If a trial of an initial medication at one or more dosages doses is not helpful, then the addition of a trial of a second or third medication is in order. However, some physicians will add a second medication early in the course of treatment and report that such additions are helpful. Whether it takes one or two medications, most physicians will aim to use the lowest effective dose. In addition, frequent follow-up with the physician is necessary to provide the best possible care.
Legitimate Concerns About Medications for ADHD
Parents, medical professionals, and the general population have expressed concerns about the widespread use of medication for ADHD. Indeed, these concerns are legitimate. According to a 1998 report from an expert panel convened by the National Institute of Mental Health, there are "many important questions regarding treatments [of ADHD] that remain unanswered." Here are their concerns:
- No major studies have been published that have examined the long-term effects or effectiveness (more than two years) of either behavioral therapies or prescription medications.
- There are no national guidelines (or even reliable guidelines) on the treatment of the inattentive subtype of ADHD.
- There are no national guidelines for treating adolescents or adults with ADHD.
- There are no proven therapies for targeting some of the specific problems seen with ADHD, such as deficits in language processing or impaired working memory.
Evidence for the Use of Medications in ADHD
One group of researchers assessed the effectiveness of prescription stimulant drugs using a comprehensive systematic review of the many studies that have been published. The authors identified 18 randomized controlled trials that used behavioral rating scales to measure the effect of stimulant medications, The review concluded that three drugs-methylphenidate (available as a generic and in the brands of Ritalin, Metadate ER, Methylin ER, Ritalin SR, Metadate CD, and Concerta), dextroamphetamine (available as a generic and in the brands of Dexedrine and Dexedrine Spansules), and pemoline (Cylert) - were all significantly more effective than placebo.
Studies have shown that some children who are unresponsive to or intolerant of methylphenidate have tolerated or responded well to dextroamphetamine, and vice versa. So, if one medication does not work, a trial of the other is usually considered appropriate.
Another group of researchers looked at all the studies evaluating the effectiveness of the stimulants and reported on 18 studies that compared stimulant drugs. In general, rnethylphenidate, dextroamphetamine, and pemoline were found to be equivalent.
These same researchers found nine studies that compared the effectiveness of tricyclic antidepressants with placebo: Five of six studies showed that desipramine (Norpramin) was more effective than a placebo. They also found one of three studies of imipramine (Tofranil, Tofranil-PM) reported a similar benefit to desipramine. Four studies compared stimulants with tricyclic antidepressants - sort of a head-to-head comparison. Unfortunately, the results were inconsistent.
One caveat about the stimulant medications: We simply have no long term studies of either their safety or effectiveness. Countless people living with ADHD can attest to their safe and long-term use, but that anecdotal evidence is not nearly as helpful as actual research studies. One study, published in 1999, showed that taking stimulants for ADHD was both safe and effective for at least two years. Other long term studies are currently being performed. Medication For Adhd Inattentive Type
Drug Vacations
When I was in my medical training at Duke, we were taught to try to give our ADHD patients drug holidays. The advice was to try to avoid medications on weekends, holidays, and vacation. Some physicians still ascribe to this practice; however, not only is there no evidence supporting this theory, there is evidence that this may, for some kids, be harmful.
Why? Simply because those with ADHD, who are being successfully treated with medications, find that their social and family functioning is so improved on the medication that withholding it may actually contribute to peer rejection, family conflict, and reduced self-esteem.
Medication is a double edge sword. You have to be the master to control it and not letting it control you.If possible, try all natural methods before medication. To learn more, you can check out Medication For Adhd Inattentive Type.
