About Medication for ADHD

However one feels about medication, there is no question regarding its capacity to serve as a potent and useful tool, when used with precision. The first tier treatment for ADHD has been and will likely always be the class of medications known as "the stimulants.“  Ritalin, Dexedrine, Adderall, Adderall XR, Concerta, Vyvanase, etc. are all examples of amphetamines or methamphetamines. The comments that follow apply only to this class of medications.

One approach to titration, (the process of determining best dosage of a medication), is derived from research-based protocols. It systematically increases short acting forms of a stimulant to arrive at optimal dosage.   One begins with a very low dose of a short-acting (4-6 hours) stimulant, gradually increasing dosage daily (under medical direction) in very small increments, until achieving one of three possible outcomes; A) no further improvement in symptoms, B) a worsening of symptoms, or C) a side effect. At that point, a choice must be made between either reducing the dose to the highest previous effective dosage, or switching to a different short-acting stimulant entirely.

If the side effects have really been intolerable, ultimately second tier drugs like Strattera, Wellbutrin, or Intuniv might have to be considered, if medication is to be part of the treatment regimen. 

If an optimal stimulant dosage has been successfully identified by this process, it is usually a pretty simple calculation to determine the equivalent dosage of a longer-acting form of the specific stimulant you have successfully titrated. These medications are usually a bit more expensive, but much more practical, as taking a pill one time a day is a lot easier than taking it four times a day, not to mention the simplicity of not having to take medication at work or school.
 If you have had to switch to a second tier drug, the titration process may be very different, as the preceding model is intended only for short-acting stimulants. Once a stimulant dosage is properly set, it tends to be fairly stable. Unfortunately, the time and effort to get titration right in the first place is frequently short-changed in practice, leading to more frequent dosage adjustments, and typically less than optimal outcomes.

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