Stimulants and Adult ADD Treatments: Fact and Fiction

Stimulants are the primary treatment of children and adults with ADD and ADHD. Benefit and side effects are different in adults and children, in my experience, and misconceptions are rampant in both.

There are two categories of stimulants used in treatment: amphetamines and methylphenidate. Both stimulate brain cells in the frontal lobe of the brain to release stored up dopamine (amphetamines) or norepinephrine (methylphenidate). These are neurotransmitters that allow one neuron brain cell to “talk” to nearby cells and transmit thoughts, memories, or reflex actions.

The frontal lobe of the brain is known as the “executive” function area where problems are recognized, solutions formed, then action for solution executed. This is the “proactive”, vs the “reactive”, part of the brain. Planning, organizing, and tasking to solve problems arise here.

When neuron brain cells in the frontal lobe communicate poorly, problems are poorly recognized, solutions are not forthcoming, or execution of solutions fail. This often results from low dopamine or norepinephrine levels or inability of brain cells to release these chemicals, even if stored in ample supply. This presents as procrastination, delayed action, poor organization, frequent mistakes, inability to follow directions or complete tasks. Items are lost, broken, or simply misplaced frequently bringing frustration to the patient, their family. teachers, or employers. ADD individuals cannot stay on task.

When amphetamines “release” dopamine, cells connect. Solutions arise, execution occurs, and work gets done-while the medication is active, usually 4-8 hours. Amphetamines are not like psychiatric medications which change or alter brain cells over time. They simply work, like caffeine, while present. Then, when they are gone, they’re gone-and all the dysfunction recurs. They therefore require multiple doses during the day or a time release formula to last longer.

When taken orally, they work slowly and do not overstimulate the brain or cause a “high” like potent inhaled or injected stimulants, like methamphetamines. In fact, they decrease the desire for drugs of abuse including opiates, marijuana, alcohol, and even cocaine or methamphetamines. Abuse rates are 20-30% less than the general population in kids who are properly treated, even into adulthood. The reason is not exactly clear. In my experience, it is from a reduction in failure, and increase in success, and improved esteem. There is less need to “self medicate” to feel better. Success. they say, is “habit forming”.

In adults, we strive to improve brain function in every way. such as removal of brain-slowing drugs like THC, alcohol. benzodiazepines, or opiate pain meds. Controlling blood sugar, blood pressure, losing weight, exercising, or treating depression and anxiety is equally important. Sometimes simply replacing estrogen or testosterone can perk up brain cells. Avoiding head trauma is vital. Sleep is brain cell restoring. Everything counts. Stimulants are a single but important piece to the puzzle of optimal life performance.

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