Treating your ADHD: Is one pill a day enough to adequately subdue a patients’ symptoms? How so? Also, Why?  

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental medical condition in which there are more than three million new cases in the United States every year. Patients diagnosed with ADHD range from as early as two years old to as late as eighty years old. Although this condition is not life threatening, an ongoing pattern of inattention or hyperactivity-impulsivity can interfere with functioning and development. In recent years, neuropsychological professionals have presented patients with two main options for treatment: stimulants (oral medication) in combination with therapy. 

The therapeutic approach allows patients to better understand and recognize the symptoms of their disorder. Furthermore, communication with others who have ADHD traits may help certain patients to cope with their symptoms. The most common forms of therapy are support groups, Cognitive Behavioral Therapy (CBT), and anger management. CBT is especially interesting because it is based on three core principles:

#1 – Psychological problems are based, in part, in unhelpful ways of thinking. 

#2- Psychological problems are based, in part, on learned patterns of bad behavior. 

#3 – People suffering with psychological problems can learn better ways to cope. 

Support groups and CBT, as reported by the Center for Disease Control (CDC), are some of the most effective ways to treat symptoms of ADHD through therapeutic intervention. CBT treatment centers around ways to change patients’ thinking patterns. Some of these strategies include gaining a better understanding of the motivations of others, using problem-solving to cope with difficult situations, and raising confidence in oneself and (his/hers/their) own abilities. Furthermore, psychological professionals administering CBT would encourage patients to face their fears instead of avoiding them, and would also role-play scenarios in which ADHD traits could manifest. One of the main benefits of CBT is a better understanding of oneself and their environment. 

But what happens if therapeutic interventions are not enough? 

Many patients (children and adults alike) turn to oral medication in order to help alleviate some of their symptoms. Medications prescribed to patients with ADHD are divided into two categories: short-acting medication and long-acting medication. The four most commonly prescribed short-acting medications in the United States are amphetamine, (Adderall) dextroamphetamine, (Dexedrine, ProCentra, Zenzedi) dexmethylphenidate, (Focalin) and methylphenidate (Ritalin). Dosage often depends on the height and weight of the patient, but many are frequently prescribed somewhere between 5 m/g and 40 m/g a day. A prescription of more than 40 m/g per day indicates the patient has prolonged symptoms of ADHD that severely impact the individual’s ability to carry out everyday functioning. A benefit of taking a short-acting stimulant medication is that the synaptic levels of monoamine dopamine, (DA) serotonin, (5-HT) and norepinephrine (NE) increase immediately. This results in alertness, attention and energy for the patient. It is also associated with less mood and eating side effects. Due to the fact that patients have to take multiple pills to achieve a stable level of focus and alertness, it is likely that the patient will be more stringent with the medication. They will also be less likely than long acting stimulant users to overuse or abuse the drug. In terms of eating, the reason why short-acting stimulants are preferred to long-acting stimulants is because the medication(s) usually wear off between four to six hours after ingestion. This means that patients’ talking a short-acting medication will be more likely to eat a full meal at lunch or dinner time than those taking long acting medication. Both groups of stimulants list appetite suppression as a well-documented side effect, but taking a long-acting stimulant results in prolonged appetite suppression for many patients. 

Now, there are also some benefits to long-acting medication. The most prescribed long-acting stimulants include amphetamine, (Adzenys XR, Dyanavel XR) dexmethylphenidate, (Focalin XR) and dextroamphetamine (Adderall XR). Again, dosage often depends on the height and weight of the patient, but many are frequently prescribed somewhere between 5 m/g and 40 m/g a day. It is quite interesting how patients are commonly prescribed between 5 m/g and 40 m/g regardless of whether or not they ingested a short-acting or long-acting stimulant. The benefits of long acting stimulants are that patients may only have to take one pill every morning and that they remain at stable levels of focus and alertness for roughly 12 to 14 hours. The major side effects of long-acting stimulants are that users have a greater risk of overdose – this is due to the fact that the medication does not reach peak effectiveness until 4 to 6 hours after ingestion. Furthermore, appetite suppression is more common in those taking long-acting stimulants. This may cause patients to inadvertently lose weight and may lead to greater health complications as a result of diminished caloric intake and weight loss. 

I believe that there is an argument to be made in support of both long-acting and short-acting oral medications for ADHD. More research is absolutely necessary in order to expand our knowledge about patient responses to each type of stimulant. I hope to see future studies further examine ADHD and possible treatment options. 

Sources: 

Cascade, E., Kalali, A. H., & Weisler, R. H. (2008). Short-acting versus long-acting medications for the treatment of ADHD. Psychiatry (Edgmont), 5(8), 24.

Punja, S., Zorzela, L., Hartling, L., Urichuk, L., & Vohra, S. (2013). Long-acting versus short-acting methylphenidate for paediatric ADHD: a systematic review and meta-analysis of comparative efficacy. BMJ open, 3(3), e002312.

López, Frank A., and Jacques R. Leroux. (2013). Long-acting stimulants for treatment of attention-deficit/hyperactivity disorder: a focus on extended challenges. ADHD Attention Deficit and Hyperactivity Disorders, 5(3), 249-265.

Swanson, James M. “Long-acting stimulants: development and dosing.” The Canadian Child and Adolescent Psychiatry Review 14, (Suppl 1), 4. 

Rains, A., & Scahill, L. (2004). New long-acting stimulants in children with ADHD. Journal of Child and Adolescent Psychiatric Nursing, 17(4), 177.

5 thoughts on “Treating your ADHD: Is one pill a day enough to adequately subdue a patients’ symptoms? How so? Also, Why?  

  1. Good blog post, Tyler! I like that you discussed both therapy and pharmacological interventions for treating ADHD. Relating it back to the theme of our seminar, which is on emotions, how does ADHD affect certain emotions? How do the treatments affect those emotions?

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  2. Hello Tyler,

    I enjoyed your blog post. I virtually know nothing about ADHD and was intrigued by your discussion of the risk and benefits of short-acting and long-acting medications. I also found it interesting that both short-acting and long-acting medications have an average dose of 5 m/g and 40 m/g a day.

    While reading your blog, I wondered if there is a sex difference in how ADHD symptoms present themselves and the doses needed for ADHD medication to be effective.

    Great post!
    Sincerely, Bashaina (Shasha)

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  3. Hi Tyler, this blog post taught me a lot about ADHD! I had little knowledge of how ADHD is treated, so I enjoyed learning about both types of interventions, therapeutics and medications. It was fascinating to learn about the advantages and disadvantages of the short-acting and the long-acting prescriptions. I was wondering how effects would differ depending on what time individuals take their medication. What might happen if an individual takes their medication at different times every day, rather than taking it at the same time every day? I would also be interested in learning about experiences of individuals with comorbidities, such as depression. Would the dosage/prescription for ADHD treatment change? Would we see different effects on the transmission of monoamine neurotransmitters in the brain?

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  4. Hi Tyler! Great post. I feel this is a very pertinent topic on college campuses like Colby, since I’ve met so many people with an ADHD diagnosis so far. The varying effects of short and long-term treatments are fascinating indeed- perhaps using a combination of the two is the best method of treating ADHD? I do wonder how ADHD changes over the lifespan, and if certain medications are better fit for specific age ranges. I look forward to researching this further after reading your work. This a great addition to the discussion of psychological treatment and medication for common conditions.

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  5. Hi! Great post! I’ve worked with a lot of special needs children in the past and will be working with them again this summer so this post really hit home for me. I’ve always been more familiar with the symptoms of ADHD than I have been with the treatment but this was really informative and helpful in understanding that.

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