“How Do I Choose the Right Medication for ADHD?”
“There are basic parameters to prescribing ADHD meds, but patients’ responses are unpredictable. So, how do we decide? It’s trial and error.”
The following article reflects the author’s opinions and is not intended to substitute for the expertise of your prescriber. Medication for each individual needs to be carefully selected and adjusted by a licensed prescriber who can consider all relevant characteristics of the patient’s health profile.
Stimulant medications, mainly methylphenidate and amphetamine, remain the primary medications used to treat ADHD. For more than 80 years, stimulant medications have been used to safely and effectively treat ADHD, however some basic questions from patients linger. I’ll address a few of them here.
Q: “How Do Patients Decide Whether to Try Medication for ADHD?”
I believe people with ADHD are best served by medication. If your doctor recommends medication, try it. If it helps and doesn’t cause side effects, continue taking it under medical supervision. If the medication isn’t effective or causes side effects, talk with your doctor about alternatives.
At first, most of my patients want no part of ADHD medication. My job is to make sure they make their decisions based on facts, rather than rumors and negative press. Once they know the facts, 90% of my patients decide to give meds a try. If you don’t like the medication, stop taking it. It will be out of your system within a day. But opting not to even try medication is like saying to your eye doctor, “Let’s try a year of squinting before we try eyeglasses.”
[Free Guide: What You Need to Know About ADHD Medications]
Q: “How Do Providers Decide Which ADHD Medication to Prescribe?”
Though there are basic parameters, patients’ responses are unpredictable. How a given medication affects one person may be completely different from how it impacts someone else. So how do we decide? It’s trial and error. For the first trial, I usually offer methylphenidate (e.g., Ritalin) or amphetamine (e.g., Adderall).
Q: “What Is a Good Starting Dose of ADHD Medication?”
I start low and go slow. Prescribers may change the dose every three days if a patient is not seeing any improvement. Some people need only a small dose, while others need a bigger one. For example, Ritalin at 5mg or 10mg once or twice a day is a typical starting dose for some kids.
Once it’s established that a medication works, the prescriber may switch your child to a long-acting methylphenidate like Concerta or Ritalin LA, or a long-acting amphetamine like Vyvanse or Adderall XR, which is taken after breakfast. Some children take an immediate-release Ritalin or Adderall, which I call a “homework pill,” around 3 or 4 p.m. as well.
Q: “How Do You Know If Your Child’s ADHD Medication Is Working?”
Before your child starts medication, make a list with your doctor about what you hope it will address. You might say that you hope your child will get dressed and out the door without a struggle in the morning, that they will finish their homework more quickly, that they will be less forgetful and get better grades, and that they will be more engaged in class and less disruptive.
[Free Download: The Ultimate Guide to ADHD Medication]
Use your list as an objective measure of the medication’s effect. If you see no improvement in your child, ask your prescriber to find a dose of a medication that provides symptom improvement with no side effects (other than appetite suppression without unwanted weight loss). Keep in mind that about 20% of people with ADHD don’t benefit from any medication.
Q: “What Medication Do You Turn to If the First Two Stimulants Don’t Work?”
I might have my patients try Mydayis, a very long-acting form of amphetamine. The non-stimulants approved for ADHD include Strattera (atomoxetine); Qelbree (viloxazine); Intuniv or Tenex (guanfacine); and Kapvay (clonidine). Several medications that have proven effective for ADHD off-label include the stimulant modafinil (Provigil or Nuvigil); Wellbutrin (bupropion); and amantadine, a dopaminergic anti-viral agent that’s primarily used to treat Parkinson’s disease.
Q: “What Are the Most Common Side Effects of ADHD Medications?”
Appetite suppression in children is the most common side effect of stimulants. Less common side effects in adults and children include elevated blood pressure and heart rate, and insomnia. This is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.
It’s important to monitor weight, sleep, heart rate, blood pressure, and moodiness or irritability. If you or your child has problems with moodiness, weight loss, or sleep, talk with your doctor and make changes promptly.
For further details on ADHD medications, including dosages, precautions, and interactions, visit the WebMD Drugs & Medication Database.
Managing Medications for ADHD: Next Steps
Free Download: What to Ask Before Starting ADHD Medication
Q&A: “How Do Doctors Decide Which ADHD Medication to Prescribe First?”
Read: How Safe Are ADHD Medications?
Find: ADHD Specialist or Clinic Near You
Edward “Ned” Hallowell, M.D., is a child and adult psychiatrist and a leading authority in the field of ADHD.
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