ADHD Medication Articles

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ADHD medication is one of the most powerful ways to manage ADHD. Not the only one, and not a complete method of ADHD management, but a very useful one if you’re willing to give them an honest try since it takes a while to find the right ADHD medication or medications and then get the right dose.

They call it a trial of medication for a reason, they don’t call it psychic doctors who magically know the right medication/s and the right dose the first time:)

The articles below are for individuals with ADHD.

Also, take a look at my ADHD Medication Companies Websites Chart to go to the website of the companies that make the major ADHD drugs.

While these articles may be useful to you it is important to discuss medication with your doctor or psychiatrist to go through the trial and error process to find the medication or medications that work for your unique ADHD brain and the optimal dose.

There is no one “best” medication for ADDers, we’re not clones:)

The ADHD med(s) that works for other people may or may not work for you.

People with ADHD often forget to take ADHD medications, I often coach my adult ADHD clients in specific ways that will work for their unique ADHD brains and personality to overcome the obstacles to remembering to take ADD meds.

After all, forgetfulness is part of the condition of ADHD. Plus distraction, impulsivity, and time management problems, etc.

 

What ADHD Medication Can and Can’t Do

Realistic expectations to have of ADHD medications.

Vs.

Unrealistic expectations of ADHD medications as a miracle pill that will magically solve all of your problems with ADHD and also teaches you time management and social skills too! or ADHD medications as the tool of the devil that will summon the alien reptilian lizard people into infesting your apartment block:)

 

Canadian ADHD Practice Guidelines. Chapter 5: Pharmacological Treatment Of ADHD

These are the free guidelines to teach your doctor who claims they don’t know ADHD how to diagnose and treat ADHD.

You can read the chapter on ADHD medications. And maybe the other ones if you want.

You need to download the whole thing to access the medication section.

Topics Covered:

Medication classification
First-line treatments,
Second-line treatments
Third-line treatments
Stepped approach to prescribing
Step 1 – setting treatment objectives
Step 2 – medication selection
Step 3 -titration & monitoring
Step 4 – ongoing follow-up
Managing side effects
Common adverse events
When to reduce the dose, or stop a medication
How to stop medication
Choosing to change to a different
Medication side effects management techniques
Unsatisfactory response to treatment
Information on specific medications
Canadian medication tables per age group
Psychostimulants
Non-stimulants
Frequently asked questions on ADHD medications

 

CADDRA Canadian ADHD Medication Chart

CADDRA Guide to ADHD Pharmacological Treatments in Canada - 2019 just amphetamine based only

This shows you just one section of the full 2-page free chart.

Canadian ADHD Resource Alliance’s ADHD medications chart. Lists amphetamine-based psychostimulants, methylphenidate-based psychostimulants, non-psychostimulant – selective norepinephrine reuptake inhibitor, non-psychostimulant – selective alpha-2a adrenergic receptor agonist. Lists characteristics of each medication, picture of it, duration of action, starting dose, dose titration as per product monograph, and dose titration as per CADDRA.

It also lists the contraindications of each and the main potential drug interactions. “Laminated versions of the medication charts are included with every copy of the new Canadian ADHD Practice Guidelines,  which are provided without cost to CADDRA members or can be ordered from the CADDRA office by non-members.”

 

UK’s NICE ( National Institute For Health And Care And Excellence) Guidelines for ADHD Medication.

Covers: baseline assessment, medication choice – children aged 5 years and over and young people, medication choice – adults, further medication choices, medication choice – people with coexisting conditions, dose titration, shared care for medication, maintenance and monitoring, adherence to treatment, review of medication and discontinuation.

Sadly many doctors don’t know much about ADHD and some often only think the only ADHD medications out there are 3-4 hour short term ADHD medications like Ritalin and Dexedrine and don’t know and don’t tell their patients about long term once a day medications (8-14 hours).

So they expect patients who by the nature of the condition of ADHD are often impulsive, forgetful, easily distracted, disorganized and time blind to remember to take short term ADHD medications three times a day. So I’m including this section of the NICE Guidelines.

“1.7.20 When prescribing stimulants for ADHD, think about modified-release once-daily preparations for the following reasons:

Convenience

Improving adherence

Reducing stigma (because there is no need to take medication at school or in the workplace)

Reducing problems of storing and administering controlled drugs at school

The risk of stimulant misuse and diversion with immediate-release preparations

Their pharmacokinetic profiles.

Immediate-release preparations may be suitable if more flexible dosing regimens are needed, or during initial titration to determine correct dosing levels.”

 

The Most Popular ADHD Medications: Comparison Chart USA

From Additude Magazine. Lists the medication, formulation, compound, duration, dosing considerations and savings program of these different types of ADHD medications:

Methylphenidate

Dexmethylphenidate

Dextroamphetamine

Mixed Amphetamine Salts

Lisdexamfetamine

Clonidine

Guanfacine

Bupropion

 

Setting up an ADHD Medication Log

My suggestions on how to set up an ADHD med log to track how your ADD medication is working and its side effects. This can really help your doctor manage your medications better and find the right dose that works for your unique ADHD brain faster.

 

A Parent’s Complete Guide to ADHD Medications

By ADHD Editorial Board, Laurie Dupar, Pmhnp, Rn, Pcc, William Dodson, M.D. “Everything you need to know to help your child find the right ADHD medication — by learning how medications work, monitoring their effectiveness, and knowing when to switch to another medication if your child isn’t getting the best results.”

 

How Do ADHD Doctors Titrate Medication?

Some people think doctors and psychiatrists are psychics on ADHD medication. “You, the spirits tell me, Vyvanse, 40 milligrams will work.” It’s called a medication trial for a reason.

Some Adults and Children with ADHD will try one ADHD medication at one dose and it doesn’t work for them and they’ll say it didn’t work so they’ll stop taking ADHD meds vs trying another.  It’s like “I tried durian, I didn’t like it, so I am never going to try any other fruit.”

It takes a while to find the right ADHD med or meds and then the right dose. If you’re going to try ADHD meds at least give them an honest try. You almost never get the right med and dose on the first try.

So if you try ADHD medication, at least give it an honest try.

“There is no way to predict the dosage of ADHD medication that will work best for any given patient. So, doctors titrate medication, meaning they slowly increase the dosage until you or your child reaches the maximum symptom relief with minimal side effects.”

 

Generic Concerta Problems

Some generic ADHD medications work fine. Some do not. Pharmacists often get bribes, oops, incentives to sell generics vs the brand name and they are cheaper than brand names. But I’ve never heard as many complaints by ADDers on ADHD medications than with some of the generic brands of Concerta. Gina Pera has been following that problem for YEARS. Check out her posts on it.

 

Does Stimulant Medication Cause Addiction?

Explains what the title says.

One day we’ll see articles saying things like does not taking ADHD medication increase the chance of your son or daughter or adult child instead self-medicating with booze, tobacco and illegal drugs to get the dopamine from them they’d otherwise get with ADHD medications?

 

Children on Methylphenidate Less Likely to Abuse Drugs, Study

“Pre-teens who have been treated with methylphenidate may develop an aversion to abusable drugs, according to a team of researchers from Harvard Medical School. The Harvard study also rebuts arguments that treating children with stimulants such as Ritalin, Concerta or other medications containing methylphenidate may lead to later substance abuse.”

 

Does Stimulant Therapy of ADHD Beget Later Substance Abuse?

A Meta-analytic Review of the Literature. By the Clinical Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Boston, Harvard Medical School, Pediatrics.

Conclusion? No. They found it actually reduced the risk of later substance abuse.

 

ADHD Medication and Substance-Related Problems. It Reduced Them. Study of 2,993,887 ADHD Patients.

“Substance use disorders are major contributors to excess mortality among individuals with attention-deficit/hyperactivity disorder (ADHD), yet associations between pharmacological ADHD treatment and substance-related problems remain unclear. This study investigated concurrent and long-term associations between ADHD medication treatment and substance-related events.

Method

The authors analyzed 2005–2014 commercial healthcare claims from 2 993 887 (47.2% female) adolescent and adult ADHD patients. Within-individual analyses compared the risk of substance-related events (i.e., substance-use-disorder-related emergency-department visits) during months in which patients received prescribed stimulant medication or atomoxetine relative to that during months in which they did not.

Results

In adjusted within-individual comparisons, relative to periods in which they did not receive ADHD medication, male patients had 35% lower odds of concurrent substance-related events when receiving medication (odds ratio [OR] = 0.65, 95% CI, 0.64–0.67), and female patients had 31% lower odds of concurrent substance-related events (OR = 0.69, 95% CI, 0.67–0.71).

Moreover, male patients had 19% lower odds of substance-related events two years after medication periods (OR = 0.81, 95% CI, 0.78–0.85), and female patients had 14% lower odds of substance-related events two years after medication periods (OR = 0.86, 95% CI, 0.82–0.91). Sensitivity analyses supported most findings but were less consistent for long-term associations among women.

Conclusions

These results provide evidence that receiving ADHD medication is unlikely to be associated with a greater risk of substance-related problems in adolescence or adulthood.

Rather, medication was associated with lower concurrent risk of substance-related events and, at least among men, lower long-term risk of future substance-related events.”

 

Medscape Search for ADHD

This allows you to search Medscape for articles on ADHD medications i.e., Straterra, Concerta, Vyvanse etc or just general medical or other research on ADHD. Requires free registration.

“Medscape is the leading online global destination for physicians and healthcare professionals worldwide, offering the latest medical news and expert perspectives; essential point-of-care drug and disease information; and relevant professional education and CME.”

 

Predictors of Medication Continuity in Children With ADHD

Days covered with medication for (A) short-term medication continuity and (B) long-term medication continuity.

Predictor Variables on ADHD medication adherance

 

Pediatrics. William B. Brinkman, MD, MEd, MSc, Heidi Sucharew, Ph.D., Jessica Hartl Majcher, and Jeffery N. Epstein, Ph.D.

One thing that many people don’t realize is that many people using medications for long-term conditions like ADHD, diabetes etc have poor rates of adherence, many stop taking their medication for a wide variety of reasons.

One thing I’ve noticed coaching ADHD adults since 2003 and running The Vancouver Adult ADD Support Group is that many have told me that their doctors or psychiatrists don’t properly explain the medications for Attention Deficit Hyperactivity Disorder, what they can and can’t do, what the side effects are and how to deal with those side effects and proper expectations on ADHD medications.

So I think this is an important article. And I have other ones on the problem below it.

“We identified 7 important predictors of short-term medication continuity.

Our finding that stronger parent perceptions of the controllability of ADHD symptoms at baseline predicted continuity is similar to reports involving adults with a variety of chronic conditions

Consistent with past research, greater parent satisfaction with information about medicine and comfort with the treatment plan were important predictors.

Consistent with our past research, the presence of a medication titration, which is recommended in ADHD clinical practice guidelines to maximize benefit and minimize side effects, was an important predictor of continuity. Improving the prevalence and timeliness of titration for children newly treated for ADHD holds promise to improve subsequent medication continuity.

However, no algorithms or quality metrics exist to guide such efforts.

Greater reduction in symptoms was also an important predictor, similar to past research.

We identified 2 important predictors of long-term medication continuity.

As hypothesized, the differential between parent perception of the need for and concerns about ADHD medication predicted greater long-term continuity.

As hypothesized, child dislike for taking medicine predicted worse long-term medication continuity. This is akin to past studies revealing child oppositional symptoms being influential, presumably because of the child’s refusal to take the medicine.

It is possible that parent beliefs about “outgrowing ADHD” exert an influence later.

It is noteworthy that the baseline factors that predicted getting off to a good start did not predict long-term continuity.

Rather, child acceptance of medicine and parent perception of the need for and concerns about ADHD medication became important factors.

This is consistent with conceptualizing adherence as a process that can change over time in response to experiences with treatment.

Pediatricians can help support families early in the treatment process by providing education about treatment options and engaging in shared decision-making to decrease decisional conflict.

Moreover, pediatricians should titrate medicine to maximize symptom reduction and minimize side effects.

Additional research is needed to determine whether monitoring child and parent beliefs about medicine over time with validated measures has a clinical utility that would aid physicians to support medication continuity.”

 

Adherence to ADHD Medication Treatment, The UK’s NICE ( National Institute For Health And Care And Excellence) Guidelines

Adherence to treatment

“Use this guideline with NICE’s guideline on medicines adherence to improve the care for adults with ADHD. The principles also apply to children and young people.

Be aware that the symptoms of ADHD may lead to people having difficulty adhering to treatment plans (for example, remembering to order and collect medication).

Ensure that people are fully informed of the balance of risks and benefits of any treatment for ADHD and check that problems with adherence are not due to misconceptions (for example, tell people that medication does not change personality).

Encourage the person with ADHD to use the following strategies to support adherence to treatment:

Being responsible for their own health, including taking their medication as needed

Following clear instructions about how to take the medication in a picture or a written format, which may include information on dose, duration, adverse effects, dosage schedule (the instructions should stay with the medication, for example, a sticker on the side of the packet)

Using visual reminders to take medication regularly (for example, apps, alarms, clocks, pill dispensers, or notes on calendars or fridges)

Taking medication as part of their daily routine (for example, before meals or after brushing teeth)

Attending peer support groups (for both the person with ADHD and for the families and carers).

Encourage parents and carers to oversee ADHD medication for children and young people.”

 

Adherence To Treatment Studies. Several.

From the ADHD Institute. Funded by Takeda, a Japanese pharmaceutical company that bought Shire maker of several ADHD medications. On this page, they have references to specific studies. Here are a few.

“Adherence to ADHD medication is often suboptimal and can be encouraged by psychoeducation and the patient’s acceptance of their condition.

A 2016 review by Frank et al identified 41 studies that reported reasons for patient non-adherence to ADHD medication. All studies were published from 1997–2014 and examined ADHD medication adherence over the long term (>1 year) in children, adolescents or adults.

Commonly reported reasons for poor adherence to ADHD medication included:

Own wish/remission/don’t need (19.9%)

Withdrew consent (16.2%)

Adverse effects (15.1%)

Suboptimal effect (14.6%).

The reasons why children and adolescents stop and restart ADHD medication were also investigated here, using the prospective longitudinal cohort from the Multimodal Treatment of ADHD study in children with ADHD.

At the 12-year follow-up, 372 participants (mean age 21.7 years) reported ever taking ADHD medication, and 286 (77%) reported stopping medication for ≥1 month at some time during childhood or adolescence (mean age 13.3 years).

The most common reasons for stopping medication related to:

Medication not needed/helping

Adverse effects

Logistical barriers of getting or taking medication

Social concerns or stigma.

After stopping medication for ≥1 month, 64 (17%) participants reported restarting medication, which was commonly due to the medication being needed or it being helpful, and the logistical barriers to getting or taking the medication were resolved. Parent involvement in decisions to stop or restart medication decreased with age, suggesting that tailored strategies may help engage adolescents as full partners in their treatment plan.

One study in 39 children with ADHD found that patients who used a mobile app demonstrated significantly greater adherence to medication (p<0.05) and a significant improvement in Clinician Rating Scale score (p<0.05) compared with patients who were treated as usual. The mobile app not only served as a medication reminder but facilitated communication between the patient and the treating physician.

A Canadian study of 53 university students with ADD or ADHD (mean age at diagnosis 14.7 years) reported that participants were adjusting levels of medication adherence on a day-to-day basis, according to perceived benefits and risks.

Adherence rates in university students with ADHD
The participating students were surveyed on whether they took, or intended to take, all of their ADHD medication as prescribed a) last Tuesday, b) last Saturday, c) next Tuesday and d) next Saturday. The frequency of not taking ADHD medication ‘on purpose’ and ‘because of forgetting’ was also ascertained.

Students were more likely to take medication for ADHD on weekdays than at the weekend (Figure). Adherence on weekdays was associated with the belief that ADHD medication enhances academic performance and social skills, whereas weekend adherence was influenced by the perceived loss of authentic self and negative side effects.”

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