How stimulants work in Adult ADHD: Most people know that the stimulant medications can be of great help in Adult ADHD, but most people think it just boosts concentration. They can be extremely helpful, and I have seen many people who found them transformative. There is no such thing as a free lunch. It can help to be aware of some of the negative aspects and ways you can minimize them.
The stimulants (dexamphetaine/Adderall, ritalin/concerta/methylphenidate) have many effects on the brain/body. Many of these stimulants are not well-known to the public or their doctors. We’ll discuss the 10 secrets and
benefits of stimulant medications.Secret 1: Stimulants can inhibit natural distractibility
Secret 2: Stimulants can decrease spontaneity, creativity, and playfulness
Secret 3: Stimulants can make it worse to sleep, anxiety, panic, and anger
Secret 4: Sometimes stimulants can reduce anger and anxiety
Secret 5: Stimulants can sometimes lead to addiction
Secret 6: Stimulants can improve physical performance, blood pressure, and heart rate
Secret 7: The reverse of stimulant effects
are rebound effectsSecret 8: Sometimes, the “crash”, can help with sleep
Secret 9: Tolerance may develop over time. This can lead to dose creep Regular (weekly) breaks from them
can reduce the risk of secret 10: tolerance/dose creep
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*Duration of Effectiveness-DOEShould Become The New Standard
Language and Precision: Maps & Changing Territories - Korzybski: M
- *DOEmarks the specific metabolic patterns for each individual, and each stimulant medication, and will announce them to both the patient and practitioner for accurate precise, individualized treatment. To not measure DOE at every med check is to passively ignore the built-in marker for effective treatment and should be the *essential evaluation toolin every med check with stimulant medications.
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Details Matter:
The Meds Don't Work Long Enough: The Duration of Effectiveness [DOE] is not adequate: Each stimulant drug, each family of stimulant drugs has its own expected DOE. This DOE is not discussed in the literature as a measuring tool, but it's common knowledge with any who watches carefully for drug action and duration throughout the day.
All stimulant medications have an expected, less than 24 hr duration. Duration is an obvious point but is overlooked so often as an essential tool. If meds last less than 24 hr, then how long should each last? Dialing in the particular duration is necessary to get the best action out of each specific med. [AMP=Amphetamine Family, MPH=Methylphenidate Family]
Vyvanse [AMP] and Daytrana [MPH patch] both win the DOE race with 12-14 hr expected as optimum.
Adderall XR [AMP] is next with 8 hr DOE -- sometimes can get 10, but often more DOE is too much - out the top of the Therapeutic Window: w
Concerta [MPH] and Focalin [MPH] both run 8 hr if dialed in effectively - some studies show longer, my experience: more than 10 hr with either of these is too much -- see other articles on the 'Top of the Window.'
Metadate CR [MPH] and Ritalin LA [MPH] are both right at 8 hr, rarely longer, with side effects, if pushing the dose higher
The Immediate Release Stimulants, the tablets with no extended time
expected, last only a portion of the day with Adderall IR [AMP]
[Immediate Release Tabs] lasting about max 5 hr, Ritalin IR [MPH] is 4-hour max duration.
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