Alison Poulton is the president of the Australasian ADHD Professionals Association. In addition to receiving non-financial support and personal contributions from Takeda Pharmaceuticals, the company that manufactures some of the ADHD medications this study covers, she previously sat on an advisory council. Her book royalties have been paid by Disruptive Publishing (ADHD Made Simple).

Attention deficit hyperactivity disorder, or ADHD, is a condition that can affect individuals at any stage of life. Even while it's not the only kind of treatment, medication is often the one that can make the most difference for someone who has trouble controlling their impulses, staying still, or attention span.

But what happens once you or your child has discovered the appropriate medication? Do you just take it at face value without question? It is worthwhile to consider these.

What are ADHD medications?

The mainstay of treatment for ADHD is stimulants. Among them are methylphenidate and dexamfetamine (marketed as Ritalin and Concerta, respectively). Furthermore, lisdexamfetamine, marketed under the name Vyvanse, is a "prodrug" of dexamfetamine; the body needs to eliminate a protein molecule attached to it before dexamfetamine can be released.

Non-stimulants, on the other hand, such guanfacine and atomoxetine, are less commonly used but can still be quite beneficial. Non-stimulants are prescribed by general practitioners (GPs); nevertheless, the cost and coverage of these drugs may differ and the Pharmaceutical Benefits Scheme may not always cover them.

How stimulants work

For ADHD, a few "short acting" stimulants are recommended. This suggests that the effect begins approximately 20 minutes beforehand and lasts for approximately 4 hours.

The effects of longer-acting stimulants stay longer since they usually deliver their medicine more gradually. Whichever approach works best for the patient will depend on whether they wish to take their medication once daily or restrict its effects to specific times or tasks.

With the possible exception of lisdexamfetamine, stimulants almost never have a carry-over effect for the next day. This suggests that ADHD symptoms could be very apparent until the morning's first dose kicks in.

One of the main objectives of treatment is for the person with ADHD to live their best life and achieve their goals. It is the parents' duty to consider the pros and cons on behalf of their young children. As they become older, children have a greater say in the decisions they make.

What about side effects?

The most common adverse effect of stimulants is appetite suppression, which causes weight loss. This is connected to a momentary deceleration in a child's growth rate and potentially a slight postponement in pubertal development. They might also cause the heartbeat to speed and blood pressure to rise. Stimulants frequently cause insomnia.

These changes are typically reversible when medication is stopped. Over time, those who take medication may have a little increased risk of heart attacks or strokes because of concerns that small elevations in blood pressure may accelerate the development of heart disease.

This does not mean that elderly people with ADHD should not receive treatment. Rather, children should know about the potential risks so they may make informed decisions. They also need to make sure that episodes of chest pain and high blood pressure are taken seriously.

Stimulants may give rise to headaches or stomachaches. These effects may lessen over time or at a reduced dosage. There have been reports of stimulant usage among students, but little study has been done on the risks associated with long-term prescription stimulant use.

Will medication be needed long term?

Even though ADHD can affect a person's functioning at any age, most individuals stop taking their medication after the first two years.

When taking medication, those who don't enjoy it may stop because they don't like how it makes them feel. Their brief drug experience may have increased their self-awareness and provided them with useful strategies for managing their ADHD.

The medication may lose its effectiveness if youngsters stop taking it when they outgrow the recommended dosage. But this must be differentiated from tolerance, which happens when a dose increase results in only temporary improvements and the medicine becomes less effective.

By using non-stimulants, switching between stimulants, or taking short breaks from medication, tolerance can be managed.

Too many prescriptions?

As more people—between 2 and 5% of adults and between 5 and 10% of children—are being diagnosed with ADHD, the disorder is becoming more widely known. Stimulants are tightly controlled in Australia, however this varies from state to state, and are usually administered by professionals (psychiatrists or pediatricians). There simply aren't enough experts to deal with the growing number of cases for this chronic illness.

The desperation felt by people seeking treatment was highlighted in a November Senate inquiry report on ADHD screening and support programs.

Laws in New South Wales have already been changed to let more general practitioners to treat ADHD patients. The confidence of general practitioners in treating ADHD may increase with additional training. A shared-care plan or general practitioners' (GPs') independent management of ADHD could be examples of this. One model being studied at Nepean Blue Mountains Local Health District involves educating GPs to treat ADHD within a clinic (where I work as a specialty clinician).

Not every person with ADHD will need or want to take medication. Nonetheless, those who could use it should have easier access to it.