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 it’s 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 taking medication as part of their treatment. Together with these patients, we will discuss which types of therapy and guidance we can offer as an alternative.
What can you expect from medication?
When the medications works, our patients tell that they feel calmer, their heads are clearer, their thoughts are no longer jumbled up and they literally have a better understanding of their brains. They also experience less chaos in actions, more overview in planning and things that were not done before (or were done halfway), are now completed. More structure is created in life. Tidying up becomes easier and studies and housework are manageable. People become better listeners and forget fewer things. Another pleasant change is the decrease in conflicts: because impulsivity is reduced, there are fewer fights.
Many people are afraid that they will no longer feel like themselves. Of course, this is not the aim when using medication. Therefore we explore with you what the right medicine is in the right dosage, until you feel more like yourself.
There are a number of medications for treating ADHD. Stimulants are the preferred drugs. 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.
Short-acting methylphenidate is best known as Ritalin. It inhibits the reuptake of dopamine and noradrenaline. It is an amphetamine, it is not addictive and does not give a kick. It ‘puts the brakes on’, improves concentration, increases inner peace 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 highly 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 during its duration. 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.
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. Its 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 (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 for 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 initially side effects but should disappear after a few weeks.
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 is noticeable 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.
Because many adults with ADHD have a shifted sleep rhythm, which results in falling asleep later than desired, fatigue often occurs. Melatonin can help to restore the rhythm. It’s 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
For adults, a number of drugs are prescribed off-label. We know that they can have a positive effect on the core symptoms, but the medication officially has a different indication.