The drug therapy of ADHD

Attention Deficit Hyperactivity Syndrome, Fidgety Phil Syndrome Fidgety Phil, Psychoorganic Syndrome (POS), Hyperactivity Syndrome, Hyperkinetic Syndrome (HKS), Attention Deficit Hyperactivity Disorder, ADHD, Attention – Deficit – Hyperactivity – Disorder (ADHD), minimal brain syndrome, Behavioral Disorder with Attention and Concentration Disorder, Fidgety Phil, ADD, Attention Deficit Syndrome, ADD. The Attention-Deficit Hyperactivity Syndrome comprises a distinctly inattentive, impulsive behaviour that manifests itself over a longer period of time (about six months) in several areas of life (kindergarten/school, at home, leisure time). Due to the variable and sometimes below average ability to build up attention, other areas (German and/or mathematics) are often affected by problems at school.

Many ADHD children develop LRS (= literacy and spelling weakness) and/or dyscalculia. In addition, ADHD children can also be highly gifted. Even the first “suspicions” of this can be much more difficult to express, because – due to the symptoms of ADHD – the symptoms of giftedness may not be interpreted correctly and therefore cannot be recognised.

A drug therapy should alleviate symptoms and enable the child to live and learn adequately. Drug therapy in the field of ADHD therapy is probably the most controversial form of therapy in this area. There are two opposing opinions in this respect: We are of the opinion that ADHD should never be treated exclusively with medication, but should always be embedded in a multimodal (= multi-layered) and thus individually appropriate therapy.

One must not see a panacea in the drug therapy but rather recognize that this is only a contribution to alleviate the symptoms of ADHD on several levels. Of course, the support of the family is particularly important. In addition to love, affection and security, a consistent education with rights and duties, with adherence to rules will contribute to the improvement of the symptoms.

A drug therapy should be started at the earliest from the age of 6 years. Drugs are used to regulate the imbalance of messenger substances in the brain. In addition to first-choice drugs, the so-called stimulants, antidepressants are also used.

They are aimed at increasing the concentration as well as the stamina and attention of an affected child. By strengthening the impulses and their accompanying symptoms, the child as such appears calmer and more orderly. If a decision is made in favour of a drug therapy for ADHD, the individual dose and the right time for taking it must first be determined with the doctor treating the child.

Depending on the medication, the effect is immediate and lasts differently. Some drugs must be taken several times a day, others release the active substance gradually, so that a single daily intake is sufficient (“retarded drugs”). Each drug has its own individual side effects.

In the case of ADHD medication, these are often loss of appetite, headaches and stomach aches, sleep disorders, depression, etc. It is not always said that a child responds immediately to medication. Furthermore, it is important to know that drug therapy does not “cure” ADHD.

It relieves the symptoms for as long as the medication is taken. However, this does not mean that an ADHD child will be dependent on drug therapy for the rest of his or her life. The more complex and individually suitable a therapy is, the better the symptoms can be improved.

Frequently, drug therapy provides the basis for further forms of therapy to become possible in the first place. Through this multi-layered therapy, negative behaviour patterns can be influenced favourably and replaced by other behaviour patterns. The declared aim is to strengthen the child’s behaviour in such a way that it learns to use these positive behaviours itself (self-management), so that at some point, in agreement with the treating physician, the medication can be reduced or even discontinued completely.

Recent research results and studies prove that medication does not usually lead to dependency in cases of clearly proven ADHD and individually appropriate dosage. Unfortunately, there is a lack of long-term studies, especially with newer medications, which can confirm or disprove such a result in the long term. At this point, we would like to point out that the risks that can occur with drug therapy vary from case to case and no general statements can be made here.

  • Those who reject a drug therapy in any case and
  • Those who approve of them. As already mentioned in the causes section on the ADHD page, the latest research suggests that the main cause is a change in the way the brain functions. This altered functioning describes a complex disorder of the so-called catecholamine balance, which must be imagined as follows.

In the presence of a proven ADHD and thus a correct diagnosis, there is an imbalance of the above-mentioned messenger substances. This imbalance disturbs the transmission of information between the individual nerve cells in the area of individual brain areas. If this balance is disturbed, stimuli cannot be transmitted in the usual way.

Since the messenger substances have a considerable influence on human behaviour through their properties, an imbalance of the messenger substances means behaviour that deviates from the norm. Now, some messenger substances may be present in sufficient quantities, while others may be insufficiently present. In the end, this results in the different symptoms of ADHD.

Now it becomes clear why not every symptom must be present and why a list of criteria can never be complete. – With regard to ADHD, three different catecholamines (messenger substances) become important: noradrenalin, serotonin, dopamine. – All the catecholamines mentioned have a specific function: norepinephrine drive, serotonin impulsiveness, dopamine drive.

  • Normally these substances are in a balance
  • Further effects result from the interaction. The interaction of norepinephrine and serotonin, for example, is responsible for the development of anxiety states, while serotonin and dopamine are responsible for appetite, but also for aggression and lust. Norepinephrine and dopamine regulate motivation; all three together have effects on mood, emotionality and cognitive abilities.

Due to the varying imbalance of the messenger substances in individual cases, different groups of drugs are needed that are targeted. In principle, a distinction is made mainly between antidepressants, which in turn are divided into

  • Stimulants, which also include drugs with the main active ingredient methylphenidate (e.g. Ritalin® ). – Antidepressants
  • NARI (Selective Norepinephrine Resumption Inhibitors)
  • SNRI (Serotonin – Norepinephrine – Resumption inhibitor)
  • MAO – Inhibitors
  • SSRI (selective serotonin reuptake inhibitor)
  • RIMA (Reversible Monoaminooxidase Inhibitor

The active ingredient methylphenidate is marketed under the trade name Ritalin®.

The main application of this drug is the treatment of attention deficit hyperactivity syndrome. Ritalin® belongs to the group of stimulants. It is not known why it has the exact opposite effect in patients suffering from ADHD.

The active ingredient was developed as early as 1944. At that time it was used as a performance-enhancing substance. In addition to its stimulating effect, the drug also has a concentration-enhancing effect.

Furthermore, fatigue is reduced. Performance wrinkles and exhaustion are reduced by taking the drug, but also appetite. After taking methylphenidate there is an accumulation in the blood plasma.

The highest concentration is measured after about 2 hours. Today methylphenidate is used in children with ADHD from the age of 6 years. However, due to the high number of prescriptions, guidelines have been developed which make it clear that methylphenidate may only be prescribed after a completely certain diagnosis of ADHD has been made.

Furthermore, Ritalin® should not be used as the sole treatment for ADHD, but should be used as part of a multimodal treatment concept that also consists of psychotherapy. After a comprehensive diagnosis, Ritalin® is then used in children in a dose between 2.5 and 5 mg. The dose can then be further adjusted, increased and reduced depending on the success.

Patients who regularly take Ritalin® appear more balanced. However, Ritalin® has no calming effect at all. The use of methylphenidate can also lead to undesirable side effects.

A very frequent loss of appetite should be mentioned here. Patients have less hunger under Ritalin®, sometimes this can also lead to an unwanted weight reduction. Furthermore, there are also reports of increased difficulties in falling and staying asleep.

These are greatest when the drug is administered and can then be reduced if Ritalin® is taken for a longer period of time. Sometimes Ritalin® leads to gastrointestinal complaints. Patients complain of nausea, stomach pressure and sometimes vomiting.

In rare cases Ritalin® can also have a negative influence on the psyche. For example, increased suicide attempts under Ritalin® have been observed. Sometimes the use of methylphenidate can also lead to tachycardia and high blood pressure.

Since Ritalin® can also lead to fatigue, special care should be taken when driving and working with machines. andMedikinet® is, like Ritalin® , also a substance with the active ingredient methylphenidate. It has its field of application in the treatment of attention deficit hyperactivity syndrome.

Children from the age of 6 can be treated with the drug if a definite diagnosis of ADHD has been made and other forms of treatment have not helped. Treatment should be given over a longer period of time. If the symptoms have improved over several months, an attempt to reduce the drug may be made under certain circumstances and after careful consideration.

Medikinet® should not be taken if the person concerned is allergic to the active substance methylphenidate, if he or she suffers from severe high blood pressure or heart problems, if there is liver or kidney damage, and if severe depression has already occurred. If a suicide attempt has already been made, Medikinet® must not be used because taking it can increase the risk of suicide. Medikinet® should initially be taken in low doses and, if necessary, the dose should be increased depending on the success of the treatment.

The maximum daily dose is 60 mg a day. The active ingredient atomoxetine is marketed under the trade name Strattera®. It is mainly used for the treatment of ADHD and is one of the newer substances for the treatment of this disease.

Strattera® is available in hard capsules and in solution form. Atomoxetine was approved for the treatment of ADHD in children and adolescents in 2005, and the drug was originally developed for the treatment of depression. In terms of structure, the active substance is very similar to the group of serotonin reuptake inhibitors that are successfully used in the treatment of depression.

However, atomoxetine inhibits serotonin less than norepinephrine, which means that this messenger substance is more available in the synaptic cleft of the nerve cell. The exact effect of Strattera® in the treatment of ADHD is not yet fully understood. As with the other drugs used in the treatment of ADHD, Strattera® is suspected of causing possible psychological skip actions when taken.

For example, it has been reported that there have been increased suicide attempts during treatment. Possible liver damage in the event of overdose and improper use has also been reported. There are two extreme opinions on the use of medication in the case of ADHD: Generally, it can be said that it always depends on the individual case.

However, it is important that there is no doubt about the diagnosis, because as already mentioned, not every child with behavioural problems is an ADHD child. There are many studies that investigate the effects and side effects of, for example, methylphenidate (active ingredient in Ritalin®). As long as the diagnosis and the indication were made correctly, no study could prove a dependence on the active substance.

The starting point – if the diagnosis is clear – is the fact that the imbalance of the messenger substances really exists and that the children are given medication to restore the balance that they lack. The following can be stated:

  • Denial
  • Believes that this is the only effective way to address the altered brain function described above. – Drug therapy only in clear cases.
  • Drug therapy not for pre-school children (< 6 years)
  • Side effects can occur – depending on the medication
  • The dose is individually different and must be “tested” in some way. Dosage recommendations based on body weight are available to the treating physician. Drug therapy is also possible for adults, although it is much more difficult to choose the right medication.

The main problem with adults is that their metabolism works faster than that of children. Especially in this respect the influence of hormones, which is not or only slightly present in children, plays an important role. As this varies from one individual to another, the method of calculating the dosage based on body weight is also inadequate.

Stimulants are also generally used in adults. However, it can also happen that so-called tricyclic antidepressants are used as medication, or a combination of both is prescribed. In this case, the treating physician will help.

Experience reports from adults also show that the effect of the stimulants only occurs after several months – here, too, there is a decisive difference compared to children. Moreover, there are not as many reports of experience with drug therapy in adults as in children. The studies also show different and by no means uniform results.

Similar to the children, the success of drug therapy is probably mainly due to those adults whose ADHD is clearly established and who do not show any other personality disorders (borderline, depression, Tourette’s syndrome). The additionally mentioned forms of therapy are not superfluous even with drug therapy. The medication should always be used as part of an overall therapeutic strategy – as a combination with home therapy, psychotherapeutic and curative education therapy and/or nutritional therapy. – General information about ADHD and family

  • Information on ADHD therapy through psychotherapy
  • Information on therapy of ADHD through curative education
  • Information on specific nutrition in ADHD
  • Information on ADHS and homeopathy