ADHD in Adults - Treatment
This is an exciting time in ADHD research. The expansion of knowledge in genetics, brain imaging, and behavioral research is leading to a better understanding of the causes of the disorder, how to prevent it, and how to develop more effective treatments for all age groups.
Currently available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments include various types of psychotherapy, medication, education or training, or a combination of treatments.
Education and psychotherapy
A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as a large calendar or date book, lists, reminder notes, and by assigning a special place for keys, bills, and paperwork. Large tasks can be broken down into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment.
Psychotherapy, including cognitive behavioral therapy, also can help change one's poor self-image by examining the experiences that produced it. The therapist encourages the adult with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.
Medications
ADHD medications, including extended-release forms, often are prescribed for adults with ADHD, but not all of these medications are approved for adults.16 However, those not approved for adults still may be prescribed by a doctor on an "off-label" basis.
The most common type of medication used for treating ADHD is called a "stimulant." Although it may seem unusual to treat ADHD with a medication considered a stimulant, it actually has a calming. Many types of stimulant medications are available. A few other ADHD medications are non-stimulants and work differently than stimulants. For many, ADHD medications reduce hyperactivity and impulsivity and improve the ability to focus, work, and learn. Medication also may improve physical coordination.
Although not FDA-approved specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. Older antidepressants, called tricyclics, sometimes are used because they, like stimulants, affect the brain chemicals norepinephrine and dopamine. A newer antidepressant, venlafaxine (Effexor), also may be prescribed for its effect on the brain chemical norepinephrine. And in recent clinical trials, the antidepressant bupropion (Wellbutrin), which affects the brain chemical dopamine, showed benefits for adults with ADHD.17
Adult prescriptions for stimulants and other medications require special considerations. For example, adults often require other medications for physical problems, such as diabetes or high blood pressure, or for anxiety and depression. Some of these medications may interact badly with stimulants. An adult with ADHD should diskuss potential medication options with his or her doctor. These and other issues must be taken into account when a medication is prescribed.
NOTE: "extended release" means the medication is released gradually so that a controlled amount enters the body over a period of time. "Long acting" means the medication stays in the body for a long time.
Current medications do not cure ADHD. Rather, they control the symptoms for as long as they are taken. Research shows that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the patient's needs.12
What are the side effects of stimulant medications?
Under medical supervision, stimulant medications are considered safe. The most commonly reported side effects are decreased appetite, sleep problems, anxiety, and irritability. Some patients also report mild stomachaches or headaches or may have a personality change such as appearing “flat” or without emotion. Most side effects are minor and disappear over time or if the dosage level is lowered. Talk with your doctor if you see any of these side effects.
US FDA warning on possible rare side effects
In 2007, the United States FDA required that all makers of ADHD medications develop Patient Medication Guides that contain information about the risks associated with the medications. The guides must alert patients that the medications may lead to possible cardiovascular (heart and blood) or psychiatric problems. The agency undertook this precaution when a review of data found that ADHD patients with existing heart conditions had a slightly higher risk of strokes, heart attacks, and/or sudden death when taking the medications.
The review also found a slight increased risk, about 1 in 1,000, for medication-related psychiatric problems, such as hearing voices, having hallucinations, becoming suspicious for no reason, or becoming manic (an overly high mood), even in patients without a history of psychiatric problems. The FDA recommends that any treatment plan for ADHD include a detailed behavioral health history, including family history and medication history as well as examination for existing cardiovascular and behavioral health problems.
For some adults, a diagnosis of ADHD can bring a sense of relief. Adults who have had the disorder since childhood, but who have not been diagnosed, may have developed negative feelings about themselves over the years. Receiving a diagnosis allows them to understand the reasons for their problems, and treatment will allow them to deal with their problems more effectively.
