Treatment for ADHD in Adults

By Jim Haggerty, M.D.

Attention deficit hyperactivity disorder (ADHD) can take quite a toll on a person’s life as they seek to find a way to become more focused, less distracted, and more organized. People around them can feel like the person with ADHD never quite has things all together, which can make for frustrating relationships at home, work, and with family and friends.

It’s normal for a person to feel somewhat helpless and confused about the best ways to handle their ADHD symptoms. Fortunately there are treatment options that can help alleviate the symptoms of ADHD and arm a person with the tools they need to combat the symptoms of attention deficit disorders.

These interventions include:

  • Medication
  • Psychotherapy
  • Or a combination of these two approaches

Medications

Used properly, medicines such as methylphenidate hydrochloride (Ritalin) and other stimulants help suppress and regulate a person’s behavior, to help them be less hyperactive and distracted, allowing them to better focus. They squelch hyperactivity, improve social interactions and help people with ADHD concentrate, enabling them to perform better in school and at work.

When used with proper medical supervision, medications prescribed for ADHD are considered generally safe and free of major unwanted side effects. They rarely make a person feel “high” or, on the flip side, overly sleepy or “out of it.” Common side effects include appetite suppression, sleep disturbances, and weight loss. Less common side effects include an increase in heart rate/blood pressure, headache, and emotional changes (social withdrawal, nervousness, and moodiness). These medications are not considered addictive, however, they should be carefully monitored in adults because they can be either abused or misused.

It is important to understand that these medications are not a cure-all, but they can be highly effective when used appropriately in the right dosage for each individual. In fact, as many as nine out of 10 adults do better when they are taking one of the most commonly used stimulants. However, in combination with other techniques such as psychotherapy, symptoms may improve even more. Researchers are currently evaluating the effectiveness of medications in combination with these other approaches to determine the best route to take.

Individuals taking any of the medications listed below should see their doctor regularly for a check-up to review the types and timing of ADHD symptoms. The benefits and potential risks of using these medications also should be discussed before the first prescription is filled.

The most commonly used stimulants are:

  • methylphenidate hydrochloride (Ritalin, Ritalin SR, and Ritalin LA)
  • dextroamphetamine sulfate (Dexedrine or Dextrostat)
  • a dextroamphetamine/amphetamine formulation (Adderall)
  • methylphenidate (Concerta)
  • atomoxetine (Strattera, marketed as a “non-stimulant,” although its mechanism of action and potential side effects are essentially equivalent to the “psychostimulant” medications)

When these “front-line” medications are not effective, physicians sometimes opt to use one of the following:

  • buproprion hydrochloride (Wellbutrin) — an antidepressant that has been shown to decrease hyperactivity and aggression.
  • imipramine (Tofranil) or nortriptyline (Pamelor) — these antidepressants can improve hyperactivity and inattentiveness.
  • clonidine hydrochloride (Catapress) — used to treat high blood pressure, clonidine also can help manage ADHD and treat conduct disorder, sleep disturbances or a tic disorder. Research has shown it decreases hyperactivity, impulsivity and distractibility, and improves interactions with friends.
  • guanfacine (Tenex, Intuniv) — this antihypertensive decreases fidgeting and restlessness and increases attention and a child’s ability to tolerate frustration. Tenex is the short-term preparation, while Inuniv is the long-term preparation.

Duration of treatment

On the one hand, health professionals know that ADHD is a chronic condition that lasts for years and sometimes for a lifetime. On the other hand, the risks and benefits of medications can change over time, so typically the treating physician or psychiatrist need to regularly re-evaluate medication use.

Unlike a short course of antibiotics, ADHD medications are intended to be taken for a longer period of time. You should never discontinue use of a prescribed medication without first checking with your doctor. Psychiatric medications generally have special discontinuation strategies, which help minimize unwanted side-effects when getting off of them.

While these medicines can be very beneficial, side effects can occur and should be monitored. Non-stimulant medications, including the antidepressant buproprion hydrochloride (Wellbutrin), have been used. Newer reports show other antidepressants such as venlafaxine (Effexor) may be beneficial in adults as well.

Psychotherapy

Research has shown that medication alone is not always sufficient. For more than two decades, research has demonstrated that psychotherapy can also be helpful for an adult with attention deficit hyperactivity disorder. The most commonly used psychotherapy approach for ADHD is a form of cognitive-behavioral therapy (CBT). In this type of therapy, patients learn new skills and ways of approaching situations to help combat unhelpful, broken behaviors and ways of thinking. These skills are designed to help reduce stress, which can in turn reduce ADHD symptoms.

Psychotherapy, unlike medication, is always time-limited — meaning you see a therapist as long as you’re learning new skills and strategies to help in your life. In most cases, people are successfully treated for symptoms related to attention deficit disorders in in under a year’s time.

Support groups link adults who share similar concerns.

Treatments to Avoid

These therapies that have not been scientifically proven to be helpful in the treatment of ADHD:

  • herbal products
  • restrictive or supplemental diets
  • allergy treatments
  • supplements
  • megavitamins
  • chiropractic adjustment
  • perceptual motor training
  • medications for inner ear problems
  • yeast infection treatments
  • pet therapy
  • eye training
  • colored glasses

What type of professionals should be sought

An experienced mental health professional with specific background, training and treatment experience with ADHD should be sought — usually a psychologist or psychiatrist. A psychiatrist is often a good first choice, especially if you’re seeking a medication to help with your ADHD symptoms (psychiatrists are medical doctors that can prescribe medications). A psychologist is a good choice for ongoing psychotherapy.

Most people benefit the most from a combination approach to treatment — using both medication and psychotherapy. If you choose one or the other, your treatment may be longer than it needs to be.

Prognosis

Even though most people will never completely outgrow ADHD, a thorough assessment and treatment catered to the individual’s particular set of challenges can help them master their symptoms and lead productive, achievement-filled lives. Many believe the disorder’s characteristic behaviors can actually give these individuals a unique creative edge. People with ADHD have gone on to have successful careers in an array of occupations.

Prevention

Because researchers do not yet fully understand what causes ADHD, there are no documented strategies for preventing the disorder.

 

APA Reference
Haggerty, J. (2006). Treatment for ADHD in Adults. Psych Central. Retrieved on December 23, 2014, from http://psychcentral.com/lib/treatment-for-adhd/000136
Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
    Published on PsychCentral.com. All rights reserved.