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ADHD Treatment

ADHD Treatment – The Best Ever

After treating many, many children and adults with ADHD through the years, it’s wonderful and heartwarming to see the change. He/she starts at, “I want to do it but I just can’t get it done.” A while later life is in a better place. He has realized that he has more control over himself and his every day activities than he thought. This isn’t changing a devil into an angel. It’s evolving a mischievous rascal into putting energy into becoming a true competitor in life.

A Reader Asks:

With Non-Controlled Drugs Available for ADHD Why Does Anyone Use the Stimulants?

A great question, and many people with ADHD ask the same question, as do parents with children with ADHD, and readers of this Neuroscience Research & Development Consultancy website. As part of our answer we include the few paragraphs below. The answer is that typically one of the stimulants works much better and much more quickly than the non-stimulant medications. When there’s a family of medications that usually works better, it makes sense to try a few medications in this group first. If for some reason none of them work well or if they cause problematic side effects, then the next medications to try would be the non-stimulants viloxazine (Sebree®) or atomoxetine (Strattera® or generic atomoxetine).

ADHD Treatment – Sort of Medical News

Further down the page we make the case that the most well studied medications, with the most well-known safety profile, are the stimulants. In use since the 1950s, they are the best tried-and-true medications for ADHD. True, these medications are DEA Schedule II. And true, in some instances they can be abused. But, for treating children with ADHD, the stimulants are rarely abused. And the DEA scheduling doesn’t matter for appropriately handled medications. The medications that are FDA-approved for ADHD that are not Schedule II are considered by many doctors as second-line treatments to be used if, for some reason, the stimulants cannot be used.

ADHD Treatment – When Not To Use Stimulants

We discuss this topic more fully below, but in short for now… If none of the stimulant medications can be used because they don’t help enough or they cause too many side effects, there are FDA-approved medications to try next. These medications aren’t stimulants. They are  taken daily (just like the stimulants) but take several weeks, up to 4 to 6 weeks, to begin to help.

The Medical Letter on Drugs and Therapeutics on One of the Newest of These Non-Stimulant Medications

The Medical Letter on Drugs and Therapeutics is a highly respected medical information source that has been published since 1958. One benefit is that It’s independent of the pharmaceutical industry, supported by subscriptions, accepts no advertising, and has a strict policy that no reprints will be sold to the pharmaceutical industry. In the June 28, 2021, issue The Medical Letter reviewed the latest FDA-approved non-stimulant. (The full Medical Letter reference is at the bottom of this page.) The Medical Letter’s conclusion is below. The conclusion ends with the statement, “Stimulants are preferred for most patients.“

The Medical Letter on Drugs and Therapeutics on Viloxazine 

“Standard Treatment — Stimulants such as amphetamines and methylphenidate are the drugs of choice for treatment of ADHD.” “Nonstimulants such as atomoxetine and the alpha2-agonists clonidine and guanfacine are not controlled substances. They are less effective than stimulants but may be preferred for school-age children because they cause fewer adverse effects.”

“Conclusion — In short-term clinical trials, the selective norepinephrine reuptake inhibitor viloxazine (Qelbree) was more effective than placebo for treatment of ADHD in children 6-17 years old. As with atomoxetine (Strattera, and generics), the other selective norepinephrine reuptake inhibitor approved for treatment of ADHD, somnolence, increases in heart rate and blood pressure, weight loss or failure to gain weight, and suicidal ideation may occur with its use. How viloxazine compares in efficacy with atomoxetine or other nonstimulants for treatment of ADHD is unknown. Stimulants are preferred for most patients.

ADHD Treatment Usually Requires a Medication

It’s true that many parents don’t want to use a medication to treat their child’s ADHD. Similarly, many adults with ADHD don’t want to take a pill every day. But trying to avoid a medication is usually a mistake. The medications that work to treat ADHD, when you find the right one, will typically help remarkably with just a few side effects. 

How the Right Medication Can Help with ADHD Treatment

For one thing, the right medication will lessen the driven over-activity. It’ll also help lessen the dilemma of acting before thinking (rather than thinking before acting, the usual best way). And finally, the right medication can help improve clear thinking and focus. That is, for her to do the things that she wants to do and not daydream or waste time doing things that don’t matter to her. When you find the correct medication that works it’s likely that she’ll be more able to make choices to help herself and to succeed more often. Her life will be better in school, at work, and at home with family.

If You Can Find the Right Medication for ADHD Treatment…

The challenge is to find the best medication for him, for her, for yourself. There are several medications that are effective for treating ADHD. What matters is that you work with your doctor and his/her team to find the right medication. Medication for ADHD is not “one size fits all”. Some will help a lot while others will not help at all. Some will have only a few side effects while others might have side effects that make you feel awful.

Your Doctor Will Help Find the Best Medication More Quickly

You and your doctor need to find the medication for you that has the best balance of helping and with the fewest side effects. But here’s the dilemma: There’s no way to tell for sure what will happen before trying a medication. If your doctor does not usually treat people with ADHD, hopefully he can refer you to a doctor with lots of experience. A skilled clinician who knows what she’s doing, and who’s working hard to help you, can find this best medication for you much more quickly.

How Much Does a Medication Help and What Are Its Side Effects?

Once you’re trying a new medication, the easy way to learn if and how much it helps is to ask trusted people around you. Here’s the dilemma. Your brain is the organ that needs the medication. But your brain is also the organ that needs to decide if the medication works. When your brain is trying hard to work how can it, at the same time, know how well a new medication is working. It’s like looking at yourself in a mirror and judging yourself fairly. It’s hard to do.

Trusted Advice from Trusted People

So check out your medication’s benefits and side effects with a trusted relative and/or a trusted close friend. “Trusted” is an important word here. Someone who is on your side. Ask each of them what they think. For a child, it’s valuable for parents to go to the child’s school and find out what the teachers are seeing.

Which Medication Works Best and Most Often for ADHD Treatment?

There are several medications that, since the 1950s, have been found to be the medications that most often work best for ADHD. The common name for all these medications is “stimulants” because they are stimulants for people who don’t have ADHD. They don’t work as stimulants for people with ADHD. For people with ADHD they usually slow and calm behavior. When started, these medications start working to treat ADHD in a day or two, or within a few days.

How Do These Medications Work?

These medications allow those brain nerve circuits to work better that do the clear thinking and that keep everything under control. And they calm the circuits that push hard to drive activity and action before thinking. They’re safe when given and watched by a doctor who knows them and who follows what’s happening with your child. But these medications are not always safe. One has to take them seriously and use them with care.

Which ADHD Treatment Medications Are These?

The typical medications in this group are methylphenidate (e.g., Ritalin®, Concerta®), dextroamphetamine (e.g., Dexedrine®), and the dextroamphetamine/amphetamine combination (Adderall®). All are available as less expensive generics.

Only Certain Doctors Can Write for these Medications

All of the medications in this group are prescription medications that are DEA Schedule II controlled substances. A licensed medical doctor has to write the prescription for them. And, not all licensed doctors are willing to work with these medications. Doctors who know these medications well and who regularly treat people with ADHD will write for the prescriptions if they are appropriate.

Mostly, These Medications Are Safe

These medications are mostly safe when used with care and when you’re working with a doctor who knows these medications and is experienced in treating ADHD. If the medication you finally choose works well and the side effects are minimal, it can be used for a long time, for years. You might be able to use the same medication for a lifetime if needed. If a medication you try doesn’t work or has problem side effects, stop it and find a different medication or a medication of a different type. One that will work.

CHADD Links (CHADD is Children and Adults with Attention-Deficit/Hyperactivity Disorder.)

Here is a link to a CHADD site discussing medication management for children with ADHD with a long section on use of, benefits of, side effects of, and risks of the stimulant family of medications:

Here is a link to another CHADD site for these same topics for adults with ADHD:

Other Types of ADHD Treatment Medication

There are ADHD medications of other types to try if none of the medications discussed above help enough or have too many side effects. These other medications are not stimulants, are taken daily, and take several weeks to work. They might take as long as 4 to 6 weeks to start working.

atomoxetine and viloxazine

Two such medications are atomoxetine (Strattera®) and viloxazine (Qelbree®). They’re meant to work in the same way as the stimulants, that is, to boost activity in the brain’s circuits that support clear thinking and that keep everything under control. And, to calm the circuitry driving the activity and action before thinking. While these two medications might be thought of as second-choice medications after the stimulants, some people do find that they are effective and have tolerable side effects. The atomoxetine is FDA-approved for ADHD in children, teenagers, and adults and viloxazine is FDA-approved for children and adolescents ages 6 to 17.

venlafaxine and desvenlafaxine

This different family of medications includes venlafaxine (Effexor®) and desvenlafaxine (Pristiq®). Doctors and medical scientists have less information about using venlafaxine for ADHD. And even less information on desvenlafaxine. So, more doctors have experience with the stimulants, atomoxetine, and viloxazine, and fewer doctors have much experience with venlafaxine and desvenlafaxine. These two medications are effective for some people with ADHD, however, so ask your doctor about them. If the other medications listed above aren’t effective for you or cause problem side effects, maybe it’s time to try venlafaxine or desvenlafaxine.

clonidine and guanfacine

This is another whole type of medication that sometimes helps when treating ADHD. These two medications were originally developed for treating high blood pressure. If a person with ADHD has intolerable side effects with the other ADHD medications discussed above, your doctor might suggest you try one of these. Examples are clonidine (Catapres®, Kapvay®) and guanfacine (Tenex®, Intuniv®). They do lower blood pressure and affect heart rate so these vital signs need to be checked regularly while taking these medications. They can also make an otherwise energy-filled child or teenager feel slow and tired.

Be Super Cautious Regarding “Herbs” and “Natural” Products

There are many websites and stores with a marketing “hard-sell” that one does not need real medications to treat ADHD. This is false information and bad information. The natural supplement and herbal market is completely not inspected and not regulated. It’s a jungle of a few quality vitamins and many, many bogus substances. Some of the popular commercial hard-sell pitches are for ginko biloba, bacopa monnieri, caffeine (good grief, just have a cup of coffee or tea), L-theanine, rhodiola rosea, phosphatidylserine, omega-3 fish oil (here again, just eat some fish), alpha GPC, huperzine A, L-tyrosine, 5-HTP, and GABA.  Be super cautious, and buyer beware!

ADHD Treatment Is Often Really Successful

Children with ADHD often do much, much better in school and with family and friends when taking one of these good medications for ADHD. Adults with ADHD are more successful at work and have a better family life with their spouse and children when taking the right medication that works well.

Therapy – The Essential Non-Medication Part of ADHD Treatment

Along with finding and taking the right medication, it’s important to become educated about ADHD and about yourself. One can learn about ADHD and how it affects you in psychotherapy or other types of supportive help. Those who have ADHD, whether children, teenagers, or adults, need a good person they trust with whom to work. Really. It’s true. Having ADHD is not easy. Living with it and getting it treated can be really confusing. Look at it this way. This ADHD person is trying to think clearly and get it right. But thinking is the problem. If the person could think clearly to start with they would not need the medication or the therapy. The journey through the jungle goes better with a guide.

Many Non-Medication Choices for ADHD Treatment  

There are many choices for this essential therapeutic help.  Some examples are:

• Behavior therapy
• Interpersonal therapy
• Family therapy
• Marital therapy (for parents or for adults)
• Educational approaches, training on specific skills or situations, like:
  • Stress management
  • Test taking in school
  • Dating relationships
• Group therapy
• Parenting skills training (raising a child with ADHD, while eventually rewarding, is a fast-moving challenge day-to-day)

Therapy is essential. A doctor cannot just give a child or adult a pill and expect everything will go well. It doesn’t. Get into therapy, the therapy of your choice.

One Final Word of ADHD Treatment Caution

People who try to treat ADHD without using any medications are making a huge mistake. Whether it’s your ADHD or your child’s, avoiding a medication altogether usually increases the frustration level for everyone. Yes, therapy has an essential role. One cannot throw pill at a person and expect all to go well. But at the same time, therapy without a medication is robbing the person of the best chance he/she has of having all go well. We know you’ll read many opinions to the contrary, but they are balderdash.

Below are two more links to expand on this topic of therapies for ADHD:

CHADD on Treatment of ADHD

CHADD Treatment Overview for Parents

Literature Reference

Viloxazine ER (Qelbree) for ADHD, The Medical Letter on Drugs and Therapeutics, Vol. 63, Issue #1627, June 28, 2021, p. 98 – 100.