As a board-certified specialist in pediatric nutrition, I see children with ADHD frequently, mostly for just 2 reasons why these patients are referred to me. These children are either failure to thrive due to the anorexic side effects of ADHD medications OR newly diagnosed ADHD and parents wants to try the “natural way” or “diet” first.
Based on these, we know the side effects of ADHD medications are real and parents are aware. Besides, people also know that ADHD can be treated with changing diets.
It is true that ADHD medications can help reduce symptoms of hyperactivity, inattentiveness, and impulsivity in children and adults with ADHD. However, these medications come with side effects and risks—very bad side effects and very risky outcomes.
Remember, ADHD medications don’t cure ADHD. They are only for symptoms relief to make life easier for the adults (namely the parents and teachers). Don’t forget there are many other alternative options for ADHD treatment. ADHD medications are just “boo-boo bandaid” for the problem without treating the underlying causes.
Needless to say, ADHD medications do work well for some. And in some cases, it is necessary.
I once have this family who is adamant about not starting ADHD medication on their young. Like I said, in some cases, medication is probably a good idea, at least for the short-term while trying to fix the body.
This child is WILD…one parent had to literally hold her down with both arms to keep her to stay in the exam room. And when not paying attention, this child would just dash out of the door and down the hall. The parents had to literally chase her down to bring her back.
This is the situation where the child needs medication.
ADHD medications do not work for everyone. And not to mention the many unpleasant side effects, it’s important to know the facts about ADHD medications so you can make an informed decision about what’s best for your child and family.
And administration of ADHD medications should always be personalized and closely monitored by a trained psychiatrist (not psychologist or your pediatrician).
How Do ADHD Medications Work?
There are two classification of ADHD medications: stimulants and non-stimulants.
Stimulants are the most common type of medication prescribed for ADHD. They have the longest track record for treating ADHD and the most research to back up their effectiveness.
Stimulant ADHD medications include:
• Amphetamine (Adzenys XR ODT, Evekeo)
• Amphetamine/Dextroamphetamine (Adderall and Adderall XR)
• Dextroamphetamine (Dexedrine, ProCentra, Zenzedi)
• Dexmethylphenidate (Focalin and Focalin XR)
• Lisdexamfetamine (Vyvanse)
• Methylphenidate (Concerta, Daytrana, Metadate CD and Metadate ER, Methylin and Methylin ER, Ritalin, Ritalin SR, Ritalin LA, Quillivant XR)
For many people with ADHD, stimulant medications boost concentration and focus while reducing hyperactive and impulsive behaviors. Stimulants are believed to work by increasing dopamine levels in the brain by inhibiting its re-uptake mechanism. Dopamine is a neurotransmitter associated with motivation, pleasure, attention, and movement. There is concern that the re-uptake inhibition may deplete neurotransmitters throughout the body and potential neurotoxicity of amphetamine.
In addition to the traditional stimulant drugs, there are several other non-stimulant medications used to treat ADHD. In cases where stimulants don’t work or cause unpleasant side effects, non-stimulants might be used. These include certain antidepressants and blood pressure medications, and are shown to improve concentration and impulse control.
Non-stimulant ADHD medications include:
• Amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), or other tricyclic antidepressants
• Bupropion (Wellbutrin)
• Escitalopram (Lexapro) and sertraline (Zoloft)
• Venlafaxine (Effexor)
Atomoxetine (Strattera) was the first and only non-stimulant ADHD medications approved by the FDA. Unlike stimulants, which affect dopamine, Strattera boosts the levels of norepinephrine, a different brain chemical.
Warning, Strattera may cause an increase in suicidal thoughts and actions in some children and teenagers, especially if your child has bipolar disorder or depression in addition to ADHD.
This is a tough choice. Do I want a hyper child? Or do I want a suicidal child? Hmmm…
Guanfacine (Intuniv) is also approved for children and teens between ages 6 and 17.
Certain blood pressure medications, such as clonidine (Catapres) and guanfacine (Tenex), has also been approved for treating ADHD. While these medications can be effective for hyperactivity, impulsivity, and aggression, they are not as effective when it comes to attention problems. These medications can also cause daytime drowsiness. If this happens, reducing the dose or spacing it out over the course of the day may solve the problem. If not, ask your doctor about trying another non-stimulant medication.
For people suffering from both ADHD and depression, certain antidepressants, which target multiple neurotransmitters in the brain, may be prescribed. Wellbutrin, also known by the generic name bupropion, is most widely used. Wellbutrin targets both norepinephrine and dopamine.
Another option is the use of tricyclic antidepressants, such as Imipramine (Tofranil), desipramine (Norpramine), and nortriptyline (Pamelor). Unlike the stimulant medications, tricyclic medications must be tapered off slowly. Stopping abruptly can cause aches and other flu-like symptoms.
In some children, tricyclics can affect brain wave activity. If your child has a seizure disorder, a tricyclic might exacerbate the problem. Discuss this matter with your doctor before starting your child on a tricyclic.
Tricyclics have also been known to affect the electrical conduction pattern within the heart, triggering a rapid pulse. This is a rare side effect, and it generally stops once the medication is stopped.
We have not even dive into all the side effects of ADHD medications, and so far, there are some very scary ones. Knowing what you are dealing with helps to make better decisions for your child and family.
Don’t rush into making a decision. ADHD symptoms can also be the results of other medical conditions or even malnutrition or nutrient deficiencies.
Related article: ADHD Symptoms or Something Else
Take your time to rule out other possibilities, weigh your options and get your child’s input in the decision-making process.
A friend of mine recently was faced with the decision to start ADHD medication for her daughter. The psychiatrist explained to her daughter why she needs medication, and her daughter flat out told both my friend and the psychiatrist “no, i don’t need medication! I can focus on my own”. For sure, after that doctor’s visit, my friend’s daughter changed her behaviors and start showing more focus and completing tasks as expected.
Trust your instincts and do what feels right to you. Don’t let anyone—be it your physician or the principal at your child’s school—pressure your child into medication if you’re not comfortable with it. Remember: medication isn’t the only treatment option, and it’s not even a good option to start with.
ADHD medications should be the absolute last resort if nothing else works.