work by improving the imbalance of neurochemicals that are thought to contribute to ADHD.

Some commonly prescribed medications include the following:

• Stimulants (U.S. Food and Drug Administration [FDA] approved for ADHD, except Cylert)
  • Methylphenidate (Ritalin, Ritalin LA, Concerta, Metadate, Methylin, Quillivant, Daytrana)
  • Dexmethylphenidate (Focalin, Focalin XR)
  • Mixed amphetamine salts (Adderall, Adderall XR)
  • Dextroamphetamine or pre-Dextroamphetamine (Adderall, Dexedrine, Dextrostat, Vyvanse, Zenzedi)
  • Methamphetamine (Desoxyn)
  • Pemoline sodium (Cylert); no longer available in the United States due to instances of severe liver toxicity
• Nonstimulants (Only the medications indicated with an * are FDA approved for treating ADHD)
  • Atomoxetine (Strattera*)
  • Guanfacine (Tenex, Intuniv* [extended release])
  • Clonidine (Catapres, Kapvay* [extended release])
  • Vayarin (omega-3 dietary supplement)
• Antidepressants (None of these medications are FDA approved for treating ADHD.)
  • Bupropion (Wellbutrin)
  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)
  • Desipramine (Norpramin)
  • Imipramine (Tofranil)
  • Nortriptyline (Aventyl, Pamelor)

If one medication does not work effectively, some of the others are often tried because individuals may respond quite differently to each one. Medications in different groups used in combination may be more effective than each medication alone for some people. In general, the medications used to treat ADHD in adults are the same ones used to treat ADHD in children.

Stimulants are the most commonly used class of medications for treating ADHD in adults and children. All of these medications increase brain levels of dopamine and norepinephrine. Both of these brain chemicals are thought to be related to the ability to sustain attention. Stimulants are misused or abused by some people, and can be addictive, so they should be used with care and may not be appropriate for some individuals. Almost all people will see an improvement in their attention, focus, and performance on certain tasks while taking a stimulant. This is important to know, since there is a common myth that a positive effect from a stimulant can prove a diagnosis of ADHD.

On a related note, it has become increasingly common for high school and college students to misuse stimulants (for example, take them without a prescription or take more than prescribed) as a cognitive enhancer or performance-enhancing drug (PED) as a way to try to improve their academic performance. While there are far fewer studies on the long-term effects of stimulant medications like Ritalin, Adderall, or Focalin, some research shows that the effectiveness of stimulants sometimes wanes over time.

The FDA approved nonstimulant medications work in a slightly different way. Atomoxetine (Strattera) increases norepinephrine levels and is not an addictive medication. Both guanfacine and clonidine modulate the sympathetic (fight or flight) nervous system and are thought to decrease the impulsiveness related to ADHD.

Certain antidepressants are also used to treat ADHD, since they may also affect dopamine and norepinephrine levels. None of the antidepressants have an FDA approval for ADHD treatment; however, they may be a useful treatment option, particularly when stimulant medications are contraindicated, have caused intolerable side effects, or have not improved symptoms. The antidepressants most commonly used for ADHD are bupropion (Wellbutrin), venlafaxine (Effexor), and duloxetine (Cymbalta). Older tricyclic antidepressants (TCAs) such as imipramine (Tofranil, Tofranil-PM), desipramine (Norpramin), and nortriptyline (Pamelor) are less often prescribed for treatment of ADHD because they are more likely to cause more serious side effects.

Antidepressant medications and atomoxetine may increase the risk of suicidal thinking and behavior (in children, adolescents, and young adults in their early 20s) as side effects of the medication, particularly in individuals with a history of bipolar or other mood disorder, or a personal or family history of suicidal behavior.

Medication can help some or all of the following areas:

• Academic underachieving and inattentiveness
• Hyperactivity or fidgeting
• Verbal and/or behavioral impulsivity (for example, blurting out, interrupting others, acting before thinking)
• Difficulty falling asleep at night
• Trouble waking up (not getting out of bed in the morning)
• Excessive irritability without cause and/or easy frustration
• Episodic explosiveness, emotional outbursts, or temper tantrums
• Unexplained and persistent emotional negativity

If an ADHD medication is not significantly helping with a number of these concerns or is causing uncomfortable or problematic side effects, ask about changing the dosage or changing medicine.

While a number of natural remedies and changes in diet to treat ADHD have been tried, research indicates that many such interventions are either too restrictive to daily life to implement in a realistic way or have yet to be found to have a significant impact on ADHD symptoms.

For more information, read our full medical article on adult ADHD.