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Medication for ADHD: what do you need to know?

January 18, 2025
Escrito por:
Karen Palermo
Revisto por:
Dr. Maria Antunes
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Lidar as Attention Deficit Hyperactivity Disorder (ADHD)se puede ser problemas, como para adultos a vida con esta diagnostica y para los parents cerca de la mejor para su niños.

Medication is often seen as a promising solution, but it also lifts issues and concerns: Is it the right choice? What are its real benefits and potential risks?

In this article, we clarify the role of medication in the treatment of ADHD, explore the options available in Portugal and demonstrate how it can be supplemented with other effective approaches.

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The Role of Medication in the Treatment of ADHD

Medication for ADHD is often seen as a controversial solution: for some, it is a real hero, relieving symptoms and allowing greater focus and productivity 💪; for others, it is a villain, associated with side effects such as insomnia, loss of appetite or mood swings 😞.

The truth is, as in many cases, in the mid-term.

Medicines not to cure ADHD, but they can help regulate brain function, allowing the person to take greater advantage of other therapies, such as cognitive behavioral therapy (CBT) and/or neurofeedback.

It is important to remember that the medication for ADHD is not a one-size-fits-all solution, but part of an integrated and personalized treatment plan.

International Guidelines for the Treatment of ADHD

⚠️ According to international recommendations, medicines no se indicato come trattamento prima linea per tutte le persone con questa diagnostica.

Prescription of medicines is generally recommended in cases of moderate or severe symptoms, and only when psychological treatment has not produced satisfactory results.

This approach seeks to ensure that treatment is as safe and effective as possible, reducing the risk of unnecessary side effects.

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Kinds of medicines for ADHD available in Portugal

In Portugal, there are some medication options for ADHD, approved and regulated by entities such as Infarmed.

These drugs are divided into two main categories: Stimulants and Non-stimulants.

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Stimulant Drugs for ADHD

Stimulants are the most widely used approach in the treatment of ADHD.

These substances act increased dopamine and norepinephrine levels in the brain— neurotransmitters that help regulate attention and behavior, being also linked to the phenomenon of neuroplasticity.

Check out some examples:

  • Ritalin®, Concerto®, Rubifen®: Contain methylphenidate, often the first drug of choice for the treatment of ADHD, especially in children.
  • Elvanse®:Containing lisdexamphetamine, generally indicated as a first choice for adults, being more common in children when there is no adaptation to methylphenidate.

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👍 Main advantages of stimulant drugs:

  • Quick start of action (about 30 minutes).
  • Ease of taking (prolonged-release tablets require only one dose per day).
  • Availability in various formulations, allowing greater flexibility in treatment.
  • Methylphenidate is co-administered by the NHS.

👎 Main disadvantages of stimulant drugs:

  • The adaptation period until finding the drug and the “ideal” dose can be complex and accompanied by a generalized feeling of malaise.
  • Possible side effects, such as: lack of appetite, insomnia, headache, abdominal pain, weight loss, motor or vocal tics, anxiety, emotional lability, nausea, vomiting and diarrhea.
  • “Crash effect”: occurs when the effect of the drug begins to diminish, leading the brain to a sudden drop in stimulation. This phenomenon can cause intense fatigue, irritability, loss of focus and general malaise, such as a “sudden disconnection” after a state of high productivity and concentration.

⚠️ Important Note: side effects are not common in most people and each case is unique and requires individual monitoring.

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Non-Stimulant Drugs for ADHD

Non-stimulants are an important alternative for the treatment of ADHD, especially in cases in which stimulants are not well tolerated or do not produce the expected results.

These substances act more gradually, regulating norepinephrine levels and promoting a stabilizing effect on brain receptors.

Check out some examples:

  • Strattera®: contains atomoxetine, which is a potent selective inhibitor of norepinephrine reuptake in the brain.
  • Intuniv®(not available in Portugal) and Catapresan®:Contain guanfacine and clonidine, respectively. They act by reducing the excessive release of neurotransmitters and regulating neural activity.

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👍 Main advantages of non-stimulant drugs:

  • They do not cause the “crash effect” present in stimulant drugs and have fewer reports of cases of abuse or improper use.
  • They have additional benefits: atomoxetine is effective for symptoms of anxietye disturbi comportamentali, si clonidine/guanfacine è utile per la trattamento di Insomnia.
  • Atomoxetine is co-administered by the NHS.

👎 Main disadvantages of non-stimulant drugs:

  • They are less effective in controlling PHDA and are therefore generally used only in cases of therapeutic failure or contraindication to stimulants.
  • Possible side effects: headache, drop in blood pressure, nausea, vomiting, diarrhea, tiredness, changes in behavior and irritability.
  • They should be used cautiously in people with heart problems.

⚠️ Important Note: side effects are not common in most people and each case is unique and requires individual monitoring.

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Frequently Asked Questions about ADHD Medication

Stimulants, such as methylphenidate (Ritalin®, Concerta®, Rubifen®) and amphetamines (Elvanse®/Vyvanse®), are the most widely used, with a broad base of clinical evidence. These medications increase the availability of dopamine and norepinephrine in the brain regions responsible for attention and impulse control.

For people who do not respond well to stimulants or experience significant side effects, non-stimulants such as atomoxetine, guanfacine, and clonidine can also be effective options.

It is common for psychiatrists to use the response to medication as a complementary indicator in the diagnostic process: if the medication consistently relieves symptoms, the hypothesis of ADHD is reinforced.

On the other hand, if there is no improvement, it may be a sign that another underlying condition, such as anxiety or learning difficulties, should be investigated.

Stimulants act quickly, usually within 30 to 60 minutes, and have a direct effect on dopamine and norepinephrine, improving attention, focus, and impulse control. They usually have a long-acting effect and are more effective in most cases.

Non-stimulants, on the other hand, have a slower onset of action and may take weeks to reach the optimal effect. They are more indicated when there is a risk of severe side effects or a history of substance abuse.

Stimulant medications can cause tolerance and psychological dependence if not used properly. However, when administered correctly under medical supervision, the risk of dependence is very low.

It is important to differentiate between therapeutic use, which aims to control symptoms, and recreational or abusive use (self-medication), which can increase the risk of dependence. Non-stimulant medications present a much lower risk of dependence.

The choice of medication and dosage is made based on a detailed assessment of clinical history, response to treatment, body weight, and tolerance to side effects. Adjustment is done gradually, with monitoring to evaluate efficacy and possible adverse effects. It may take weeks or months to find the ideal combination, so professional follow-up is necessary.

The combination can be safe, but it depends on the medications and supplements involved. For example, some antidepressants or anxiolytics can be combined with caution. Supplements like melatonin can help with sleep disorders associated with medication.

However, it is essential to inform the doctor about all medications and supplements being used to avoid dangerous interactions.

Treatment does not need to be lifelong in all cases. Some people need medication only during periods of greater demand, such as childhood and school adolescence, while others may continue into adulthood. Long-term use is periodically re-evaluated, taking into account symptom evolution and changes in routine demands.

Therefore, it is important that medication treatment be combined with non-pharmacological approaches.

- Improvement in concentration capacity

- Reduction in impulsivity

- Greater emotional control

- Decrease in hyperactive behaviors

- Greater ease in completing daily tasks that were previously difficult

If these results are achieved without significant side effects, it indicates that the medication is appropriate.

If there is no improvement or if side effects are intolerable, the doctor may adjust the dose, change the administration time, or try another type of medication, such as switching from a stimulant to a non-stimulant.

It is also important to verify if the person is following instructions correctly and if there are external factors, such as inadequate sleep, that may influence treatment response.

A lack of response to medication may be an indication that the diagnosis needs to be re-evaluated. Often, when medication has no effect, the psychiatrist investigates whether there are other coexisting conditions or if the initial picture was confused with another disorder, such as mood disorders or anxiety.

Yes, especially stimulants. Some people report insomnia and loss of appetite, especially at the beginning of treatment – but this is an individual issue and therefore not present in all cases.

Adjusting the dose or administration time, switching to a short-acting formulation, or considering the addition of a supplement can help minimize these effects.

Yes, in some cases. These breaks, known as "medication holidays," should be planned with the doctor.

Not everyone benefits from this approach. In children with severe symptoms, breaks can cause significant setbacks. However, in milder cases, it can be a way to reduce continuous exposure to the medication.

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Complementary approaches to medication

It is important to remember that medication is only one of the pillars in the treatment of ADHD.

Other therapies may play a key role, especially when combined with medicines:

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Approach How does it help?
Cognitive Behavioral Therapy (CBT) CBT helps individuals identify and modify dysfunctional thought patterns, promoting strategies to manage impulsivity and improve organization.
Neurofeedback Neurofeedback is a technique that uses real-time feedback on brain activity to help improve emotional regulation and focus.
Educational and Lifestyle Interventions Changing the study or work environment, practicing regular physical exercise, and maintaining a balanced diet can also make a difference.

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Final Considerations

Medication for ADHD is not a miracle solution, but it can be a valuable tool in the context of personalized and multidisciplinary treatment.

The most important thing is to recognize that each case is unique and that professional monitoring is essential to achieve the best results. 🧑 ‍ ⚕️

If you think your child may benefit from more comprehensive treatment for ADHD, get in touch with us.

At NeuroImprove Clinic, we offer a integrative and targeted approach, which includes an initial assessment with qEEG, neurofeedback sessions and specialized psychological support.

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References:

National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder Diagnosis and management of ADHD in children, young people and adults. NICE Guideline 2019. Available in: https://www.nice.org.uk/guidance/ng87

Medications for Attention Deficit Hyperactivity Disorder. INFORMATION AND STRATEGIC PLANNING OFFICE - Infarmed, 2015. Available in: https://www.infarmed.pt/documents/15786/17838/Relatorio_ADHD.pdf/d6043d87-561e-4534-a6b1-4969dff93b78 

Mechler K, Banaschewski T, Hohmann S, Häge A. Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacology & Therapeutics, Volume 230, 2022. doi: 10.1016/j.pharmthera.2021.107940

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