Medication

ADHD is a neurobiological disorder. There is reduced functioning of certain areas of the brain and reduced activity of messenger substances, the neurotransmitters, such as dopamine and norepinephrine. Medication corrects this reduced activity.

ADHDcentraal treats its patients according to the applicable guidelines within psychiatry (see also: https://www.ggzstandaarden.nl/zorgstandaarden/adhd/behandeling-en-begeleiding/behandeling-en-begeleiding/combinatiebehandeling). Within these guidelines, medication has an important role. Treatment with medication is very effective. In the majority of patients, the symptoms become much more manageable.

The ADHDcentraal treatment protocol allows for medication to be administered under supervision, so that you as a patient can experience for yourself whether medication has a positive effect on your ADHD symptoms.

Some patients who are referred to us indicate that they do not wish to consider medication as part of their treatment. In those cases, we advise these patients to apply to one of our fellow institutions, for example psychologist practices, which are more specialised in this type of treatment.

If, during the course of treatment, you and your therapist come to the conclusion that medication is not appropriate for you, we will of course work with you to see what type of support and therapy we can offer.

What can you expect from medication?

When the drug works, our patients say they feel calmer, their heads are clearer, their thoughts are no longer jumbled up and they literally have a better understanding of their brains. There is also much less chaos in actions, more overview in planning and things that were not done before (or were done halfway), are now done. It seems as if there is more sense in bringing structure to life. Tidying up becomes easier, studies and housework are manageable. People listen better and forget fewer things. What is also experienced as very pleasant is that there are fewer conflicts: because the impulsivity decreases, there are fewer fights.

Many people are afraid that they will no longer feel like themselves. Of course, this cannot be the intention of medication. We therefore search with you for the right medicine in the right dosage, until you feel more like yourself.

There are a number of medications for treating ADHD. The stimulants are the drugs of first choice. They compensate for the shortage of dopamine and/or norepinephrine by inhibiting the reuptake or by stimulating the production. When used properly, stimulants are safe, effective and non-addictive.

Methylphenidate

Short-acting methylphenidate is best known as Ritalin. It inhibits the reuptake of dopamine and noradrenaline. It is an amphetamine, is not addictive and does not give a kick. It ‘puts the brakes on’, improves concentration, inner peace increases and many patients mention an increase in decisiveness. Ritalin only works for 2 to 4 hours. When it wears off, you can get a rebound (increased anxiety). It is therefore very important that it is taken regularly throughout the day. Side effects include high blood pressure, headaches, heart palpitations, difficulty falling asleep and loss of appetite. These side effects are usually mild and transient. The right dose and the frequency of intake must be determined in collaboration with a physician, usually in an accumulation schedule. Taking a tablet every 2 hours is almost impossible to maintain. For this reason, there are also longer-acting preparations on the market. The best-known of these is Concerta (oros-methylphenidate). This is methylphenidate that slowly releases more and more. It therefore works for approximately 12 hours. This reduces the chance of withdrawal and rebound symptoms during the day. The day of an adult lasts approximately 16 hours. This means that usually a capsule will be taken twice a day or that separate tablets will be used as the first dose wears off. Long-acting medication is (partly) reimbursed by some insurance companies. For a recent overview of these reimbursements, please visit www.medicijnkosten.nl.

Other long-acting preparations containing methylphenidate include: Medikinet CR, Equasym XL and Sandoz Retard.

Dexamphetamine

This amphetamine stimulates the release of dopamine and noradrenaline. It has a slightly longer duration of action than methylphenidate, about 5 hours, and it causes slightly milder side effects. It is about twice as strong as methylphenidate. Tablets contain 5 mg. Adults usually get by with one dose three times a day. Dexamphetamine is available under the registered brand names Tentin and Elvanse (Elvanse has a different release profile and is longer-acting).

Bupropion

Bupropion (Wellbutrin XR) is a reuptake inhibitor of dopamine and noradrenaline.
The slow-acting Wellbutrin XR can be taken once a day and is also effective in depression. The effect on inner turmoil and concentration takes longer than with the stimulants. The effect is generally noticeable after 2 weeks. After 4 weeks, the dose can be increased. Nausea, palpitations and headaches are side effects in the beginning but should disappear after a few weeks.

Atomoxetine

Atomoxetine (Strattera) is a reuptake inhibitor of mainly noradrenaline. It works for 24 hours, so you only need to take it once a day. The effect begins after 2 to 3 weeks. Only after 6 weeks can its effectiveness be properly assessed. The side effects are initially nausea, fatigue and dizziness; flu-like symptoms. These usually subside after a few days.

Melatonin

Because many adults with ADHD have a shifted sleep rhythm, falling asleep later than desired, fatigue often occurs. Melatonin can help to restore the rhythm. It is a hormone produced naturally by the body, which is broken down under the influence of light and produced when it gets dark. This is how it affects your biorhythm. Hardly any side effects are reported. It is also available as a dietary supplement in pharmacies. For serious sleep problems, between 2 and 5 mg are prescribed.

Good to know

In adults, a number of drugs are prescribed off-label. We know that they can have a nice effect on the core symptoms, but the drugs are used while there is officially a different indication. Your doctor will explain this to you.
ADHD, medication and driving
For some disorders and medications, legal rules apply. See the link below for further information.
www.cbr.nl/nl/rijbewijs-houden/nl/hoe-kan-ik-rijden-met/hoe-kan-ik-rijden-met-adhd.htm