Introduction
In the fall of 2022, the Swedish National Board of Health and Welfare released new national guidelines for ADHD and autism. These guidelines emphasize the importance of early interventions and short waiting times for assessments, services that Orange Psychiatry is committed to providing. Regarding ADHD management, the guidelines primarily recommend treatments such as Cognitive Behavioral Therapy (CBT) and medication. In this article, we will explore various ADHD medications and provide essential information about them.
We will cover:
- Different types of ADHD medications
- How they function and influence your brain and behavior
- Their effects and potential side effects
- Our approach to medication management
- A concluding summary
Various types of ADHD medications
In Sweden, five different medications are approved for the treatment of ADHD. These can be categorized into two groups:
- Central nervous system (CNS) stimulants
- Non-stimulant medications: guanfacine and atomoxetine
CNS stimulant medications
CNS stimulants are the most commonly used treatments for ADHD in adults. Research indicates that these medications increase levels of dopamine and norepinephrine, two types of neurotransmitters. They affect brain regions responsible for attention and behavioral regulation, areas often challenging for individuals with ADHD. Common side effects of CNS stimulants include dry mouth, reduced appetite, elevated blood pressure, and increased heart rate. Therefore, we conduct regular follow-ups with our ADHD patients to monitor these parameters.
The most common types of CNS stimulant medications are:
- Lisdexamfetamine
- Methylphenidate
- Dexamphetamine
Let’s take a closer look at these medications.
Methylphenidate
Methylphenidate is the first-line treatment for ADHD according to the Swedish Medical Products Agency. It is available in both short-acting and long-acting formulations. Primarily, only the long-acting preparations are used for adults with ADHD, but exceptions can be made when deemed necessary to achieve satisfactory effects. The short-acting variant needs to be taken multiple times a day to maintain adequate effect throughout the day.
Methylphenidate is available under various brand names for adults with ADHD, including:
- Concerta
- Ritalin
- Medikinet
These medications come in different strengths to help find a dose that suits the individual patient.
Lisdexamfetamine
Lisdexamfetamine is considered a second-line treatment for ADHD. Its mechanism of action is similar to that of methylphenidate, increasing concentrations of dopamine and norepinephrine. Lisdexamfetamine is only available in a long-acting form and comes in various strengths.
Lisdexamfetamine is sold under the brand name Elvanse.
Dexamphetamine
Dexamphetamine is chemically very similar to lisdexamfetamine (Elvanse) but is short-acting. In some cases, it can be combined with lisdexamfetamine to achieve satisfactory effects throughout the day.
Dexamphetamine is sold under the brand name Attentin.
Non-stimulant medications
Non-stimulant medications are considered second-line treatments for ADHD but can be effective. They are mainly used when CNS stimulants cannot be used due to lack of effect, side effects, or risk of misuse or dependence. There are two medications in this group.
Atomoxetine
Atomoxetine was originally a medication used to treat depression but is now primarily used for ADHD. Like CNS stimulants, it leads to an increase in norepinephrine and dopamine, but its mechanism of action differs slightly. The effect in ADHD patients can be somewhat weaker than that of CNS stimulants, although some studies suggest the effect is comparable. The medication can, like CNS stimulants, cause elevated blood pressure. Other side effects may include nausea or fatigue. Atomoxetine is not classified as a controlled substance and is also sold under the brand name Strattera.
Guanfacine
Guanfacine is a medication originally used to treat high blood pressure. It has been found to have some effect on ADHD but is only approved for treating children with ADHD. Exceptionally, it is used in adults, but the effect is often milder. It is not uncommon for patients to feel drowsy when taking guanfacine. Since the medication can lower blood pressure, it is sometimes used in combination with CNS stimulants, which can have elevated blood pressure as a side effect. This combination can achieve a good effect on ADHD symptoms while maintaining stable blood pressure.
Guanfacine is also sold under the brand name Intuniv.
Individualized adjustment of ADHD medication
When starting medication for ADHD, it’s important to know that individuals respond differently to these drugs. What works well for one person may be ineffective or cause side effects in another. Therefore, it’s not possible to say that one medication is better than another. Additionally, we metabolize medications at different rates; one person may experience effects throughout the day, while another may only feel effects until lunchtime and need an additional dose in the afternoon. At Orange Psychiatry, we always strive for an optimal balance between the medication’s effect and potential side effects.
If you have undergone an assessment and been diagnosed with ADHD, we at Orange Psychiatry offer various treatments and interventions, including targeted treatment in the form of medication. There are currently several different medications used in the treatment of ADHD.