I am 35. Which ADHD medicine has the fewest side effects?

Question

Hi doctor,

I am 35 and just got diagnosed with ADHD last month, which explains so much about my life. I have been struggling since childhood, but everyone just said I was lazy or not trying hard enough. My psychiatrist started me on Adderall XR 20 mg, but I am having terrible side effects. My heart races, my pulse is around 110 beats per minute most of the day, and I cannot sleep at night.

I lost 12 pounds in three weeks because the medication kills my appetite. The ADHD symptoms are better. I can actually focus and finish tasks now, but the side effects are unbearable. I am also dealing with PMDD, and my mood crashes hard the week before my period. The stimulant seems to make that worse. I tried Strattera before Adderall, but it made me so nauseous I could not keep anything down. My blood pressure went up to 142/88 mm Hg, which is concerning. need to find an ADHD medication that works without these problems.

Can hormones affect ADHD symptoms? I am way more scattered and forgetful during certain times of my cycle.

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

I can understand it must have been difficult for you to experience both ADHD (attention deficit hyperactivity disorder) and side effects. The side effects you mentioned are due to stimulant use. Usually, these improve with the passage of time, and stimulants are always the best choice due to their efficacy. But the side effects you mentioned are red flags and need a medication change.

Another challenge is your PMDD (premenstrual dysphoric disorder), which causes irritability, mood swings, and also worsens the ADHD and stimulant side effects. Keeping in view the raised pulse, blood pressure, and irritability, Atmoxetine will also not be a good option for you. A2 agonists such as Clonidine and Guanfacine are the best possible medications that you need. They were originally made to reduce blood pressure, but they are evidence-based management for ADHD symptoms in those who cannot tolerate the side effects of stimulants.

They do not increase blood pressure, pulse, and also improve insomnia. Low blood pressure and dizziness should be monitored for a few days, but they usually improve with the passage of time. It will not only improve your ADHD symptoms but also manage your anxiety. Augment behavioral therapy and lifestyle modifications along with ADHD medicines, such as coaching, CBT (cognitive behavioral therapy), dividing tasks into small, manageable portions, and following sleep hygiene. They are as important as medicine. For PMDD, take Sertraline intermittently for 14 days, one to two weeks before menstruation. But start it after you get stable on ADHD medicines. Rule out Hyperthyroidism and co-morbid anxiety disorder. If you have other questions, please feel free to ask.

I hope this information will help you.

Thanks.