Increasing ADHD Medications: The Clinical Outcome

Introduction:

ADHD, or attention deficit hyperactivity disorder, is a psychiatric disorder. This primarily affects children and adolescents. One of every 100 children is affected by this condition. Though this condition can be diagnosed at an early age, in certain cases, the symptoms may persist in adults. ADHD is known for the impairment of cognitive functions, which may be responsible for functional brain abnormalities.

What Are the Treatment Options for ADHD?

The treatment of ADHD starts with the identification of the disorders and addressing the issue. Early diagnosis is key to successful therapy. Non-pharmacological treatment options include processes like cognitive behavioral therapy, psychological counseling, family and marital therapy, and parenting skills training. It is important to understand that support from parents and different support groups like teachers, family members, and psychologists is important for successful treatment. Children should be taught about stress management protocols and specific behavioral management protocols. In severe cases, pharmacological options can be explored.

However, for adult patients, treatment options are difficult. Due to the complexities of the disease pattern, it is difficult to formulate proper treatment protocols in such cases. Treatment protocols like behavioral management protocols, cognitive retraining, and brain stimulation techniques are very helpful.

What Are the Causes of the Increase in the Medications in ADHD Treatment?

The rise in the use of prescription drugs among adult ADHD patients is due to the following reasons:

1. One of the main reasons is the presence of other comorbid conditions. Due to the presence of several comorbid conditions like bipolar disorder, anxiety disorder, and major depressive disorder, it is often difficult to treat such patients with traditional non-pharmacological treatment approaches.

2. In many cases, symptoms are severe due to past negligence. As a result, pharmacological options are used to treat such conditions.

3. In certain cases, patients want rapid relief from complications and symptoms. In those cases, medications have shown a 75 percent immediate effect.

4. Due to the increase in the number of telemedicine and online drug delivery systems, ordering drugs has become easy.

What Are the Medications for ADHD?

The medications used for the treatment of ADHD are divided into two types. These are stimulant or non-stimulant medications. Apart from this, additional drugs are prescribed based on the presence of additional comorbid conditions. The drugs used for ADHD treatment are the following.

Stimulant Medication:

These drugs are the most commonly used medication for the treatment of ADHD. They have almost 80 percent responsiveness. These drugs change behavioral patterns, attention span, distractibility, impulsivity, hyperactivity, and restlessness. The drugs belonging to this category are;

1. Amphetamine:

Alpha-methylphenethylamine, or Amphetamine, is the most potent drug for the treatment of ADHD. However, it was found that this molecule existed in two different forms: the dextro form and the levo form. The potential therapeutic benefits of using Amphetamine for treating ADHD were first observed in 1937. However, a clinical trial conducted in the 1970s revealed that the therapeutic potential of l-amphetamine is significantly lower compared to Dextroamphetamine. Dextroamphetamine is composed of dextroamphetamine sulfate, while plain Amphetamine is the only available combination of d-amphetamine and L-amphetamine salts, and is composed of a 3:1 ratio of these two isomers. Amphetamine functions as a stimulant on the central nervous system, resulting in increased levels of neurotransmitters such as dopamine, norepinephrine, and serotonin within the synaptic cleft. Its mechanism of action involves inhibiting the reuptake of monoamine oxidase, leading to a significant increase in monoamine concentrations like dopamine, norepinephrine, and serotonin. These effects are contributed through the activation of various receptors, including TAAR1 (a receptor involved in amine recognition in the brain), DAT (dopamine receptor), NET (norepinephrine receptor), and SERT (serotonin receptor).

2. Methylphenidate:

This is another central nervous system stimulant that is used both for children and adults for the treatment of ADHD. The commercial formulation of methylphenidate contains both racemic of the d- and l-isomers. This drug prevents the reuptake of neurotransmitters like norepinephrine (NE) and dopamine. As a result, the concentration of these neurotransmitters increased in the synaptic cleft region. Apart from this, it has a stimulant effect on the prefrontal cortex area of the brain. This drug is also known for improving the firing rate of neurons. All these actions have neuroprotective roles. As a result, this can be used in comorbid conditions associated with ADHD.

This drug is available in solutions, or the form of chewable tablets, immediate-release tablets, and extended-release tablets. It should be given to children who are aged six years and above. The initial dose starts from 10 milligrams. In adults, the maximum dose may go up to 60 milligrams per day. Nowadays, transdermal patches of the drug are available in 10, 15, 20, and 30 milligrams nominal doses over 9 hours.

Non-stimulant Medication:

These drugs are considered the second line of drugs in the treatment of ADHD. The responsiveness of these drugs is only up to 30 percent. However, these drugs are often combined with stimulant drugs. Also, these drugs are used in some cases to treat comorbid conditions. The drugs that belong to this category are;

1. Atomoxetine:

This is the first non-stimulant drug that has received FDA approval for ADHD treatment. This drug prevents the reuptake of norepinephrine and acts on the norepinephrine receptor (NET). The chemical compound is available in both R (-) and S (+) isomeric forms. However, the R (-) isomer is nine times more potent than the S (+) form. This drug is available as a hydrochloride salt in capsule format. The initial dose starts with 40 milligrams per day.

One of the main disadvantages of this drug is its slow onset of action. However, this drug is beneficial in ADHD patients suffering from substance use disorders.

2. Bupropion:

This is an antidepressant drug mainly used for smoking cessation. This drug also prevents the uptake of norepinephrine and dopamine. This is also used as the first line of the drug in ADHD patients suffering from substance abuse disorder.

What Are the Complications of Medications in ADHD?

It should be kept in mind that medications should be taken after consulting the doctor. Also, over and excessive use of medications can be fatal. The possible complications associated with these medications are;

1. Amphetamine can be harmful in patients suffering from cardiac complications. This may cause severe cardiomyopathy, myocardial infarctions, and tachycardia (increased heartbeat). It is also known for causing severe drug-related allergic reactions.

2. Atomoxetine is known for drug side effects like dizziness, headache, and severe skin rash. It may also cause severe liver toxicity.

3. Methylphenidate is known for the development of drug dependency. That is why a higher dose should be used very cautiously. Also, this drug may be associated with growth retardation and mood swings.

4. Bupropion can also be responsible for cardiac complications and complications like tremors. Overuse of this drug may also be associated with neurological abnormalities.

Conclusion:

Adult ADHD can be a severe problem for any individual. Due to the presence of complex symptoms and additional comorbid conditions, it is often difficult to treat such conditions with traditional mood treatment. In such cases, medications can be helpful and provide rapid relief. However, excessive use of these medications may be associated with severe local and systemic complications. Severe cardiac complications associated with such drugs may lead to death. It is necessary to take precautions before consuming such medications.