The Atlanta Center for Adult ADHD offers a full range of medical and behavioral treatment options.
While counseling and coaching can be valuable additions to the treatment program, medications are the mainstay of treatment. Scientists have defined a connection between a person’s ability to pay attention and brain chemistry. The areas of the brain affected by ADHD use neurotransmitters (chemicals that transmit information between nerve cells) called dopamine and norepinephrine to communicate with one another. The deficiency of these chemicals usually must be corrected for significant symptom improvement to take place.
FDA-aproved medications for ADHD include stimulants and non-stimulants. In the stimulant group are amphetamines and methylphenidate. The amphetamine group includes the long-acting medications lisdexamphetamine (Vyvanse )and extended release d, l amphetamine (Adderal XR). The methylphenidate group includes the long acting formulation Concerta, as well as Ritalin-LA and Focalin XR. At the Atlanta Center for Adult ADHD, we will usually try a long acting medication from the amphetamine group first, as these seem to be better tolerated and more effective for most patients.
We prefer to use long-acting stimulants as they provide sustained medication levels throughout the day and are “smoother”, ie, ups and downs are minimized during the day. And of course, it is also much easier to remember to take a medication once a day.
In the non-stimulant group, atomoxetine (Straterra) is an often utilized option. This medication boosts norepinephrine and provides 24 hour coverage for ADHD symptoms. It can take from four to six weeks for the full effect of Straterra to be seen. Some patients do very well with Straterra, while others find that stimulants are more “robust” (more effective) for them. Another recently FDA- approved medication is extended release guanfacine (Intuniv). This medication can be used alone for ADHD but is usually prescribed as an add-on to other medications to increase the effectiveness of the drug combination. Intuniv can cause sedation and dizziness, which can limit its use.
Even with taking a long acting stimulant in the morning, it is sometimes necessary to add a short acting stimulant towards the end of the day. The long acting stimulants last from 8-12 hours (sometimes 13 in the case of Vyvanse) but an adult’s waking day is 16 hours. While some patients only want to take stimulants during their work or school hours, others find that it is helpful to have their ADHD symptoms controlled in the evenings as well so that they can function well in home and social settings.
Insomnia is sometimes a problem when starting stimulants but usually improves within the first few days. It is always important to “time” taking stimulants so that they wear off by bedtime. At the beginning of treatment, non-dependence producing sleeping medications such as trazodone may be prescribed.
At the Atlanta Center for Adult ADHD, we always recommend aerobic exercise to our patients who are physically capable as regular vigorous exercise can improve ADHD symptoms significantly.
While we have not found any supplements that are consistently effective for ADHD, it is important that patients do maintain a healthy diet with the minimum FDA recommended vitamins and minerals. A multivitamin should be taken if necessary.
For patients interested in ADHD counseling and/or coaching, our program assists in referrals to top local specialists in these areas. Neurofeedback referrals can be made as well.