.png)
Introduction
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that usually manifests in childhood and may persist into adulthood. Adults with ADHD often struggle with symptoms like inattention, impulsivity, and hyperactivity, which can hinder their daily functioning. While therapy and lifestyle modifications can be beneficial, stimulant medications like amphetamine and methylphenidate have emerged as vital tools in managing adult ADHD.
Treatment of ADHD in adults
Treatment for ADHD in adults is often holistic and multi-faceted. This allows for the healthcare provider to conceptualise the therapy goals as per the individual’s symptoms. Non-medical interventions for ADHD include:
- Psychotherapy: Here, adults with ADHD can learn how to manage negative emotions and stress, explore behavioural patterns, learn tools and interventions for time management, and work on self-esteem.
- Mindfulness and meditation: Mindfulness practices such as yoga, tai chi, journalling and deep breathing can help with improving focus, managing stress, and dealing with impulsivity. These techniques help to build present moment awareness and build self-awareness. Research has suggested this can aid attunement to thoughts and emotions, and lead to better emotional regulation.
- Exercise: Physical activity releases important neurotransmitters that are implicated in ADHD. This includes norepinephrine and dopamine. Exercise also releases endorphins, improving mood and concentration. For adults with ADHD, finding a fun and enjoyable physical activity such as dancing, hiking, working out can provide a structured outlet for excess energy. This can also improve overall well-being and executive function.
- Dietary changes: These include cutting down on sugars and food with preservatives, food colouring, and additives. Supplementation of Vitamin B, Vitamin D, omega-3, zinc, and magnesium have also been recommended. Having a well-balanced diet is essential for individuals of all ages.
Medication based treatment of ADHD in adults
Stimulant medications, such as amphetamine and methylphenidate, have long been considered the gold standard in treating ADHD. They work by increasing the availability of certain neurotransmitters, such as dopamine and norepinephrine, in the brain. These neurotransmitters aid in the regulatory process of focus, impulse control, and attention.
A commonly prescribed class of stimulants is Methylphenidate-based medications, available in the brand names such as Ritalin, Concerta, etc. They come in three forms - immediate-release, intermediate/sustained release and extended-release. They are administered orally in adults, with a starting dose of 10 mg and a maximum dose of 80-108 mg a day.
Methylphenidate primarily increases the levels of dopamine in the brain, which helps regulate attention and focus. These medications can be effective for adults with ADHD, often leading to improvements in concentration and the ability to complete tasks.
The other class of stimulant drugs are amphetamines, that are usually available in the brand names of Adderall and Vyvanse. They are commonly prescribed in the treatment of adult ADHD. They are also available in immediate-release and extended-release formulations, allowing for tailored treatment plans.
Amphetamine-based drugs work by enhancing the release of neurotransmitters and inhibiting their reuptake. This leads to improved attention and focus. Patients often report increased alertness, reduced impulsivity, and better executive functioning when taking these medications.
It is also important to consider the side effects of these medications in adults. Some of the common adverse effects include disturbance in sleep patterns, decreased appetite, headaches, increased blood pressure and pulse, mood swings, irritability, and abdominal pain. In rare cases, stimulants might cause hypertension, psychosis, seizures, suicidality, and hepatotoxicity. The side effects are seen early in the treatment and can be managed by changing the dosage or by understanding where these symptoms are coming from.
There is a risk of misuse and addiction associated with stimulant medications, particularly among individuals with a history of substance abuse. Healthcare providers carefully evaluate patients before prescribing these drugs and monitor their use closely to mitigate this risk. Hence, non-stimulant medications can be considered. However, these are less effective compared to stimulant medications in the treatment of symptoms of ADHD. Non-stimulants include Atomoxetine, Bupropion, Clonidine, Guanfacine, Modafinil, and tricyclic antidepressants. These medications aid in mood elevation, hyperactivity, and inattention. They can also be used by individuals for whom stimulant medications are contraindicated. A major benefit of non-stimulants are their low potential for abuse.
Thus, stimulant medications like amphetamine and methylphenidate have revolutionised the treatment of adult ADHD. They offer a lifeline to individuals struggling with the persistent symptoms of inattention, impulsivity, and hyperactivity.
It's crucial for individuals with adult ADHD to work closely with their healthcare providers to find the appropriate treatment approach for them. The treatment of adult ADHD is not one-size-fits-all. Healthcare providers work with patients to develop individualised treatment plans tailored to their specific needs and circumstances. This may involve a trial-and-error process to find the most effective medication and dosage.
It's essential for patients to communicate openly with their healthcare providers about their experiences with stimulant medications. This feedback can help fine-tune the treatment plan to achieve the best possible outcomes while minimising the side effects. Through collaboration and open communication with the team of experts- psychiatrists and psychologists at Rocket Health, adults with ADHD can start on a path to better focus, productivity, and overall well-being, ultimately enabling them to thrive in both their personal and professional lives.
References
Hariprasad, V. R., Arasappa, R., Varambally, S., Srinath, S., & Gangadhar, B. N. (2013). Feasibility and efficacy of yoga as an add-on intervention in attention deficit-hyperactivity disorder: An exploratory study. Indian journal of psychiatry, 55(Suppl 3), S379–S384. https://doi.org/10.4103/0019-5545.116317
Mehren, A., Reichert, M., Coghill, D., Müller, H. H. O., Braun, N., & Philipsen, A. (2020). Physical exercise in attention deficit hyperactivity disorder - evidence and implications for the treatment of borderline personality disorder. Borderline personality disorder and emotion dysregulation, 7, 1. https://doi.org/10.1186/s40479-019-0115-2
Lange, K. W., Lange, K., Nakamura, Y., & Reißmann, A. (2023, July 28). Nutrition in the Management of ADHD: A Review of Recent Research. Current Nutrition Reports. https://doi.org/10.1007/s13668-023-00487-8
Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatric disease and treatment, 4(2), 389–403. https://doi.org/10.2147/ndt.s6985
Storebø, O. J., Pedersen, N., Ramstad, E., Kielsholm, M. L., Nielsen, S. S., Krogh, H. B., Moreira-Maia, C. R., Magnusson, F. L., Holmskov, M., Gerner, T., Skoog, M., Rosendal, S., Groth, C., Gillies, D., Buch Rasmussen, K., Gauci, D., Zwi, M., Kirubakaran, R., Håkonsen, S. J., Aagaard, L., … Gluud, C. (2018). Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents - assessment of adverse events in non-randomised studies. The Cochrane database of systematic reviews, 5(5), CD012069. https://doi.org/10.1002/14651858.CD012069.pub2
Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatric disease and treatment, 4(2), 389–403. https://doi.org/10.2147/ndt.s6985
Cerrillo-Urbina AJ, García-Hermoso A, Pardo-Guijarro MJ, Sánchez-López M, Santos-Gómez JL, Martínez-Vizcaíno V. The Effects of Long-Acting Stimulant and Nonstimulant Medications in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Meta-Analysis of Randomized Controlled Trials. J Child Adolesc Psychopharmacol. 2018 Oct;28(8):494-507. doi: 10.1089/cap.2017.0151. Epub 2018 Jun 13. PMID: 29897263.
.jpg)
.jpg)
.jpg)
.jpg)