This is without a doubt the most controversial area of treatment regarding ADD/ADHD.
Opponents state our society rushes to put a "chemical straightjacket" on children just because their
behavior may be socially unacceptable. They also note that medication, especially when used with children or
adolescents, can result in numerous and sometimes permanent side effects, such as reduced appetite, headaches,
trouble falling asleep, and decreased growth rate.
Opponents also cite numerous articles detailing the flawed approval process of the Food and Drug
Administration (FDA), the federal agency responsible for reviewing new medications. One example: the FDA
routinely relies on panels composed of physicians and medical researchers to
provide data from clinical drug trials. Studies have found that anywhere from
one-quarter to three-quarters of panels had at least one advisor with financial
ties to drug companies, thus creating a conflict of interest.
Supporters of medication maintain that ADD/ADHD is the best-researched condition in medicine, and many long-term,
rigorous studies demonstrate the effectiveness of medications and the absence of severe or permanent side-effects.
Brain imaging studies have implicated at least 3 areas of the brain that are under-active in people with ADD/ADHD:
the prefrontal cortex, basal ganglia, and cerebellum. Because of the complex interaction between these areas, the
type, amount, and combination of medications which successfully treat ADD/ADHD can vary from patient to patient.
Further complicating matters, it is estimated that up to 60% of people with ADD/ADHD have other disorders as well,
which generate their own symptoms and treatment protocols.
Psychostimulants are the most widely used medications. General categories are:
- Methylphenidate (Ritalin, Concerta, Focalin, Daytrana patch)
- Mixed salts of a single-entity amphetamine product (Adderall)
- Dextroamphetamine (Dexedrine)
Many studies document a 70-80% success rate using stimulants.
Antidepressants influencing the neurotransmitters dopamine and norepinephrine such as bupropion (Wellbutrin) have been
shown to be effective. Antidepressants affecting only the serotonin system (called SSRIs), such as Prozac, Zoloft,
and Celexa, have not been shown to be viable.
In November 2002, the FDA approved a first-ever non-stimulant drug for treatment of ADD/ADHD, atomoxetine (Strattera).
It has been tested on over 1500 children, adolescents, and adults with ADD/ADHD, but due to its recent release there
are no long-term studies.
Currently under study is the drug modafinil (Provigil). It has shown beneficial results in treating narcolepsy, and
anecdotal evidence suggests it may be effective with ADD/ADHD. Proponents note it stimulates only the brain while
ignoring the rest of the nervous system, thereby avoiding "jitters" and other side effects.
Amantadine, a drug originally developed as an antiviral agent, has been shown by a Boston-area doctor to be an
effective treatment for ADD/ADHD. It has limited side effects and is not a controlled substance. However,
no scientific studies have been conducted at this point.