Traditional Medical Treatment
In addition to behavioral management, medical treatment of ADHD includes stimulant and non-stimulant drugs.
Stimulant drugs. Effective prescription drugs are primarily the so-called stimulant drugs. These agents are known to increase concentrations of a variety of brain neurotransmitters, most importantly dopamine, and exert a calming effect on people who have ADHD. Since dopamine enhances signaling between nerve cells that are involved in task-specific activities and also decreases "noise" or "nonsense signaling," increased concentrations of dopamine are thought to help individuals stay focused and on-task.
Despite their limitations, stimulants are still considered first-line treatment for ADHD. They are effective in 70 to 80 percent of patients. Stimulants are highly effective at alleviating core ADHD symptoms (e.g., inattention, hyperactivity, or impulsivity). Original stimulant preparations had very short periods of action that could result in dramatic rises and falls in drug levels. Newer long-acting preparations have been developed to even out these swings.
Even with the newer formulations, some adverse effects are inevitable. Long-term effects, although unusual, can occur. There is some evidence, for example, that long-term use of stimulants, especially methylphenidate (Ritalin®), can cause a delay in growth (Holtkamp 2002). It is understandable that many parents are hesitant to give their young children this medication.
While they are effective, stimulant drugs are members of the amphetamine class, which means they can have significant adverse effects and hold some potential for abuse. Unfortunately, methylphenidate has gained popularity as a recreational drug, especially among adolescents and college students. While methylphenidate paradoxically acts as a calming drug among people diagnosed with ADHD, it acts as a stimulant among people who do not have ADHD. Surveys have indicated that more than 90 percent of college students and adolescents who abuse prescription drugs identified methylphenidate as their drug of choice (White 2006).
Non-stimulant drugs. The negative effects of stimulant drugs have led to an intensive search for better alternatives. Atomoxetine is the first non-stimulant drug approved by the US Food and Drug Administration (FDA) for treatment of ADHD and the only agent approved by the FDA for treatment of ADHD in adults.
Atomoxetine therapy for ADHD controls symptoms, maintains remission, has comparable efficacy with methylphenidate, a favorable safety profile, and non-controlled substance status (Christman 2004). Atomoxetine is safe and well tolerated (Kelsey 2004). It effectively reduces ADHD symptoms and improves social functioning in school-aged children, adolescents, and adults. As with stimulant medications, atomoxetine should be used with caution in patients with hypertension or a cardiovascular disorder (Christman 2004).
In addition to atomoxetine, other drugs that increase brain concentrations of dopamine and/or serotonin have been used with varying degrees of success. Among these are the anticonvulsant gabapentin (Hamrin 2001), dopamine-enhancing antidepressant bupropion (Daviss 2001), wakefulness-promoting modafinil (Taylor 2000), and acetylcholinesterase inhibitor donepezil, which increases brain levels of acetylcholine. Studies, however, have cast doubt on donepezil's effectiveness (Wilens 2005).