Treating Adult ADHD

There is no single treatment strategy that works best for all patients with ADHD. Pharmacotherapy (medication treatment) remains the best-established and most effective treatment for most patients, but it is often just the first step in treatment.  Interventions such as cognitive-behavior therapy (CBT) and/or organizational coaching can provide additional important benefits for many patients. I am not a CBT provider but am glad to provide referrals to skilled local clinicians.

A healthy lifestyle with particular emphasis on physical exercise, regular sleep habits and cessation of unhealthy habits (such as marijuana and excessive alcohol usage) will benefit nearly all patients with ADHD.

The medications with the longest established record of efficacy are methylphenidate and amphetamine. These are often categorized together as “stimulant medications.” Commonly known brand names of methylphenidate and its associated compounds include Ritalin, Concerta and Focalin. The most commonly known brand names of amphetamine are Dexedrine, Adderall, Adderall XR and Vyvanse.

Approximately 70-80% of patients will experience clinically meaningful benefits from one of the stimulants. Within that 70-80%, however, there is wide variability of response; some patients will be fortunate to have dramatic and sustained benefits, but it is more common to experience a level of symptom reduction that is helpful but far from complete. And for some patients there can be significant initial benefits that diminish over time. Unfortunately we don’t yet know how to predict which of these responses any particular patient will experience.

There is a great deal of clinical lore regarding which of the stimulants is the most effective and which side effects each is more likely to cause. There currently is not a reliable way to predict specific benefits or side effects of any particular medication for any particular person. Each of the stimulant medications has the same potential for beneficial effects and the same list of potential side effects, but for every patient who experiences good benefits and/or minimal side effects from one of these medications, another patient will have no benefit and/or unpleasant side effects from the same medication. The best that a physician is able to do with the available scientific data is to provide patients with information on the range and likelihood of potential benefits and side effects, and try to guide what is essentially a trial-and-error process of finding the most effective and best-tolerated medication.

A person’s response to the usage of an ADHD medication is not diagnostic; many people who don’t have ADHD will still experience improvements in attention and focus from a stimulant medication. This is among the reasons that these medications are legally classified as “controlled substances.” Conversely, some patients who have been diagnosed with ADHD will not experience meaningful benefit from treatment with medications.

For patients who struggle in a work environment that does not suit their interests or abilities, any medication treatment will be of limited benefit. They may need to consider finding a career that better aligns with the particular strengths and challenges commonly found in patients with ADHD.

Other medications in usage for ADHD are atomoxetine (Strattera), guanfacine (Intuniv) and bupropion (Wellbutrin). The primary advantage of these medications as compared to the stimulant medications is that they are not controlled substances.

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As procrastination is a frequent feature of ADHD (and for many people who don’t have ADHD), here is a nice easy-reading article on following through on committments :  How to Keep Your Resolutions.

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