Almost every person with adult ADHD eventually faces the decision of whether or not to take medication. This can be a tough decision. First, ADHD usually is not life threatening, although it can be highly disabling, so you don’t have to treat it with medication to live. Second, ADHD has its good points, including creativity, energy, and the ability to hyperfocus, so treating can create problems if you need those traits. Third, medications are difficult to take–they often have side effects, are potentially addictive, and in 30% of patients, do not work. This guide is to help you walk through the decision of whether or not to use medication to treat your ADHD.
How severe are the symptoms?
Severe symptoms mean that active, intensive treatment should be considered, including medication and counseling.
Indicators of severe ADHD include having:
1) a family history of ADHD
2) symptoms severe enough to cause school or job failure
3) difficulty making or keeping friends due to symptoms
4) symptoms severe enough to cause your marriage to be in danger of dissolving.
5) symptoms severe enough to cause danger to self or others. This can include impulsive acts, aggression or speech, and includes behavior while driving.
6) symptoms that interfere with needed other rehabilitative services, like drug rehab or counseling for other psychiatric conditions, marital issues, or parenting issues.
How certain are you about the diagnosis?
As long as the symptoms are not severe, it is worth your while to be certain about the diagnosis. Get educated. See your health care provider to rule out other medical problems, especially depression, sleep disorders, and thyroid problems. Consider seeing a neuropsychologist or neurologist for testing if you’re still not convinced.
What else have you tried?
Self help books, coaching or counseling can help with organizational skills, time management, and other specific symptoms that cause problems at work and at home. College students find that certain study skills can also be learned. These skills will last a lifetime, so it is worth your while to invest in them if you have not already.
Other common sense natural approaches may be worth trying, such as cleaning up your sleep habits, eating food free of artificial colors, and trying an omega 3 supplement.
What other mental health and physical health issues do you have to take into consideration?
Anxiety. Stimulants can worsen anxiety or improve it, if the anxiety is primarily from ADHD.
Heart Arrythmias. Many cardiologists would recommend against taking a stimulant if you have an irregular heartbeat. The safety of other medications depends on the exact type of arrhythmia.
High Blood Pressure. Stimulants can raise blood pressure. Some nonstimulants lower blood pressure.
Pregnancy. You should consult with your obstetrician. Some medications are considered safer than others, but limited information is available.
Seizures. Stimulants can make it more likely to have a seizure.
Substance abuse/history of substance abuse. Many stimulants are also drugs of abuse. Some nonstimulants may be problematic for certain types of drug abuse.
Tics. People who have tics and ADHD may safely take medication for ADHD, but may require closer monitoring.
What are good things about medication?
- It works in about 70% of people.
- It often works within a couple of days of starting.
- It’s easier than lifestyle changes, like diet and changing sleep habits.
What are bad things about medication?
- Side effects occur in 30% or more patients. Some side effects must be managed with lifestyle changes. Other rare side effects can be worse than the ADHD–severe mood swings or hallucinations, for example.
- It is not unusual to need to try more than one medication before finding something that works.
- When you find a medication that works, sometimes it only works for a few months and then you need to try something else.
- Some medications are potentially addictive. Taken properly, medications may prevent substance abuse, but some patients are more at risk than other.
- The most effective medications cannot be given to last all day long, so patients are often unmedicated first thing in the morning and later at night.
- Cost can vary widely with medications. Many are generic. Many are not. Insurance plans vary on which medications are covered. Also, if the medication is a controlled substance (all stimulants), then you must factor in the cost of extra doctor’s visits as some doctors cannot or will not prescribe more than one month’s supply at a time.
What’s good about alternative treatments?
- Most alternative treatments do not have such severe and obvious immediate side effects as medications do.
- Alternative treatments often do not require a doctor’s prescription which often leads to lower costs and less hassle (in some ways).
What are the bad things about alternative treatments?
- Coaching and neurofeedback require an investment of time and mental energy. Insurance coverage varies.
- There are no alternative treatments which have proven as effective as medication in the short term, although coaching is likely more consistently effective over the long term.
- There are no alternative treatments which work as quickly as medication (although some patients notice a difference after only a couple of weeks of certain dietary changes or after implementing behavioral therapies).
- We do not know the long term side effects of many alternative therapies.
- Alternative therapies are often not tightly regulated by the FDA, so it may be difficult to obtain what you are really looking for.
What is your personal philosophy about medication?
This is the part of medication use that only you can determine. How much time are you willing to invest in this? How much do you care about avoiding artificial substances? How much do you want or need the ADHD symptoms to go away?