We could consider trying a stimulant to see if it helps. Usually we try Adderall XR as a 1st choice for adults (generic name is amphetamine- dextroamphetamine mixed salts) which is FDA approved for ADHD in kids 3 and older when using adderall instant release, and adderall XR in individuals age 3 and up. The XR, or extended relief version, usually lasts 8-12 hours, so needs to be taken in the AM with or after breakfast (so we don't have too much weight loss, as these meds impair appetite). This is the preferred version, due to this having less side effects and less of an impact once the medication wears off.
It works, as do all stimulants, by increasing norepinephrine and especially dopamine actions by blocking their reuptake and facilitating their release ; Enhancement of dopamine and norepinephrine actions in certain brain regions (e.g., dorsolateral prefrontal cortex) may improve attention, concentration, executive function, and wakefulness ; Enhancement of dopamine actions in other brain regions (e.g., basal ganglia) may improve hyperactivity ; and Enhancement of dopamine and norepinephrine in yet other brain regions (e.g., medial prefrontal cortex, hypothalamus) may improve depression, fatigue, and sleepiness
It's dosing range is between 5mg and 60mg per day, once per day.
We can start at Adderall XR 10mg and then try to adjust dose from there.
One of the other nice things about Adderall XR is that for those who have trouble swallowing capsules, you can open up the capsule to dump out the beads onto apple sauce, yogurt, or peanut butter. Don't put it in liquid though because you'll lose a lot of it as it sticks to the glass.
Here is more information on what to watch for when taking stimulants:
**If there is a history of cardiac problems such as sudden cardiac death or arrhythmias in the immediate family (parents, siblings), please get an EKG prior to starting stimulants. Stimulants are thought to be safe on the heart but, like drinking high amounts of caffeine, stimulants can be problematic for people who have a family history of severe cardiac issues.
Stimulants are the most commonly prescribed treatment for ADHD & impulse control disorders. The reason for this is that they are SO effective and they tend to be reasonably well tolerated. That said, they have side effects to watch for. Here are the big 5 that we really want to watch for, followed by other issues to consider in general:
-Appetite suppression (with weight loss eventually)
-Irritability (either when on the med or, more likely, when it wears off)
-Anxiety while on the medication (just as caffeine makes some people more anxious)
-Tics -- motor and/or verbal tics, which tend to be more of an issue in boys under the age of 10
The other issues for all stimulants are
Posted by David Danish MD