By Beth Levine
Medically reviewed by Barry K. Herman, M.D., M.M.M.
If you are an adult who has been recently diagnosed with ADHD for the first time, you haven’t benefited from being diagnosed and treated in childhood. The world of ADHD medication is entirely new to you.
Everyone reacts differently to medications, and everyone has different goals.
How can you assess if a medication is working for you in the way that you want? It can be a frustrating puzzle. Here are some tips to help you figure it out with your medical professional who is prescribing the medications:
• Set realistic expectations
Medications are not a cure-all.
“The phrase we use a lot is ‘Pills don’t teach skills,'” says Kaleigh Goehler, a registered nurse and ADHD medication education coach at the ADHD Center of West Michigan, in Grand Rapids. “They are never going to make things 100% perfect. However, medication lets you access the parts of your brain you need to build needed skills.”
Stephanie Sarkis, Ph.D., author of seven books, including “10 Simple Solutions to Adult ADD: How to Overcome Chronic Distraction and Accomplish Your Goals,” adds: “Stimulant medication helps with retrieving information. You tend to get more out of therapy when you are on an optimum dose of medication because you’re better able to pay attention, process what you’re hearing, and are more likely to ask questions.”
• Establish your goals
ADHD medications are designed to help improve attention span and executive function, and to reduce hyperactivity and impulsivity. Discuss with your prescriber what issues you would like to address. For example, do you wish to enhance maintaining focus during business meetings, organizing your schedule more efficiently, or being able to listen to conversations without hijacking the conversation?
“Make your goals really specific,” Goehler says. “So when you’re on the medication, you can look back and say this was addressed a little bit, or this hasn’t been addressed at all, or this is covered really well.”
• Give your family history of ADHD
“If anyone in your family is taking a medication that’s worked for them, or gave them certain side effects, that’s really important information for your clinician to have,” Sarkis says. Genetics being what they are, these medications might have the same positive or negative effects on you.
• Learn your medication’s response time
ADHD medications fall into two categories: stimulants and non-stimulants.
Stimulants are the most commonly prescribed medications for ADHD. There are two classes of stimulant medications, amphetamines and methylphenidate. Within these two classes are many different formulations that can determine their duration of effect. Immediate release (short acting) last around four to five hours, and extended release (long-acting) can last for six to 16 hours. Both can have very rapid onset of effect. In general, stimulants are more effective than non-stimulants in treating ADHD. Approximately 7080 percent of adults with ADHD will respond favorably to at least one of the two classes of stimulants.
Non-stimulants are usually prescribed when stimulants haven’t worked or have caused significant side effects. Non-stimulants need to build up in your body and take a few weeks before you will see changes. If you want to discontinue the medication, you often have to slowly wean yourself off, under the guidance of your prescriber.
Sometimes non-stimulants are used in combination with stimulants.
“The goal is better overall ADHD symptom control,” Goehler says. “And it can provide some 24-hour coverage, compared to eight to 10 hours with stimulants alone.”
• Watch out for side effects
If you are using stimulants, you may develop side effects such as insomnia, decreased appetite, anxiety, dry mouth, tics, upset stomach, extreme emotions and changes in blood pressure and heart rate. There is also something called “flat affect,” says Sarkis.
“When you have flat affect, you aren’t feeling or expressing your full range of emotions,” she says. “Talk to your prescriber if you just don’t feel like yourself while you are on your medications.”
Non-stimulants may produce side effects of lack of appetite, upset stomach, nausea or vomiting, fatigue, sleep disruption, and dizziness.
Report all of these to your prescriber. Depending on how disruptive these are to your overall quality of life, they could be signals to switch to another medication or fine tune your dose.
“I always tell my clients there are side effects that you can live with, side effects that you can work around, and side effects that you don’t live with,” Goehler says. “Are you going to feel a little different? Yes, but you should still feel like you.”
• Pay attention to signs the medication is working
You’ll want to pay attention to determine whether the medication is helping. The improvements can be small things — not a giant overhaul in your personality. But maybe instead of procrastinating for an hour on Reddit before working, you can get to it in 30 minutes.
“When you’re taking a medication that’s working optimally, it should feel like you’re not having to put forth so much effort to do daily things,” Sarkis says. “You don’t have to think as much to do your morning routine or to work on a project. You are able to sit down and start without having to talk yourself into it. You also may find that you are able to wait before entering a conversation; you can listen to the other person and let them finish.”
Another sign is if your exhaustion level improves. “You may find that you’re not as wiped out at the end of the day because you are not expending so much energy trying to get things done,” Sarkis says.
• Keep a journal
Write down how you are feeling each day. Note improvements, setbacks and side effects. Your provider will find this useful while monitoring you. But don’t make yourself nuts over this.
“Give it some time. You might pick up on things that you think are side effects but it’s just that you ate a bad burrito that day,” Goehler says. “You know your life. Look back and see how you feel at the end of the week. Is there a pattern?”
• Don’t give up if you have to try different drugs and doses
Everybody reacts differently to medications. It may take you a while to find the right ones, the right levels or even the right time of day to take them. “I know patience is usually not the strong suit of people with ADHD but you’ve got a lot of options,” Goehler says. “It could take going through three, four or five different ones but there’s a really good chance that there’s a good fit out there for you.”
In a study published in the journal Neuropsychiatric Disease and Treatment, stimulants had a 70% to 80% success rate.
The most important piece of advice is: Stay in touch with your prescriber. This is a complicated journey and one you should be taking together to get the best result.