What causes ADHD?
The forebrain of humans is engaged in executive function, impulse control, planning, and focus. It seeks to grant you top-down command over the brain's more basic and reptilian regions.
Dopamine and noradrenaline, two crucial hormones, are needed in a small range to function at optimal levels. By doing this, the forebrain's control over the midbrain and other more basic regions will be better managed.
There is a goldilocks zone where noradrenaline and dopamine levels rise "just right." When we titrate and modify the dosage of ADHD medication, we aim to do this.
What should ADHD medication do?
Dopamine and noradrenaline levels should rise in order to enhance focus, energy, impulse control, working memory, and concentration.
What are the 2 types of ADHD medication?
Stimulants (which raise noradrenaline and dopamine levels). Eighty percent of people find these drugs to be beneficial on average.
Nonstimulants (raises adrenaline levels). Seventy percent of people find these drugs to be beneficial on average.
More about the Diagnosis and the Symptoms:
Get ADHD-A-Guide-for-Adults-Diagnosed-With-ADHD by downloading it.
Get the ADHD-Behavior-Symptom-Checklist in download.
Stimulants:
Generally speaking, long-acting stimulants are first line. Long-acting stimulants help an ADHD sufferer maintain focus and good behaviour throughout the day. They also have the advantage of requiring less frequent dosage, so you won't need to carry your prescription with you when you go out. This works well most of the time, but if it doesn't work or is badly tolerated, we might use a short-acting stimulant in its place.
How do we dose stimulants?
We will need to start you on a low dose initially. This is mostly done to make sure your body reacts to the drug gradually and to lower the possibility of major adverse effects. When your prescription is filled, you will be given a schedule for progressively increasing the dosage. Determining the right dosage for yourself might be difficult. Before settling on your ultimate regimen, we might need to adjust your dosage a few times.
What is the “goldilocks” dosing range for stimulants?
When the dosage is too low:
The side effects of your prescription may wear off faster than you anticipated, leaving you with trouble focusing, controlling your impulses, and paying attention. You might also feel more tired and easily distracted.
If you take too much of a dose:
You could experience irritability, excessive energy, wiredness, emotional numbness, and rigidity in your thinking.
Once you've found the ideal dose:
Clear, flexible, and goal-oriented in your thinking.
Side effects:
Common side effects (1%):
The following are common adverse effects (1%): headache, dizziness, aggression, tachycardia, palpitations, dry mouth, appetite loss, weight loss, anxiety, irritability, sleeplessness, and changes in blood pressure (which typically rises in adults).
In general, decreased appetite and insomnia are transient conditions that go away in around two weeks. Please make an effort to stick with it for at least one or two weeks if you encounter these two specific adverse effects.
Serious side effects (1%):
If stimulants are used in excess and at quantities that defy your psychiatrist's prescription, the likelihood of these side effects increases.
Insanity
This include delusions, auditory or visual hallucinations, paranoia, and abnormal thinking and behaviour.
In the event that you have this symptom, please dial 000 or visit the closest emergency room.
Insanity
This involves taking chances, having lofty ideals, having more energy, speaking under pressure, and needing less sleep.
Should you encounter this symptom, kindly dial 000 or visit the closest emergency room.
Aggression and Agitation
Please stop taking your stimulant medicine and call your doctor right away if you encounter this symptom.
thoughts of suicide
Should you encounter this symptom, kindly dial 000 or visit the closest emergency room.
liver disease
Tics: Medication can frequently help with tics. Sometimes, though, they might make problems worse.
Infrequent side effects (0.1–1%)
growth retardation, rash, movement abnormalities, and tics (but see the Precautions above).
Rebound side effects:
You might notice that your pre-existing ADHD symptoms come back stronger than before as the stimulant effects start to wear off. We will need to change the dosage and frequency of your medicine in order to manage these side effects.
Cardiac side effects:
An ECG and heart physical assessment are necessary prior to starting stimulants. This is because stimulants have the potential to raise blood pressure and heart rate. On rare occasions, you might also feel syncope, elevated palpitations, or a fast heartbeat. If so, please stop taking your medicine right once and get in to see your doctor as soon as you can.
It is not recommended to use stimulants in people who have a history of verified hypertension. Your doctor could urge you to obtain weekly blood pressure readings from your neighbourhood pharmacy or using an automatic blood pressure monitor at home if you have a history of sporadic high readings.
Foods and medication to avoid:
Caffeine: Please refrain from drinking too many caffeinated beverages. Your anxiety, blood pressure, and heart rate may all rise as a result of this.
Some over-the-counter medications that contain pseudo-ephedrine. Your anxiety, blood pressure, and heart rate may all rise as a result of this.
How long will I need take this medication?
You most likely need to take this drug for years at a time. People frequently learn new techniques to control their impulsivity and attention deficiency. In this situation, we can either think of other medications for you or wean you off of stimulants.
Are stimulants addictive?
Patients may develop an addiction to stimulants if they use them in excess. The WA Health government requires an annual urine drug test to make sure this doesn't happen. Another drug on schedule 8 is stimulants. This indicates that there are several laws pertaining to their prescription and that they are heavily regulated. Please visit https://ww2.health.wa.gov.au/Articles/S_T/Stimulant-medicines for complete details.
Am I able to change to dose myself?
No, you must not alter the dosage without first obtaining your psychiatrist's approval. This is the case for a variety of safety and legal reasons. If there is proof of this, prescriptions won't be written any longer.
What happens if my script is lost or stolen?
Regretfully, a replacement script will not be provided if your script is misplaced or pilfered. Additionally, you won't be able to pick up your next prescription early. The WA Health Department regulates stimulants closely, and as a result, strict guidelines are in place. Please handle your scripts with extreme caution. We advise you to maintain all prescriptions on file with your neighbourhood pharmacy.
Non Stimulants
The way non-stimulants function is by raising noradrenaline levels. Despite having a little lower efficacy than stimulants, they are typically more well tolerated. Patients who have a history of addiction, have a poor response to stimulants, or exhibit high levels of anxiety are better off without stimulants.
The most common side effects of non stimulants in adults are:
mouth feeling parched.
sleeplessness.
anomalies of the urinary tract (e.g., difficulty passing urine, pain during urination).
menstruation that is painful.
Warm flashes.
The drug may need to be stopped due to these serious side effects.
These adverse effects, however, are usually not very serious. The limited number of patients who had negative effects during clinical studies necessitated stopping nonstimulants.
ADHD WA coaching
Grace Da Camara, an adult and teen
Dr. Andrew Sheridan, adult and teen
Karen Breeze, both adult and parental
