Stimulant medication
Psychostimulant drugs have been for many years used for ADHD treatment. Many heatlh care personnel attending to patients suffering from ADHD have observed impressive outcomes in the use of Psychostimulant drugs. Studies indicate high levels of efficacy with the use of stimulant drugs such as methylphenidate in the treatment of ADHD (Asherson et al., 2007; Bouffant et al., 2003).
Additionally, other psychiatric symptoms associated with other psychiatric conditions such as depression and anxiety improved with the use of methylphenidate. This means that methylphenidate is effective and well tolerated in ADHD treatment. Because of their effectiveness and less side effects, stimulants are often considered as first-line treatment for ADHD symptoms (Banaschewski et al., 2003).
The precise mechanism of action of stimulants remains largely unknown. However, stimulants are thought to hinder reuptake of norepinephrine and dopamine presynaptically. Recent research indicates that about 20 %-50% of adults being treated of ADHD do not respond to the stimulants due to inadequate symptom reduction or lack of ability to tolerate adverse effects (Handen et al., 2011). For adults who respond to Psychostimulant treatment, a reduction of about 50 % of ADHD symptoms is observed. For the ADHD patients who are unable to tolerate stimulants, non-stimulants such as Atomoxetine can be used (Banaschewski et al., 2004).
Previous studies have indicated a vigorous efficacy of stimulants on managing the core symptoms of ADHD in adults (Banaschewski et al., 2004). Some of the researchers have carried an extensive research on dose-response correlation in ADHD treatment (Bouffard et al., 2003). Additionally, Banaschewski et al., (2004) note that the several randomized controlled trials on ADHD establish the efficacy and safety of stimulants in ADHD treatment. Moreover, previous studies indicate a reliable evidence for the efficiency of methylphenidate and amphetamines on minimizing ADHD symptoms (Asheron et al. 2007). These stimulants have proven to be effective especially during the first weeks of treatment, and they have minimal adverse effects (Bouffard et al., 2003; Asherson et al., 2007; Banaschewski et al., 2004).
On the other hand, Adler et al., (2006) note that the efficiency of methylphenidate in the treatment of the core symptoms of ADHD was linked with physician's use of higher doses and exaggerated rating of outcomes. As mentioned earlier, the use of physician's rating may overestimate the efficacy of this stimulant. Recent studies indicate that the earlier hypothesized dose-response correlation in stimulant treatment, in support of high doses, is not so evident. The dose-response correlation seems to be extremely different among patients, implying that the dose must all the time be individualized for average efficiency and tolerability (Asherson et al., 2007; Adler et al., 2006).
Some of the studies conducted on the efficacy of methylphenidate maintained an open long-term follow up and established that very few patients adhered to medication at the period of follow-up (Handen et al., 2011). Another recent research from Canada pointed out that adherence by the 7th month after the first prescription was as low as 23.5 % for methylphenidate (Handen et al., 2011). Another study conducted by Norwegian Health authorities on ADHD patients treated using stimulant drugs indicated that nearly 80 % of patients do not adhere to the initial prescription. It is therefore evident that most ADHD adult patients choose not to adhere to initial prescription despite the positive response on core ADHD symptoms (Handen et al., 2011).
A cross section review of most studies point out that very few patients adhered to medication at the time of the follow-up (Handen et al., 2011). This issue makes it difficult to establish the effect of comorbidity on reaction to treatment in adult ADHD. When assessing efficiency of medication on outcome parameter for other symptoms apart from core ADHD symptoms i.e. quality of life, it becomes difficult to find a positive effect. In fact, there are possibilities for a negative effect on outcome parameters of anxiety and depression.
One reason that can be given behind this result may be many studies have low baseline parameters on measuring scales like anxiety and depression. Another possible explanation is that a significant number of patients do not experience a break in symptoms of depression from their ADHD treatment. The persistent depression may result to a negative attitude on treatment adherence (Banaschewski et al., 2004).
However, it is worth to acknowledge that stimulant drugs are often helpful in treating ADHD. It significantly improves the patient's attention and ability to learn. These drugs are also known to curb the coordination problem, which affects sports and handwriting. Under the prescription, these drugs do not make the user feel high although it is normal for them to feel different. As stated earlier, there is no persuading evidence that ADHD patients risk becoming addicted to the Psychostimulant drugs used to treat ADHD. In support of this argument, a study conducted by Harvard Medical school found that the rate of substance abuse were lower among the patients of ADHD who adhered to medication (Adler et al., 2006).
It is important to note that not all drugs used to treat ADHD are stimulants. There are newer kinds of drugs that are non-stimulants. These drugs share similar outcomes with stimulants only that they function in a different way. Another important category of drugs used to treat ADHD are antidepressants, which mainly act on the brain chemicals. They can be used alone, or combined with the stimulants (Adler et al., 2006).
Clinical effects of Stimulants
Stimulants have proved a high behavioral efficiency in several randomized regulated trials. It has been observed that stimulants efficiently alleviate some of the symptoms of ADHD such as restlessness, poor attention span, and hyperactivity among others. Stimulants improve reaction time, vigilance, short-term memory among others. However, stimulant medications are linked with few side effects (Bouffard et al., 2003).
Side Effects of ADHD drugs
Most of the side effects that have been related with the treatment of ADHD are minor. Consequently, they should not contribute to stopping the treatment. Some of these side effects include: [1] Decreased appetite whereby patients suffer loss of appetite especially during the day and regain it by suppertime. Good nutrition should be a top priority for patients suffering from ADHD; [2] Insomnia; however this can be regulated by taking the medication earlier in the morning; [3]This treatment also increases blood pressure and pulse.
This increase in blood pressure has major clinical significance for patients suffering from cardiac diseases (Gualtieri, Ondrusek, & Finley, 1985). ADHD medications only manage ADHD symptoms the day they are taken. Patients should therefore note that the disorder is not cured, and that it is important to adhere to medication (Banaschewski et al., 2004).
Conclusion
In treating ADHD, it is advisable to make follow-ups on the patient and take measures to stop discontinuation from the medication. Clinicians should note that the treatment of ADHD does not obviously relieve the patients from symptoms. It is also important for clinicians to establish an accurate diagnosis, support of the patient, use correct dosage, and observe the efficiency of the drug.
Moreover, there is the need for clinicians to have the right knowledge concerning ADHD including the merits, demerits, and the mechanism of action of the drug they use for treating ADHD. It is also the clinicians' responsibility to make a follow up on their patients to ensure that they adhere to the medications prescribed to them.
As mentioned earlier, non-stimulant drugs have also proved to be successful. In conclusion, there is sound evidence for both pharmacological and psychotherapeutic treatment of ADHD in adults. The clinicians are also advised to make use of combined medication approach as an efficient way of overcoming numerous comorbid conditions such as depression, bipolar conditions among others while at the same time treating ADHD.
