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Some medications originally developed to treat depression (antidepressants) also have important roles in treating some individuals with ADHD. Since these medicines have been used for many years to treat other mental health conditions, their adverse effects are well understood.

• Imipramine (Tofranil) - An antidepressant that increases levels of neurotransmitters norepinephrine and/or serotonin in the brain

• Bupropion (Wellbutrin) - An antidepressant that increases levels of neurotransmitters in the brain, especially dopamine

• Desipramine (Norpramin) - An antidepressant that increases level of the neurotransmitter norepinephrine in the brain

Other medicines that were originally developed to treat high blood pressure (alpha agonists) may also be useful in the treatment of those having ADHD. Again, due to widespread and long-term use, their side effects are well known to doctors.

• Clonidine (Catapres) - An α2 agonist that stimulates certain receptors in the brain stem; the overall effect is to "turn down the volume" of hyperactive movement and speech

• Guanfacine (Tenex) - Another alpha agonist with an effect similar to that of clonidine

Warnings concerning psychostimulant use

The psychostimulants are controlled substances; prescriptions must follow strict federal and state guidelines.

Any psychostimulants found by legal authorities (for example, while writing a speeding ticket) can cause suspicion. Thus, if the medication must be carried away from home, it should be kept in the original pharmacy container. In some states, having the medication in any container is acceptable as long as the pills are accompanied by a doctor order on a prescription or letterhead that states that the person is under the doctor's care and takes the medication as directed by a doctor.

Although the stimulant abuse rate in ADHD specialty centers is remarkably low, it is not zero. Illicit practices include crushing the psychostimulant so that it can be snorted through the nose. Unfortunately, this is not uncommon on college campuses. Pills can also be crushed and diluted and injected intravenously. These practices, which are most widespread among adolescents, are potentially addicting and dangerous, and even fatal. Any person who knowingly supplies others with these drugs is considered partly responsible for any injury sustained by the abuser. Teens should be warned about the dangers.

Controversial Diagnosis

ADHD is a controversial diagnosis for several reasons. Many well-meaning individuals have spoken out against making children behave according to a norm or take medications for the sake of improving grades. These individuals have expressed concern about addiction or drugging children. This kind of concern is valid; however, the following must also be considered:

• The negative consequences of not using medication for children with ADHD have to be weighed against the known risks. Long-term outcome studies have now been conducted with large numbers of adults diagnosed with ADHD as children, and one clear finding is that those who received medication for their disorder in childhood are more functional and have a better quality of life as adults than those who had the symptoms of the disease but did not receive medicine.

• Stimulants used for ADHD do not cause addiction. Although tolerance usually develops for the stimulant-associated effects of anorexia, insomnia, or mild euphoria, tolerance does not develop to the increased levels of neurotransmitters.

• These medications should not be used just to improve grades or quiet down classrooms. School performance should be looked at as a sign of how well the child is doing, just like other areas of health. These medications often improve school performance dramatically, which is linked to better social skills and heightened self-esteem. But the grades should be a marker, not a goal.

Studies that have examined whether taking a psychostimulant for ADHD in childhood contributes to future substance abuse have shown this to not be the case. In one very large study, in fact, children who received stimulant medication for ADHD had half the risk of future substance abuse of similar children with ADHD who did not receive medication.

Other Therapy for ADHD

Diet

No specific food or diet has been clearly shown to have a significant positive or negative effect on the symptoms or course of ADHD. People with ADHD should eat a healthy diet and probably avoid caffeine. That having been said, if the family’s experience with a person having ADHD is that some sort of dietary change, such as decreased refined sugar intake, helps, then if the person is not deprived of necessary nutrients, there is certainly no harm in trying to follow such a plan. A good rule of thumb is to discuss the plan with the family doctor or whoever is providing the primary treatment for the ADHD symptoms.

Activity

Regular physical activity has been shown to play an important role in some of the common related conditions (for example, depression, anxiety) and to improve concentration. Regular exercise may be beneficial in people with ADHD.

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Reviewed: 01/2008