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Areas › Focus, starting, and ADHD › Medication and how it works
There are people for whom one is the right first choice: tics, real anxiety alongside, a history that makes a stimulant a poor idea, or a body that will not put up with one. Worth knowing too that the worry about stimulants and addiction is less clear cut than it is usually told. If a non-stimulant has been suggested to you, ask which of these reasons is the one in play.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
'God does not burden any soul with more than it can bear' (Quran 2:286). Choosing the option your body can actually carry is part of that, not a concession.
البقرة
لَا يُكَلِّفُ ٱللَّهُ نَفۡسًا إِلَّا وُسۡعَهَاۚ لَهَا مَا كَسَبَتۡ وَعَلَيۡهَا مَا ٱكۡتَسَبَتۡۗ رَبَّنَا لَا تُؤَاخِذۡنَآ إِن نَّسِينَآ أَوۡ أَخۡطَأۡنَاۚ رَبَّنَا وَلَا تَحۡمِلۡ عَلَيۡنَآ إِصۡرࣰ ا كَمَا حَمَلۡتَهُۥ عَلَى ٱلَّذِينَ مِن قَبۡلِنَاۚ رَبَّنَا وَلَا تُحَمِّلۡنَا مَا لَا طَاقَةَ لَنَا بِهِۦۖ وَٱعۡفُ عَنَّا وَٱغۡفِرۡ لَنَا وَٱرۡحَمۡنَآۚ أَنتَ مَوۡلَىٰنَا فَٱنصُرۡنَا عَلَى ٱلۡقَوۡمِ ٱلۡكَٰفِرِينَ
God does not burden any soul with more than it can bear: each gains whatever good it has done, and suffers its bad- ‘ Lord, do not take us to task if we forget or make mistakes. Lord, do not burden us as You burdened those before us. Lord, do not burden us with more than we have strength to bear. Pardon us, forgive us, and have mercy on us. You are our Protector, so help us against the disbelievers.’
Qur’an 2:286read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
In children who had both ADHD and an anxiety disorder, a randomised double blind trial found atomoxetine improved both sets of symptoms against placebo, which is one clear reason to reach for it. The picture on substance use is less tidy than the folklore: a randomised trial in adults with ADHD and cocaine use disorder found extended release mixed amphetamine salts improved both the ADHD symptoms and abstinence. Both are single trials in particular groups, so they inform a choice rather than settle it.
Geller D, Donnelly C, Lopez F, Rubin R, Newcorn J, Sutton V, Bakken R, Paczkowski M, Kelsey D, Sumner C. (2007). Atomoxetine treatment for pediatric patients with attention-deficit/hyperactivity disorder with comorbid anxiety disorder.. Journal of the American Academy of Child and Adolescent Psychiatry doi
Levin FR, Mariani JJ, Specker S, Mooney M, Mahony A, Brooks DJ, Babb D, Bai Y, Eberly LE, Nunes EV, Grabowski J. (2015). Extended-Release Mixed Amphetamine Salts vs Placebo for Comorbid Adult Attention-Deficit/Hyperactivity Disorder and Cocaine Use Disorder: A Randomized Clinical Trial.. JAMA psychiatry doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Which drug goes first depends on what else is going on in the person, not on a league table.
Any switch between classes belongs with the prescriber, particularly where there is a history of substance use or a heart condition.
Skipping weekends, holidays and summers is a common suggestion and mostly it is the wrong call. The difficulty does not take a holiday when school does.
Capsules are not the only option any more. Long acting liquids and chewable forms exist, so a child who cannot manage a pill does not have to be left with nothing or with a dose that runs out by lunchtime.
For someone who cannot swallow tablets, or whose mornings fall apart long before the tablet gets taken, patches exist that release medicine slowly through the skin over hours.