Ritalin, Adderall, Focalin, Strattera, Wellbutrin: Are ADHD drugs right for you or your child? Here’s what you need to know, including common side effects and how to take them responsibly.
ADHD medication can help reduce symptoms of hyperactivity, inattentiveness, and impulsivity in children and adults with attention deficit hyperactivity disorder, formerly known as ADD. However, ADHD medications don’t cure ADHD. If you stop taking the medication, your symptoms will return. They can also come with side effects and risks—and they’re not the only treatment option for managing your symptoms.
Whether you’re the parent or the patient, it’s important to understand the facts about ADHD medication so you can make an informed decision about what’s best for you or your child.
The first thing to understand is exactly what ADHD medications can and can’t do.
ADHD medication may help improve your ability to concentrate, control impulses, plan ahead, and follow through with tasks. However, it isn’t a magic pill that will fix all of your or your child’s problems.
Even when the medication is working, though, some symptoms may persist. A child with ADHD might still struggle with forgetfulness, emotional problems, and social awkwardness, for example, or an adult with disorganization, distractibility, and relationship difficulties. That’s why it’s important to also make lifestyle changes to help manage your symptoms, including regular exercise, a healthy diet, and sufficient sleep.
[Read: Tips for Managing Adult ADHD or ADHD Parenting Tips]
It's also important to remember that each person responds differently to ADHD medication. What works for one person may not work for you or your child, and the effectiveness can also vary. Some people experience dramatic improvement while others experience only modest or minimal gains.
There are so many different ADHD medications available, finding the right one can often seem overwhelming. It may require patience and some trial and error with your doctor to find the specific drug and dosage that works best for you or your child.
Since the effects of ADHD medication can vary so much, its use should always be personalized to the individual and closely monitored by a doctor. When medication for ADHD is not carefully monitored, it may be less effective and more risky.
Stimulants are the most common type of medication prescribed for attention deficit disorder. They have the longest track record for treating ADHD and the most research to back up their effectiveness. The stimulant class of medication includes widely used drugs such as:
Stimulants are believed to work by increasing dopamine levels in the brain. Dopamine is a neurotransmitter associated with motivation, pleasure, attention, and movement. For many people with ADHD, stimulant medications boost concentration and focus while reducing hyperactive and impulsive behaviors.
Stimulants for ADHD come in both short- and long-acting dosages. Short-acting stimulants peak after several hours, and must be taken 2-3 times a day. Long-acting or extended-release stimulants last 8-12 hours, and are usually taken just once a day.
The long-acting versions of ADHD medication are often preferred, since people with ADHD often have trouble remembering to take their pills. Taking just one dose a day is much easier and more convenient.
Common side effects of stimulants include:
Stimulant medications may also cause personality changes. Some people become withdrawn, listless, rigid, or less spontaneous and talkative. Others develop obsessive-compulsive symptoms.
Since stimulants raise blood pressure and heart rate, many experts worry about the dangers of taking these ADHD drugs for extended periods.
Beyond the potential side effects, there are a number of safety concerns associated with the use of stimulant medications for ADHD.
Effect on the developing brain. The long-term impact of ADHD medication on the youthful, developing brain is not yet known. Some researchers are concerned that the use of stimulant drugs in children and teens might interfere with normal brain development.
Heart-related problems. ADHD stimulant medications have been found to cause sudden death in children and adults with heart conditions. The American Heart Association recommends that all individuals, including children, have a cardiac evaluation prior to starting a stimulant. An electrocardiogram is recommended if the person has a history of heart problems.
Psychiatric problems. Stimulants for ADHD can trigger or exacerbate symptoms of hostility, aggression, anxiety, depression, and paranoia. People with a personal or family history of suicide, depression, or bipolar disorder are at a particularly high risk, and should be carefully monitored when taking stimulants.
Potential for abuse. Stimulant abuse is a growing problem, particularly among teens and young adults. College students take this medication for a boost when cramming for exams or pulling all-nighters. Others abuse stimulant meds for their weight-loss properties. If your child is taking stimulants, make sure they aren't sharing the pills or selling them.
ADHD stimulants are not recommended for those with:
Call your doctor right away if you or your child experience any of the following symptoms while taking stimulant
medication for ADHD:
In addition to the traditional stimulant drugs, there are several other non-stimulant medications used to treat ADHD, including Strattera, Qelbree, Intuniv, and Kapvay.
Other medications are also sometimes used “off-label” in the treatment of attention deficit disorder (commonly prescribed by doctors for a purpose that has not been approved by the FDA). These include atypical antidepressants like Wellbutrin, and tricyclic antidepressants.
In many cases, non-stimulant medications are considered when stimulants haven't worked or have caused intolerable side effects. Non-stimulant ADHD medications tend to carry a lower risk of abuse or addiction. And while they are less likely to cause agitation or insomnia like stimulants, all medications come with some risk of side effects.
Strattera (atomoxetine) and Qelbree (viloxazine) are in a class of antidepressants called selective norepinephrine reuptake inhibitors (SNRIs), and are non-stimulant medications approved by the FDA for ADHD treatment. Unlike stimulants, which affect dopamine, Strattera and Qelbree boost the levels of norepinephrine, a different brain chemical, that can help improve attention and impulse control.
While Qelbree is approved for children aged 6 to 17, it’s sometimes also prescribed to adults. Strattera and Qelbree are longer-acting than stimulant drugs. Their effects last over 24 hours—making them a good option for those who have trouble getting started in the morning. The antidepressant properties also make it a good choice for those with co-existing anxiety or depression. Another plus is that it doesn't exacerbate tics or Tourette's Syndrome
On the other hand, Strattera doesn't appear to be as effective as the stimulant medications for treating symptoms of hyperactivity.
In both adults and children, common side effects of Strattera and Qelbree include:
Straterra and Qelbree can also cause insomnia and appetite suppression, but these side effects are more common in stimulants.
Adults using Straterra may also experience difficulty urinating, dry mouth, and sexual side effects, such as erectile dysfunction. In some cases, it can cause high blood pressure, elevated heart rate, and liver problems.
Like other SNRIs, Strattera and Qelbree may increase suicidal thoughts and actions in some people, especially children and younger adults who have bipolar disorder or depression in addition to ADHD.
Call the doctor immediately if your child shows agitation, irritability, suicidal thinking or behaviors, and
unusual changes in behavior.
In addition to Straterra and Qelbree, two blood pressure medications have been approved by the FDA to treat ADHD:
Kapvay and Intuniv are the extended-release versions of medications that have long been prescribed off-label for ADHD (Catapres and Telex).
Since these medications are designed to treat high blood pressure, they can have a calming effect, which can also be effective for ADHD symptoms like hyperactivity, impulsivity, and aggression. However, they may be less effective for countering problems with attention and focus.
Common side effects include:
Less common but more serious side effects can include changes in heart rhythm and a dangerous drop in blood pressure.
Wellbutrin, also known by the generic name bupropion, is the most widely used antidepressant prescribed “off-label” for treating ADHD. Again, it can be particularly appropriate for those suffering from both ADHD and depression or anxiety. Your doctor may also suggest Wellbutrin if stimulants have been ineffective, their side effects too severe, or you have a substance use disorder that means you have a higher risk of abusing stimulant medication.
Wellbutrin targets two neurotransmitters in the brain: norepinephrine and dopamine, which can help improve concentration.
Common side effects of bupropion include:
While bupropion rarely causes sexual side effects in adults, some people may experience more serious side effects such as anxiety, ringing in the ears, changes in vision, or even adverse cardiovascular events. Always inform your doctor about any side effects you experience.
If other stimulant or non-stimulant medications have proved unsuccessful at treating ADHD symptoms, your doctor may suggest a tricyclic antidepressant, such as Tofranil (imipramine).
Tricyclic antidepressants are an older class of depression medication and their side effects can sometimes be severe. Therefore, they’re usually only prescribed as a last resort.
Even when armed with all the facts, deciding whether or not to take ADD/ADHD medication isn't always easy. If you're unsure, don't rush the decision. Take your time to weigh the options. And if the medication is for your child, be sure to get their input in the decision-making process.
Most importantly, trust your instincts and do what feels right to you. Don't let anyone—be it your physician, other parents, or the principal at your child's school—pressure your child into medication if you're not comfortable with it. Remember: medication isn't the only treatment option.
For young children especially, it can help to view medication as a last resort, rather than the first course of treatment to try.
Consulting with an ADHD specialist or an experienced psychiatrist can help you understand the pros and cons of medication. Here are some questions to ask:
When deciding whether or not to put your child on medication, ADHD expert, Jerome Schultz, Ph.D., suggests to first consider the following questions:
Source: Family Education Network
Treatment for attention deficit disorder isn't just about seeing doctors or taking medication. There are many ways to help yourself or your child tackle the challenges of ADHD and lead a calmer, more productive life.
With the right tips and tools, you may be able to manage many of the symptoms of your ADHD on your own. Even if you choose to take medication, healthy lifestyle habits and other self-help strategies may enable you to take a lower dose.
Exercise regularly. Exercising is one of the most effective ways to reduce the symptoms of ADHD. Physical activity boosts the brain's dopamine, norepinephrine, and serotonin levels—all of which affect focus and attention. Try walking, skateboarding, hiking, dancing or playing a favorite sport. Encourage your child to put down the video games and play outside.
Eat a healthy diet. While diet doesn't cause ADHD, it does have an effect on mood, energy levels, and symptoms. Set regular snack and meal times. Add more omega-3 fatty acids to your diet and make sure you're getting enough zinc, iron, and magnesium.
Get plenty of sleep. Regular quality sleep can lead to vast improvement in the symptoms of ADHD. Simple changes to daytime habits go a long way toward resting well at night. Have a set bedtime and stick to it. Avoid caffeine later in the day.
Maintain a positive attitude. A positive attitude and common sense are your best assets for treating ADHD. When you are in a good frame of mind, you are more likely to be able to connect with your own needs or your child's.
Try therapy. ADHD professionals can help you or your child learn new skills to cope with symptoms and change habits that are causing problems. Some therapies focus on managing stress and anger or controlling impulsive behaviors, while others teach you how to manage time, improve organizational skills, and persist toward goals.
If you decide to take medication for ADHD, it's important to take the drug as directed. Following your doctor and pharmacist's instructions will help you maximize the effectiveness of medication for ADHD and minimize the side effects and risks. Here are some guidelines for safe use:
Learn about the prescribed medication. Find out everything you can about the ADHD medication you or your child is taking, including potential side effects, how often to take it, special warnings, and other substances that should be avoided, such as over-the-counter cold medication.
Be patient. Finding the right medication and dose is a trial-and-error process. It will take some experimenting, as well as open, honest communication with your doctor.
Start small. It's always best to start with a low dose and work up from there. The goal is to find the lowest possible dose that relieves you or your child's symptoms.
Monitor the drug's effects. Pay close attention to the effect the medication is having on your or your child's emotions and behavior. Keep track of any side effects and monitor how well the medication is working to reduce symptoms.
Taper off slowly. If you or your child wants to stop taking medication, call the doctor for guidance on gradually decreasing the dose. Abruptly stopping medication can lead to unpleasant withdrawal symptoms such as irritability, fatigue, depression, and headaches.
Many kids and teens with ADHD don't take their medication correctly—or stop taking it without talking to their parents or doctor—so if your child is on ADHD meds, make sure that he or she understands how to take the medication correctly and why following prescription guidelines are important.
Encourage your child to come to you with any medication-related concerns so you can work together to solve the problem or find another treatment option. It's also important to remember that ADHD medication should never have a numbing effect on a child's energy, curiosity or enthusiasm. A child still needs to behave like a child.
Here is a list of questions you should ask when your child begins medication therapy, changes dosage, or starts taking a different medication:
Source: From Chaos to Calm: Effective Parenting of Challenging Children with ADHD and Other Behavioral
Problems, by Janet E. Heininger and Sharon K. Weiss.
Most children and adults taking medication for ADHD will experience at least a few side effects. Sometimes, side effects go away after the first few weeks on the medication. You may also be able to eliminate or reduce unpleasant side effects with a few simple strategies.
Loss of appetite. To deal with reduced appetite, eat healthy snacks throughout the day and push dinner to a later time when the medication has worn off.
Insomnia. If getting to sleep is a problem, try taking the stimulant earlier in the day. If you or your child is taking an extended-release stimulant, you can also try switching to the short-acting form. Also avoid caffeinated beverages, especially in the afternoon or evening.
Stomach upset or headaches. Don't take the medication on an empty stomach, which can cause nausea, stomach pain, and headaches. Headaches can also be triggered by medication that's wearing off, so switching to a long-acting drug may help.
Dizziness. First, have you or your child's blood pressure checked. If it's normal, you may want to reduce your dose or switch to a long-acting stimulant. Also make sure you're drinking enough fluids.
Mood changes. If medication is causing irritability, depression, agitation, or other emotional side effects, try lowering the dose. Moodiness may also be caused by the rebound effect, in which case it may help to overlap the doses or switch to an extended-release medication.
If troublesome side effects persist despite your best efforts to manage them, talk to your doctor about adjusting the dose or trying a different drug.
Many people respond better to the long-acting or extended release formulations of ADHD medication, which build gradually in the bloodstream and then wear off slowly. This minimizes the ups and downs caused by fluctuating medication levels and causes less of a rebound effect, where symptoms return, often worse than before, as the drug wears off.
Reviewed by Damon Ramsey, M.D., a practicing physician in Vancouver, co-founder of InputHealth, an award-winning digital health company, and Chief Product Officer of TELUS Health.
Last updated or reviewed on May 10, 2023Learn about effective treatments and how to best help your child
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