Tuesday, 13 May 2014

Attention Deficit Hyper Activity Disorder (ADHD / ADD) Medications Cheatsheet

The use of medications revolutionised the treatment of ADHD /ADD. Today, international consensus often recommends medication as the first line of treatment for ADHD / ADD in patients above the age of 6 years of age. You can visit the following sites for more details:


Medications for ADHD / ADD can be categorised as:

1) Stimulants
2) Non stimulants
3) Antidepressants
4) Supplements

1) Stimulants

Stimulant medications have the best evidence in the treatment of ADHD for children and Adult ADD. As such it is often recommended as the medication of choice to start for both child and adult patients with ADHD. In Singapore, only methylphenidate based medications are available. They may come in short acting forms (lasting 3-4 hours) and long acting forms (lasting 8-10 hours).

Common brand names: Ritalin, Concerta

Advantage: i) Most likely to be effective, ii) works almost immediately, iii) can be taken only when necessary
Disadvantage: i) Can be potentially abused, ii) effects does not last the whole day

Common side effects: Headache, insomnia, poor appetite

2) Non stimulants

Atomoxetine is a selective noradrenaline reuptake inhibitor indicated for the treatment of ADHD /ADD. Unlike stimulants which has immediate effects, the benefits of atomoxetine is gradual and subtle, and its effect is only apparent usually after two weeks. For it to be effective, Atomoxetine has to be taken daily.

Common brand names: Strattera

Advantage: i) No abuse potential, ii) if effective, will last 24/7, iii) may be effective for concomitant depression
Disadvantage: i) Has to be taken daily, ii) only works after two to four weeks, iii) probably less likely to be effective than stimulants

Common side effects: Nausea, headache, insomnia

3) Antidepressants

Bupropion, an antidepressant, used in the treatment of depression and smoking cessation has been shown in some studies to help with the symptoms in ADHD / ADD. However, comparatively, the evidence for Bupropion is not as robust as stimulants and atomoxetine. As such, guidelines often recommends antidepressants as the third line of treatment, after stimulants and atomoxetine.

Advantage: i) No abuse potential, ii) if effective, will last 24/7, iii) effective for concomitant depression
Disadvantage: i) Has to be taken daily, ii) only works after two to four weeks iii) probably less likely to be effective than stimulants and atomoxetine

Common side effects: Headache, insomnia, anxiety

4) Supplements

There has recently been some research which suggests a decrease level of Omega-3 fatty acids (fish oils) may be associated with ADHD and taking Omega-3 supplements can help in controlling ADHD symptoms. Parents who may not be ready to medicate their children can consider this option as Omega-3 is a natural supplement. A recent product Lipirinen which contains phosphatidylserine-omega 3, EPA enriched, has shown effectiveness in studies, improving symptoms. Omega-3 can be used to supplement current treatment with other medications as well.

Advantage: i) Natural product, ii) no abuse potential, ii) if effective, will last 24/7
Disadvantage: i) Has to be taken daily, ii) only works after at least four weeks iii) probably less likely to be effective than stimulants, atomoxetine and antidepressants

Common side effects: no significant side effects