Education For Patients and Providers

ADHD Medication: Common Misconceptions About Stimulants – Education for Patients and Providers

Stimulant medications have long been the cornerstone of ADHD treatment and continue to be recognized as the gold standard for most individuals, given there are no contraindications. They are proven to be efficacious, and studies show they can significantly improve the quality of life for many individuals with ADHD. Yet, some misconceptions persist, often contributing to hesitation in both patients and caregivers about their use.

Misconception 1: Stimulants Cause Addiction

A common belief is that stimulant medications used for ADHD, such as methylphenidate and amphetamines, lead to addiction. However, when these medications are used appropriately under a doctor’s supervision, the risk of addiction is very low. In fact, research shows that treating ADHD with stimulants can lower the risk of substance use disorders. Untreated ADHD can increase the risk of developing substance abuse issues due to attempts at self-medication or impulsive behavior, aspects that are more effectively managed when ADHD is treated with appropriate intervention. Please note that the most effective known intervention for ADHD is stimulant medications. There exists no, we repeat, there exist no known pharmacologic interventions in the world of psychiatry that are as effective as stimulants are for ADHD or any other known behavioral health condition. That’s not to say they are a panacea or there are no contraindications to their use; however, providers who are in the behavioral health care space that waive the use of these treatments simply because of their own discomfort, we believe, are shirking their responsibilities and contributing to the stigma around ADHD. 

Misconception 2: Stimulants Will Change Personality

Some worry that stimulants will fundamentally change their personality or make them ‘zombies.’ While stimulants can cause side effects, including apathy, when dosed correctly, these medications do not change a person’s personality. Instead, they help individuals to better focus and control impulsivity, which can, in turn, allow their inherent personality to shine more, free from the overshadowing effects of uncontrolled ADHD symptoms.

Misconception 3: Stimulants Are a “Crutch”

Some perceive the use of stimulants as a crutch or a sign of weakness. This perspective overlooks the fact that ADHD is a real, biologically-based disorder. Using medication to manage it is no more a crutch than using insulin for diabetes.

Stimulants are considered the gold standard for ADHD treatment due to their robust efficacy, demonstrated in numerous studies. They have been found to significantly improve core symptoms of ADHD – including inattention, hyperactivity, and impulsivity. This leads to improved functioning in multiple areas of life, including academic or work performance, social relationships, and overall quality of life.

In the realm of ADHD management, it’s often misunderstood why starting with stimulant medications when there are no contraindications is important. This practice isn’t to minimize the role or effectiveness of non-stimulant options but rather reflects an understanding of the differential effectiveness and speed of action between these classes of medications.

Stimulant medications, such as methylphenidate and amphetamines, have consistently been shown to be highly effective in managing ADHD symptoms in a majority of patients. On average, they provide symptom improvement in around 70-80% of individuals, a considerably high rate. These medications also tend to have a relatively fast onset of action, with many patients experiencing symptom relief within an hour of taking the medication. This prompt response often provides quick feedback on the medication’s effectiveness and tolerability, allowing for more precise dose adjustments early in treatment.

In contrast, non-stimulant medications like atomoxetine, guanfacine, or clonidine are often less effective in managing ADHD symptoms and can take weeks to reach their full effect. While these medications have an important role in ADHD treatment, particularly for those with certain comorbid conditions or those who cannot tolerate or do not respond to stimulants, they are typically not the first-line choice.

Starting with non-stimulant options in patients who have no contraindications for stimulants may delay the process of symptom control and cause unnecessary prolongation of distress or dysfunction associated with ADHD. It’s akin to not using the most efficient tool at our disposal. From a patient-centered perspective, this could be seen as a disservice, as it may deprive the patient of the most effective and quickest relief from their symptoms.

That being said, every treatment decision must be individualized, based on a comprehensive evaluation of the patient’s symptoms, personal and family history, lifestyle, and personal preferences. And as always, open and clear communication between the patient and the provider is key to ensuring the best possible outcome.

As healthcare providers, our main concern is always the wellbeing of our patients. It is important to individualize the treatment plan to meet the specific needs of each patient. This includes a frank discussion about the risks and benefits of each treatment option, addressing misconceptions and worries, and providing ongoing support and monitoring.

Given the nature of stimulants, adherence to the prescribed regimen, regular follow-ups, and a robust doctor-patient relationship can ensure that the benefits of stimulants are harnessed effectively, while potential side effects or issues are promptly addressed. The ultimate goal is to empower each patient to achieve their best functional state and lead a fulfilling life.

References – Footnotes

  1. Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., … & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 5(9), 727-738. ↩2 ↩3 ↩4
  2. Swanson, J., Arnold, L. E., Molina, B., Sibley, M., Hechtman, L. T., Hinshaw, S. P., … & Stehli, A. (2017). Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression. Journal of Child Psychology and Psychiatry, 58(6), 663-678. ↩2 ↩3
  3. Wilens, T. E., Faraone, S. V., Biederman, J., & Gunawardene, S. (2003). Does stimulant therapy of attention-deficit/hyperactivity disorder beget substance abuse? A meta-analytic review of the literature. Pediatrics, 111(1), 179-185.
  4. Humphreys, K. L., Eng, T., & Lee, S. S. (2013). Stimulant medication and substance use outcomes: a meta-analysis. JAMA psychiatry, 70(7), 740-749[^5^]: Faraone, S. V., Buitelaar, J., Spencer, T. J., Wilens, T., Zhang, S., Orsini, C., … & Cipriani, A. (2021). Comparing the Efficacy of Stimulants for ADHD in Children and Adolescents Using Meta‐analysis. European Neuropsychopharmacology. ↩2
  5. Sciberras, E., Mulraney, M., Silva, D., & Coghill, D. (2017). Prenatal Risk Factors and the Etiology of ADHD–Review of Existing Evidence. Current Psychiatry Reports, 19(1), 1.
  6. Cortese, S., Holtmann, M., Banaschewski, T., Buitelaar, J., Coghill, D., Danckaerts, M., … & Sergeant, J. (2013). Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents. Journal of Child Psychology and Psychiatry, 54(3), 227-246.
  7. Coates, J., Taylor, J. A., & Sayal, K. (2015). Parenting interventions for ADHD: A systematic literature review and meta-analysis. Journal of Attention Disorders, 19(10), 831-843. ↩2
  8. Thapar, A., Cooper, M., Eyre, O., & Langley, K. (2013). Practitioner review: what have we learnt about the causes of ADHD?. Journal of Child Psychology and Psychiatry, 54(1), 3-16.
  9. DuPaul, G. J., & Langberg, J. M. (2015). Educational impairments in children with ADHD. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed., pp. 169-190). Guilford Press.
  10. Faraone, S. V., & Glatt, S. J. (2010). A comparison of the efficacy of medications for adult attention-deficit/hyperactivity disorder using meta-analysis of effect sizes. Journal of Clinical Psychiatry, 71(6), 754.
  11. Faraone, S. V., Spencer, T., Aleardi, M., Pagano, C., & Biederman, J. (2004). Meta-analysis of the efficacy of methylphenidate for treating adult attention-deficit/hyperactivity disorder. Journal of Clinical Psychopharmacology, 24(1), 24-29.
  12. Swanson, J., Gupta, S., Guinta, D., Flynn, D., Agler, D., Lerner, M., … & Wigal, S. (1999). Acute tolerance to methylphenidate in the treatment of attention deficit hyperactivity disorder in children. Clinical Pharmacology & Therapeutics, 66(3), 295-305.
  13. Greenhill, L. L., Pliszka, S., Dulcan, M. K., Bernet, W., Arnold, V., Beitchman, J., … & Bukstein, O. (2002). Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. Journal of the American Academy of Child & Adolescent Psychiatry, 41(2), 26S-49S.
  14. Newcorn, J. H., Kratochvil, C. J., Allen, A. J., Casat, C. D., Ruff, D. D., Moore, R. J., & Michelson, D. (2008). Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: acute comparison and differential response. American Journal of Psychiatry, 165(6), 721-730. ↩2
  15. Coghill, D. R., Banaschewski, T., Soutullo, C., Cottingham, M. G., & Zuddas, A. (2017). Systematic review of quality of life and functional outcomes in randomized placebo-controlled studies of medications for attention-deficit/hyperactivity disorder. European Child & Adolescent Psychiatry, 26(11), 1283-1307. ↩2
  16. Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., … & Searcy, Y. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4).
  17. Ahmed, R., Aslani, P., & Sadowski, C. A. (2013). A review of patient adherence to antipsychotic medications. Journal of Pharmaceutical Health Services Research, 4(3), 155-166.
  18. Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., … & Searcy, Y. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4).
  19. Banaschewski, T., Coghill, D., Santosh, P., Zuddas, A., Asherson, P., Buitelaar, J., … & Kuntsi, J. (2006). Long-acting medications for the hyperkinetic disorders. A systematic review and European treatment guideline. European Child & Adolescent Psychiatry, 15(8), 476-495. ↩2

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