Evolution of the treatment of adult ADHD:
Historically, treatment for adult ADHD began with pharmacological interventions; in the mid-20th century, stimulants like Benzedrine, followed by methylphenidate (Ritalin) in the 1950s, were used to manage what was then often called “minimal brain dysfunction” or hyperactivity in children, with use extending to adults as understanding of ADHD matured. Over time, options like ADHD medication in Mississauga have expanded to include not only stimulants but also non-stimulant medications, such as atomoxetine (Strattera), introduced in the early 2000s to provide alternatives for those who didn’t respond to or tolerate stimulants well. Behavioral treatments also evolved from basic behavior modification in the 1970s to more sophisticated cognitive-behavioral therapies (CBT) by the late 20th century, tailored to address executive function challenges in adults. Psychoeducation became integral once ADHD was recognized in adults, helping individuals understand and manage their condition. Moreover, the 1990s and 2000s saw an increase in holistic approaches, including dietary interventions, exercise, mindfulness, and coaching specifically designed for ADHD, reflecting a broader understanding of the disorder’s impact on adult life.
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Current treatments for adult ADHD:
Current treatments for adult ADHD encompass both pharmacological and non-pharmacological interventions. Pharmacologically, stimulants like methylphenidate and amphetamines are commonly prescribed due to their effectiveness in managing ADHD symptoms by enhancing dopamine and norepinephrine activity in the brain. Non-stimulant medications, such as atomoxetine, are also utilized, particularly when stimulants are not suitable or are ineffective. Beyond medication, cognitive-behavioral therapy (CBT) plays a crucial role, helping adults develop strategies for time management, organization, and coping with the emotional and social impacts of ADHD. Additionally, treatments may involve psychoeducation, where individuals learn about ADHD and its management, lifestyle modifications including diet, exercise, and sleep optimization, and sometimes alternative or complementary therapies like ADHD coaching, mindfulness, and, as mentioned in some discussions, newer treatments like ketamine-assisted therapy for comprehensive management.
Medical treatments for ADHD:
Medications used to treat adult ADHD can be broadly classified into two categories: stimulants and non-stimulants.
Stimulants: Ritalin, Vyvanse, Adderall, Concerta for ADHD, and more are often the first line of treatment and are generally more effective for many people suffering from adult ADHD. Here are approved or common medications from the 2 categories of stimulant medications:
Methylphenidate-based medications (with available forms and sizes in Canada):
- Concerta (extended-release methylphenidate), Available in 18mg, 27mg, 36mg, 54mg tablets.
- Ritalin ER (or SR) (extended-release methylphenidate), Available in 18mg, 20mg, 27mg, 36mg, 54mg tablets.
- Biphentin (extended-release methylphenidate), Available in 10mg, 15mg, 20mg, 30mg, 40mg, 50mg, 60mg, 80mg capsules.
- Foquest (extended-release methylphenidate), Available in 25mg, 35mg, 45mg, 55mg, 70mg, 85mg, 100mg capsules.
- Methylphenidate CR, Available in 10mg, 15mg, 20mg, 30mg, 40mg, 50mg, 60mg, 80mg capsules.
- Quillivant ER (extended-release methylphenidate), Available in 20mg, 30mg, 40mg chewable tablets.
- Ritalin (methylphenidate), short acting. Available in 5mg, 10mg, 20mg tablets.
Amphatime-based medications (with available forms and sizes in Canada):
- Vyvanse (lisdexamfetamine), Available in 10mg, 15mg, 20mg, 30mg, 40mg, 50mg, 60mg, 70mg capsules.
- Amphetamine XR or SR (extended-release amphetamine), Available in 5mg, 10mg, 15mg, 20mg, 25mg, and 30mg capsules.
- Dextromphetamine SR (extended-release dextroamphetamine), Available in 5mg, 10mg, 15mg capsules.
- Dexedrin (Dextromphetamine), short acting. Available in 5mg tablets.
Extended-release versions of these medications are favored because they reduce the risk of misuse. All these drugs carry a risk of dependency and abuse, and thus, they should only be prescribed and monitored by medical doctors who are experienced in mental health.
Non-Stimulants: Non-stimulant medications are an important alternative for individuals with ADHD who may not respond well to stimulants or have contraindications for their use. They can also be added to stimulants medications to improve their effectiveness. Here are the commonly prescribed non-stimulant medications for ADHD:
- Atomoxetine (Strattera): Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) and is the first non-stimulant medication approved by the FDA for the treatment of ADHD in children, adolescents, and adults. It works by increasing levels of norepinephrine in the brain, which helps improve attention and reduce impulsivity and hyperactivity.
- Guanfacine (Intuniv, Tenex): Guanfacine is an alpha-2A adrenergic receptor agonist. Intuniv is a long-acting form of guanfacine specifically approved for the treatment of ADHD in children and adolescents. It helps improve symptoms by affecting receptors in the brain that are thought to improve attention and reduce distractibility and hyperactivity.
- Bupropion (Wellbutrin): While not specifically approved by the FDA for the treatment of ADHD, bupropion is sometimes used off-label. It is an atypical antidepressant that affects the neurotransmitters norepinephrine and dopamine, which can help improve focus and reduce impulsivity and hyperactivity in individuals with ADHD.
- Clonidine (Kapvay, Catapres): Clonidine is another alpha-2 adrenergic agonist. Kapvay is the extended-release form specifically approved for the treatment of ADHD. Clonidine can help manage symptoms by affecting the brain’s receptors, leading to improved impulse control and reduced hyperactivity.
- Tricyclic Antidepressants (TCAs): Certain TCAs, such as imipramine (Tofranil) and nortriptyline (Pamelor), are sometimes used off-label to treat ADHD. They work by affecting the levels of norepinephrine and serotonin in the brain, which can help improve attention and reduce ADHD symptoms.