Treating Attention Deficit Hyperactivity Disorder in Adults

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While attention deficit hyperactivity disorder (ADHD) is often thought of as something affecting children,  those children with ADHD do grow up.  While symptoms of ADHD may not be as obvious in adulthood as they are in childhood, many adults are still impacted by distraction and impulsivity. 

While there are medications available to help those with ADHD, these medications have the potential to become addictive and also increase the likelihood of strokes and heart disease.

  Furthermore, trials of these medications for ADHD symptoms in adults are fewer and less extensive than in children, and so information is less definitive.  There are other ways adults with ADHD can be helped, but information on these methods is even thinner.  


Short-term studies of medications for adults with ADHD show a benefit, though long-term studies are less certain, albeit suggestive of improvement.  Response rates vary more than in children.  Stimulants such as methylphenidate or amphetamines are the most commonly prescribed medical therapy.   While it’s not entirely certain how they work in ADHD, the drugs probably help by increasing concentrations of the neurotransmitters dopamine and norepinephrine, the circuitry of which has been shown to differ among those with ADHD.   

Side effects of methylphenidate include appetite suppression, weight loss, moodiness, jitteriness, insomnia, and a dry mouth.

  Some people have irritability or suffer headaches.  Existing tics may be exacerbated.  Because of the potential risk for cardiovascular side effects, heart rate and blood pressure should be monitored after starting the medication. 

There are also non-stimulant medications that can be used to treat ADHD.

  For example, atomoxetine and some antidepressants.  These tend to have a less immediate effect, taking up to four weeks before changes begin to show.  Side effects of atomoxetine include dry mouth, sleep loss, nausea, decreased appetite, erectile dysfunction, dizziness, and sweating.  There is a black box warning on the medication for adults under the age of 25 due to increased risk of suicide in that group. 

Bupropion is an antidepressant which can be helpful in treating adult ADHD.  Because the drug can be helpful for smoking cessation or depression, it is ideal if the patient could benefit for one of these reasons as well.   The drug increases the risk of seizures, and can also cause dry mouth, nausea, insomnia, anxiety and tremor. 

Tricyclic antidepressants are also effective, though some physicians believe them to be less so than stimulants, and more poorly tolerated than the other medications discussed so far.  There’s little data on the recommended dose.  They can also lead to cardiac damage, and so small doses are preferred if possible.

Some doctors use alpha-2-adrenergic agonists like clonidine ,as these have been found to be effective in children, albeit usually only after other agents have not been shown to be effective.  There is little data on these medications, which also impact cardiac function and blood pressure.

Behavioral Therapies for ADHD in Adults

Cognitive behavioral therapy (CBT) seems to be effective in treating ADHD.  The effect may even be equal to that of medications.  Combining the two approaches would seem to be the best method, though one trial that compared CBT and medication to one with CBT and placebo found no difference between groups.   Overall, most trials have focused on medications.

Behavioral interventions like therapy may be especially useful for helping people organize and better manage their time.  Cognitive behavioral therapy programs specifically address problems with keeping track of tasks, procrastination, prioritization, poor organization, and long-term planning. Either CBT or other techniques, such as dialectical behavior therapy (DBT), can be helpful in addressing problems with self-regulation. These therapies generally involve 12 to 15 sessions, perhaps followed by “booster” sessions in the future.   Techniques such as mindfulness meditation may be helpful in calming racing thoughts and stress.  Other therapies may also be useful in helping with some of the problems that often accompany ADHD, such as marital stress, low self-esteem,


Oscar Bukstein: Pharmacotherapy for adult attention deficit hyperactivity disorder.  Up-to-Date, Updated October 2014, accessed December 2014. 

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