Do stimulants increase hyperactivity?
Dear Dr Quinn:
I wonder if you could answer a question for me. I was Diagnosed ADHD and cannot seem to take any medication. They make me hyper. When I am really tired, I can take a small dose of Adderall. Otherwise, I feel like I am bouncing off the walls. I take the lowest dose made of Adderall. Should I try Concerta or Ritalin? Any suggestions would be appreciated.
I have seen this response on occasion in some of the children I have treated. However, the answer may be a little confusing. For some people with ADHD, taking a too-small dose of stimulant medication actually makes them more hyperactive. In such cases, they need to increase the dose of stimulant to get the response that they are looking for. I suggest that you speak to your prescribing physician and try a higher dose of stimulant for a few days to see if that works.
If this doesn’t work, you might try to switch classes of stimulants, from an amphetamine to one in the methylphenidate class. On occasion, the amphetamines may cause irritability and jitteriness in certain individuals. Coexisting anxiety can also be made worse by the administration of certain stimulants. Changing from one class of stimulant to the other class or switching within the same class may also address these side effects. Within the same class, there are also now several delivery systems, which release the stimulants in varying amounts in a mix of short acting and long acting medication. The following chart lists the new medications and their duration of action.
|Focalin™||a refined form of Ritalin®, isolating only the effective isomer||(3-4 hours)|
|Adderall||mixed amphetamine salts||(4-6 hours)|
|Ritalin® LA||once-daily formulation of Ritalin® that mimics BID dosing and duration and designed to last the school day||(6-8 hours)|
|Adderall XR™||extended-release formulation of mixed amphetamines that mimics BID dosing||(8-12 hours)|
|Metadate® CD||methylphenidate formulation designed to mimic BID duration||(4-8 hours)|
|Concerta®||methylphenidate formulated to mimic TID duration||(10-12 hours)|
|Dexedrine spansules||longer-acting amphetamine||(8-10 hours)|
Stimulants are very effective for reducing the symptoms of ADHD, but must be taken in the correct dose. Each woman responds differently and should work with her prescribing physician to find a dose that is effective at reducing ADHD symptoms and optimizes functioning.
As of January, 2003, there is also another non-stimulant medication available. Strattera is a selective norepinephrine reuptaker inhibitor, which is indicated for the treatment of ADHD in children, adolescents and adults. The mode of action of Strattera in the treatment of ADHD is currently not known. However, it is the only medication that affects the regulation of norepinephine. It is not associated with an appreciable abuse potential and is not a controlled substance. Strattera is recommended to be administered as a single daily dose in the am or pm. and with effects lasting until the next dose.