The use of stimulant medications for the treatment of Adult ADHD has increased tremendously. I now see many psychiatrists in the community prescribing them along with antidepressants in those without ADHD. Before you commit to the use of stimulant medications here are ten things you need to now—some reassuring and some not.
1. They’re popular: Adults now receive one third of all prescriptions for ADHD medications in the US, a pattern that is not seen in other countries.
2. Kids only? The bulk of the available data on the treatment of ADHD come from studies in children, which limits the ability to make evidence-based recommendations for adults.
3. Legit for adults? It surprises many of my patients to learn that only some of the stimulants, like Adderall XR, Concerta, Vyvanse, and Focalin XR, are FDA-approved for use in adults. Adderall XR and Concerta are available in generic form so will be much cheaper for you.
4. Warnings for women: The warnings issued along with Adderall, Ritalin, and Vyvanse acknowledge that women of reproductive age should not take these stimulant medications. Use of stimulant medications during pregnancy may lead to increased risk of premature delivery and low birth weight, infants may experience symptoms of withdrawal, and birth defects have been reported with women taking Adderall during the first trimester. So any woman on these meds who plans on conceiving will have to be weaned off of them.
5. The heart: While stimulants can increase heart rate and blood pressure a large study published in JAMA in December 2011 (http://jama.jamanetwork.com/article.aspx?articleid=1104778) showed there was no increased cardiovascular risk in middle-aged adults taking stimulant medications. This was reassuring.
6. Use and abuse: Abuse potential exists, and this is different for adults who require larger doses of stimulants than those prescribed to children.
7. The energy pill: Many people feel better on stimulants and have difficulty weaning off them and feeling the “normal” periods of fatigue during the day, along with the possibility they may not feel as productive as they did while on them. Stimulants improve cognitive function in most people. As an example, methylphenidate (Ritalin) has been found in studies to reduce driving errors in all adults, not just adults with ADHD. Thus, a person’s response cannot be used to confirm or exclude the diagnosis of ADHD.
8. The downsides: If you find yourself experiencing insomnia, anxiety, weight loss or elevated heart rate or blood pressure from your stimulant, ask your doctor about non-stimulant options.
9. Finally cheaper: There has been a run on the generic options for ADHD medications like Adderall XR (amphetamine salt combination XR) and Concerta (methylphenidate ER), so many pharmacies were experiencing a shortage. This was due to increased demand and a decrease in supply and is not expected to end anytime soon.
10. Heat: During exercise know that stimulants may potentially increase your risk of developing heat illness. During the hot months watch out for heat illness and stay hydrated.