Our treatment
Medication
ADHD is a neurobiological disorder, certain areas of the brain do not function as well and there is less activity of messenger substances, the neurotransmitters, such as dopamine and norepinephrine. Medication restores this reduced activity.
Treatment with medication is very effective. Most patients see and experience a strong reduction in ADHD symptoms.
Within the carefully designed treatment protocol, it is possible to be administered medication under supervision, so you can experience for yourself whether medication has a positive effect on your symptoms.
Some patients do not want medication as part of treatment. Together we will discuss what counseling and therapy we can offer as an alternative.
What to expect from medication
Patients feel calmer with medication, are clearer in their heads, no longer have jumbled suspicions, but literally have the brain together better. These patients experience much less chaos in what they do, can plan better and are better able to finish things. More structure emerges in your life. There is more oversight in the areas of study, work and household. You can listen better and you forget less. What is also perceived as very pleasant is that there are fewer conflicts: because your impulsivity decreases, there are less frequent quarrels.
Sometimes there are patients who fear they will no longer be themselves. That, of course, is not the purpose of medication. So we work with you to find the right medicine and dosage. So that you do experience the effect but with no or as few side effects as possible.
There are a number of medications available to treat ADHD. The drugs of first choice are the stimulants. They compensate for the deficits of dopamine and/or norepinephrine in the brain by inhibiting their reuptake or by stimulating their production. When used properly, these stimulant medications are safe, effective and non-addictive.
Want to know more about how different drugs work? Read more below.
Methylphenidate
Short-acting methylphenidate you probably know by the name Ritalin. It inhibits the reuptake of dopamine and norepinephrine. It puts the brakes on, so to speak, and thus improves your concentration and inner peace. Many patients also say they are more decisive. Ritalin only works for 2 to 4 hours. When it wears off, you may suffer from the so-called rebound, an amplified restlessness. Therefore, it is important to take it regularly throughout the day. Side effects include: high blood pressure, headache, palpitations, trouble falling asleep and decreased appetite. These side effects are usually mild and pass again. The correct dose and frequency of intake should be determined in collaboration with a physician/nurse specialist, usually in a build-up schedule. Taking a tablet every two hours is very difficult to maintain. Consequently, there are longer-acting preparations on the market. The best known is Concerta (oros-methylphenidate). It is a tablet of methylphenidate that slowly releases a little bit at a time, making it work for about 12 hours. This reduces the chance of working out and rebound symptoms during the day. An adult’s day lasts about 16 hours, which usually means taking a capsule twice a day. Sometimes short-acting tablets are used in addition once the first dose has worn off. Long-acting medication is (partially) reimbursed by some insurance companies. For a recent listing of these fees, visit www.medicijnkosten.nl.
Other long-acting preparations containing methylphenidate include: Medikinet CR, Equasym XL and Sandoz Retard.
Dexamphetamine
This amphetamine promotes the release of dopamine and norepinephrine. It has a slightly longer duration of action, about five hours, than methylphenidate, and it produces slightly milder side effects. It is about twice as strong as methylphenidate. Dexamphetamine is available under the registered brand names Tentin and Elvanse, among others.
Bupropion
Bupropion (Wellbutrin XR) is a reuptake inhibitor of dopamine and norepinephrine.
The slow-acting Wellbutrin XR can be taken once a day and is also effective for depression. The effect on inner restlessness and concentration takes longer than with stimulants. The effect is usually noticeable after two weeks. After four weeks, the dose can be increased, if necessary. The side effects; nausea, palpitations and headaches do occur at first but usually disappear after a few weeks.
Atomoxetine
Atomoxetine (Strattera) is a reuptake inhibitor of norepinephrine in particular. It works for 24 hours, so you also only need to take it once a day. The effect begins after two to three weeks. Only after six weeks can it be properly assessed whether it is effective. The side effects at first are nausea, fatigue and dizziness; flu-like symptoms. But even these usually pass after a few days.
Melatonin
Because many adults with ADHD have a shifted sleep rhythm, fatigue often ensues. Melatonin can help restore your rhythm. It is a body’s own hormone, which is broken down under the influence of light and is produced when it gets dark. Thus, it affects your biorhythms. Hardly any side effects are reported.
Good to know
In adults, a number of agents are prescribed off-label. These are drugs that we know can have a nice effect on the core symptoms of ADHD but these drugs are used when there is officially another indication for them.