Download ADHD MEDICATIONS EBOOK

The educated
parent’s guide to
adhd medications
and their
side-effects
Dr. Yannick Pauli
www.unritalinsolution.com
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TABLE OF CONTENTS
Disclaimer
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Introduction
4
Chapter 1: Stimulants
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 Methylphenidate
 Amphetamines
Chapter 2: Norepinephrine reuptake inhibitors
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Chapter 3: Tricyclic Antidepressants
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Chapter 4: Antihypertensive drugs
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Appendix: Index of ADHD Medication Side Effects
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DISCLAIMER
This ebook is provided for general educational purposes only and is not intended for replacing:

Medical advice or counseling

The practice of medicine, including psychiatry, psychology or psychotherapy

The provision of health care diagnosis or treatment

The creation of a physician-patient or clinical relationship.
If you have or suspect that you have a medical problem, contact your health care provider promptly.
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INTRODUCTION
To this day, pharmacological therapies remain the mainstay of medical treatment for ADHD. No parents
take the decision to medicate their child lightly. Such as decision is usually taken when no other options
are possible. There is place for medications. But as educated parent’s you need to understand that there
are lots of limitations to the use of pharmacological interventions. Consider the following:

Medications only treat the symptoms, and not the cause. This is why your child has to take them
for long period of time. Usually, dosages have to be increased over time.

Medications lose their edge after three years. The MTA study – the longest and most extensive
study of the effects of medications on ADHD – found that, after three years, medications were
no better than other interventions. One of the authors of the study, Professor Pelham from the
University, even concluded “there were no beneficial effects of medication and the impact was
seemingly negative instead” (because they stunted growth)

The effects of medications are dependent on the context in which they are prescribed. For
example, the same MTA study found that medications helped normalize the behavior of 58% of
children within the study, but that the same medication used in a community setting only
normalized 25% of children.

Evidence suggests that 10-30% of children with ADHD who have been prescribed stimulant
medications do not show clinically significant outcomes.

ADHD medications can have nasty side-effects such as appetite suppression, weight loss, sleep
disturbances, growth stunt, and irritability. They are suspected to cause chromosomal damage
that increase the risk of cancer and have caused hallucinations and death!

Worse, if medications help with the behavior, parents thinks that their child is doing better.
Meanwhile, the many imbalances that caused the problem in the first place go uncorrected. The
child keeps living with food allergies, nutrient deficiencies, heavy metal toxicity, gut imbalances,
immune impairments and altered brain function. This opens the door for problems later on in
life.
The objective of this ebook is to give you information about the different medications used to treat
ADHD and their side-effects. We hope that, whether you decide to medicate your child or not, you will
still have him or her evaluated by us so that we can start correcting the underlying causes of the
problem.
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CHAPTER 1: STIMULANTS
You might find it odd that stimulant medications would be used to treat a condition characterized by
hyperactive behavior. After all, most people with ADHD already have an over-stimulated mind. Why
give these drugs to someone with ADHD?
Stimulants are said to improve how the brain regulates behavior and attention by increasing the
availability of brain chemicals called neurotransmitters. Most doctors believe that ADHD occurs when
the brain cannot produce enough of the neurotransmitter dopamine, which is responsible for
movement control, pleasure, motivation, and information processing. According to brain scans, the
frontal lobe region is underactive because there is not enough dopamine to fuel it. As a result, the
functions of the prefrontal cortex (the brain region responsible for executive functions like making
decisions and processing information) are impaired. Stimulants temporarily restore this imbalance,
dramatically improving behavior and reducing the symptoms of ADHD.
Although doctors claim that stimulants are the most effective way to treat the disorder, these drugs
cause worrisome side effects and have high potential for abuse. Many college campuses in the United
States have problems with stimulant use among students who do not have ADHD. In some cases,
stimulants have caused the death of young children due to heart failure, even when they didn’t have a
pre-existing heart condition.
There are two kinds of stimulants used to treat ADHD – methylphenidate and amphetamines.
What is methylphenidate?
Methylphenidate drugs are often the preferred drug treatment for ADHD because it supposedly has
fewer side effects than amphetamines and works better to control behavior. Methylphenidate is
available as brand name products like Ritalin and as generic drugs manufactured by MD
Pharmaceuticals. The drug has been used to treat hyperactivity and behavioral problems in children
since the 1960s, and the use of methylphenidate in the United States increased dramatically in later
years. Since 1990, the United States experienced a six-fold increase in the production and use of this
drug. According to the United Nations’ statistics on psychotropic substances, the United States
produces and consumes five times more methylphenidate than the rest of the world combined.
Methylphenidate is said to be a “mild” stimulant of the central nervous system. Despite being in the
market for decades, scientists are still not 100% sure how exactly methylphenidate works, nor is there
conclusive evidence about its effects on the condition of the central nervous system. However, it is
believed that methylphenidate increases dopamine levels by blocking a transporter protein responsible
for the brain’s reuptake (reabsorption) of this chemical. If there are too many dopamine transporter
proteins in a nerve cell, the amount of dopamine that can reach the prefrontal cortex drops, making it
difficult for the brain’s executive functions to work properly. If this happens, a person cannot sustain
attention, process verbal instructions, and so on.
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When methylphenidate blocks this reuptake mechanism, dopamine levels are “normalized” and there is
enough of this neurotransmitter to go around. This is what makes children and adults with ADHD more
attentive, productive, and alert. While methylphenidate is effective at increasing dopamine levels in
the brain and boosting productivity, there is a catch. Studies show that an unnecessary increase in
dopamine during childhood may alter how the brain develops. The brain might become desensitized to
natural rewards like social interactions, romance, and food, leading to depression later in life.
Incidentally, there is only one other chemical substance that produces the same stimulant characteristic,
and this is cocaine. It’s not just an urban legend – both Ritalin and cocaine do have similar chemical
structures and effects on the brain. It also means that Ritalin and other methylphenidate-based drugs
also have the same harmful side effects as cocaine if they are misused.
METHYLPHENIDATE
When is methylphenidate prescribed?
Methylphenidate is used to treat children and adults 6 – 65 with a chronic history of short attention
span, distractibility, impulsivity, moderate-to-severe hyperactivity, and abnormal EEG. The drug is also
used to treat narcolepsy. Methylphenidate should not be given to anyone with a history of heart
conditions. Ideally, methylphenidate is given after a complete history and evaluation of the child, but
many doctors are only too eager to write a prescription for this drug.
Methylphenidate is classified as a Class II controlled substance, together with amphetamine and
methamphetamine. This means that methylphenidate can only be obtained through a prescription
because of the risk of addiction. Despite these restrictions, teenagers and college students find ways to
get their hands on this drug to help them lose weight or stay awake beyond their natural means.
What are the side effects of methylphenidate?
Methylphenidate produces a long laundry list of side effects that include loss of appetite, nausea,
gastrointestinal problems, dizziness, irregular heartbeat, headaches, stunted physical growth, anxiety,
paranoia, and insomnia. Because methylphenidate’s effects only last several hours, children and adults
experiences irritability and depressive symptoms as soon as the drug wears off. In serious cases,
methylphenidate has been known to cause hallucinations, delusions, formication (sensation of bugs
crawling under the skin), and repetition of meaningless tasks and movements.
But hallucinations are not the worst of side-effects; methylphenidate is also responsible for the death of
hundreds of children. According to a study of 564 children and teens that died of sudden deaths,
researchers from Columbia University and New York State Psychiatric Institute discovered that they
were 7.4 times more likely to have been taking stimulant medication at the time of their death. In cases
of these sudden deaths, the child just collapses and dies, only to be discovered later by a family
member. According to this new study, sudden death due to these drugs happens at a rate that is 500%
higher than what is normal for a child’s age and health.
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How exactly does methylphenidate cause death? According to the American Heart Association,
methylphenidate prolongs the intervals of the heartbeat and damages the small vessels – the same type
of damage caused by cocaine. Normally, the official cause of these sudden Ritalin deaths is cardiac
arrhythmia, which means that the heart simply stopped beating. However, there is evidence to show
that even children without pre-existing heart conditions or who do not take other drugs have suffered
cardiac problems after Ritalin use. Despite these deaths, there was no move to pull methylphenidate
off drug store shelves. Instead, Ritalin and other methylphenidate drugs were merely given a “black box”
label, which warns users of the drug’s association between sudden death in children with serious heart
conditions.
One more thing that doctors fail to mention is that there is no solid evidence that methylphenidate is
safe or even effective when used on young children. In fact, studies show that this drug no longer
produces its desirable effects after three years of regular use. Between its short-term benefits and
harmful side effects, methylphenidate does not seem like a risk worth taking.
Commonly prescribed methylphenidate drugs for ADHD
Ritalin
Over the last two decades, Ritalin has become nearly synonymous with ADHD and the basis of
comparison for other pharmacological ADHD treatments. After all, it is one of the most prescribed
stimulants for children and adults with hyperactive behavior, attention problems, and poor impulse
control. In the United States alone, 6 million children and adults carry a prescription for Ritalin; around
75% of these are children, with boys receiving Ritalin four times more than girls. After the media got
wind of the drug’s harmful side effects and potential for abuse, many parents fear that Ritalin may be
over-prescribed and downright harmful.
Ritalin is orally taken in tablets with doses of 5, 10, and 20mg. An extended-release 20mg tablet called
Ritalin-SR is also available.
Concerta
In the year 2000, ALZA Corporation came up with the pill Concerta, the first once-a-day medication for
ADHD. Its beneficial effects can last for up to 12 hours, which means that kids and adults can remain
productive during the daytime hours and have no trouble sleeping at night. Concerta’s effects last this
long because the drug comes in a special controlled-release tablet. Unlike the typical pill, which acts
upon the body instantly, controlled-release pills keep their active ingredients within small
compartments. These substances eventually get released into the body through various mechanisms,
usually through small holes. The Concerta capsule is made up of an outer coat of medication that
dissolves instantly; within it are two compartments that release its active ingredient over the span of 12
hours.
Concerta has been given the same black box warning as Ritalin after a routine FDA review discovered
that children taking Concerta have reported thoughts of suicide, violent behavior, hallucinations, and
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death. At least 16 sudden child deaths due to Concerta have been reported to the FDA. Although
Concerta’s manufacturer insists that the drug has a long safety record, these 16 deaths and the suffering
of their parents clearly prove otherwise.
Metadate
Around the same time Concerta was released, Medeva Pharmaceuticals came up with a similar timereleased ADHD medication. This new drug is called Metadate-ER and releases methylphenidate through
a time-controlled mechanism. However, it is inferior to Concerta in that it only provides 6-7 hours of
effective action; to get through the day, the patient will have to take two capsules. A study published in
the March 2004 issue of the journal Pediatrics compared the effects of Metadate and Concerta. The
researchers discovered that Metadate is more effective during the morning hours, and that both drugs
had similar effects in the afternoon.
Focalin
Focalin is considered to be a more refined formulation of Ritalin, which means it is safer and more
effective. What makes Focalin different from Ritalin is that it only contains the active d-isomer
compound. Pharmaceutical medications are normally made of two isomers or parts, but only one of
them only produces the medicine’s side effects. In English, this means that Focalin only contains the part
of Ritalin that works, and leaves out the part that may cause the drug’s harmful side effects. Aside from
being supposedly more effective while causing fewer side effects, removing this other isomer allows one
to take a lower dose of the medication. In fact, Focalin is typically prescribed at half the dose someone
on Ritalin might take.
Despite its formulation, there don’t seem to be any convincing studies that prove that Focalin is safer
than Ritalin or Adderall. Actually, there haven’t been many side-by-side comparisons between Focalin
and Ritalin. There was a study in the Journal of Child Psychology and Psychiatry comparing Focalin and
Ritalin as an ADHD treatment, but it concluded that Focalin was just as safe and effective as Ritalin. The
researchers also added that Focalin may also be administered at half the dose of Ritalin while having a
“slightly longer” duration.
Daytrana
One of the latest drugs to hit the scene is Daytrana, a unique methylphenidate drug aimed for 6-12 yearold children with ADHD. Unlike pills, which release its active ingredient in the digestive system,
Daytrana delivers the methylphenidate through a patch. A patch allows the medicine to go through the
skin so it will be directly absorbed by the bloodstream. The Daytrana patch comes in 10, 15, 20, and
30mg doses, with each number representing the number of milligrams to be released over a period of 9
hours. For instance, the 10mg patch releases 1.1mg of methylphenidate per hour.
Will this mode of delivery increase the severity of methylphenidate’s side effects? It’s possible, yes. In
2006, an FDA medical officer named Robert Levin suggested that Daytrana not be approved because the
patch can cause “excessive drug exposure at inappropriate times.” Seven months later, he changed his
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mind and told the FDA that the patch does not cause significantly different problems than Ritalin or
Concerta. There is an exception though – up to 22% of children who used Daytrana became so sensitive
to it that they cannot take methylphenidate again, in any form, without suffering from toxicity.
Additionally, parents are worried that children may forget to remove the patch. Theoretically,
continued exposure to methylphenidate could increase the likelihood of insomnia and other adverse
effects of methylphenidate.
AMPHETAMINES
Crack. Speed. Meth. What do these three have in common? They belong to a drug family called
amphetamines, which stimulates the central nervous system and causes increased focus, wakefulness,
and alertness in users. They are also illegal stimulants that no parent would willingly give to his or her
child. But are you aware that drugs similar to these are routinely prescribed to children and adults for
ADHD? Although legal amphetamines have mechanisms that make them safer, they still carry the same
side effects and addictive potentials as their street counterparts if used inappropriately.
What are amphetamines?
First manufactured in 1887, amphetamines produce their stimulant effects because their chemical
structure closely resembles adrenaline and noradrenaline, natural stimulants produced by the human
body. These effects made the drug popular among people who want to reduce tiredness, increase
endurance, and stay awake for long periods of time.
So how do amphetamines treat ADHD? Like methylphenidate and cocaine, amphetamines block the
reuptake of dopamine and another neurotransmitter called norepinephrine, increasing the amounts of
these neurotransmitters in the synapse. Amphetamines can also increase the release of dopamine and
norepinephrine from their storage sites into the synapse. This boosts the brain’s response to tasks,
overcoming the chronic problem of motivating onself to do important but uninteresting work. However,
amphetamine can cause the release of too much dopamine and has a longer duration of action. Since it
stays longer in the brain than methylphenidate and cocaine, amphetamines can do far more damage
than these other drugs. The difference in the way amphetamines work can explain why different people
respond to one type of stimulant better than the other.
In doses of 15-30mg, amphetamines give the user a short-term feeling of mental alertness, renewed
strength, and better well-being. If the child is fatigued, amphetamines give him or her a physical boost.
He or she becomes more productive than normal and shows an increased capacity to think and
concentrate. Unfortunately, amphetamines push a child to burn more energy than normal, causing
them to crash as soon as the drug wears out.
When are amphetamines prescribed?
Besides ADHD, amphetamines are used as a treatment for mood disturbances, narcolepsy, and
depression. There is also some evidence that amphetamines can reduce criminal behavior in drug misusers, although this finding is very controversial.
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Clinical trials exploring the long-term efficacy of amphetamines for ADHD have never been performed.
Most studies on the matter involve children under treatment for less than three weeks and adolescents
and adults for less than a month.
What are the side effects of amphetamines?
Amphetamines have similar side effects as methylphenidate. Insomnia, dry mouth, fatigue (due to lack
of sleep), loss of appetite, malnutrition, nausea, increased heart rate, and digestive problems are the
most common. Less common side effects include mood swings, paranoia, and anxiety. Amphetamines
can also cause impaired growth in children.
Perhaps its most worrisome side effects are blood pressure rise and accelerated heart rate. Adults who
take prescription amphetamines have reported cardiac arrhythmia, cerebral hemorrhage, and
inflammation of the lining of the blood vessels. A recent study discovered that 20% of children who take
amphetamines visit a doctor for problems like irregular heartbeat. Yet these drugs continue to be
prescribed left and right.
Commonly prescribed amphetamines for ADHD
Dexedrine
Dexedrine is one of the first stimulants designed to treat ADHD and is considered the original ADHD
medication. For 50 years, its 5mg and 10mg pills have been used to manage ADHD in children as young
as 3 years old. When taken in equal doses, Dexedrine’s effects are stronger than Ritalin’s.
Adderall
Adderall is one of the most popular ADHD drug therapies among children. This improved variation of
Dexedrine contains four kinds of amphetamine salts – dextroamphetamines, amphetamine aspartate,
dextroamphetamine sulfate, and amphetamine sulfate. This combination of amphetamine salts was
initially developed 20 years ago and marketed as a drug for diet control. In 1995, this drug was approved
as a treatment for ADHD.
Adderall is a longer-acting drug than Dexedrine. Its effects last for about 10 hours, which eliminates the
need to remind a child to take the second dose. However, Adderall is infamous for the damage it does
to the heart. A study published in the American Journal of Therapeutics looks at an adult patient who
developed a condition called cardiomyopathy, a severe inflation of the heart, after taking Adderall. His
cardiac function deteriorated to the extent that he required a heart transplant. The researchers noted
that cardiomyopathy due to amphetamine use normally leads to a fatal condition.
Another study published in the Journal of the American Board of Family Medicine examines a 20-yearold student diagnosed with ADHD two years earlier. He was given a prescription for 15mg Adderall,
taken once a day. The student stopped taking Adderal for several weeks, until he took two Adderall
pills to help him study for an exam. The next day, chest pains and pressure forced his parents to bring
him to the emergency room. The student does not use illegal drugs, drinks alcohol sparingly, and has no
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family history of cardiovascular disease. He was diagnosed with myocardial infarction, a condition
where the blood supply to the heart was blocked. The student was released after five days in the
hospital but was told to avoid all medicines with amphetamines, or risk another heart attack.
Vyvanse
The new drug Vyvanae does away with the addiction potentials that come with amphetamine problems.
Vyvanse is considered a “pro-drug” – an inactive form of a drug that, when metabolized by the body,
releases the active ingredient. Vyvanase contains an amphetamine that is chemically linked to an amino
acid (a building block of proteins) called lysine. This allows the amphetamine to enter the blood and the
nervous system at a slower, more-controlled pace. Even if it is inject or snorted, Vyvanise exhibits far
lower addiction potentials compared to other stimulant drugs. However, it is not free from the usual
side effects that come with stimulant medications. Appetite suppression and insomnia are common side
effects, and appear more frequently at high 70mg doses. Nausea, headaches, and vomiting appear less
frequently in lower 30mg doses but become more severe at the 70mg level.
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CHAPTER 2: NOREPINEPHRINE REUPTAKE INHIBITORS
Methylphenidate is not the only drug therapy option available for ADHD. Over the last several years,
three classes of non-stimulant drugs have been developed and marketed to manage the symptoms of
ADHD. They are generically considered to be less effective than stimulants, but due to the bad press
received by methylphenidate, parents feel safer about giving these non-stimulants to their children.
However, these other drugs also have unwanted effects, some of which are just as serious as the side
effects of stimulants.
What are NRIs?
One of the most widely used drug therapies for ADHD come from a drug family called norepinephrine
reuptake inhibitor (NRI). As you might have guessed from the name, NRIs manage ADHD symptoms
through the use of norepinephrine, a neurotransmitter related to adrenaline. Norepinephrine levels are
found to be lower-than-normal outside neuronal cells among individuals with ADHD and depression.
This means that there is a deficiency in norepinephrine inside and outside the nervous system cells. NRIs
don’t boost the production of norepineprhine per se; rather, they “block” the reuptake or reabsorption
of norepinephrine up into neuron cells. In other words, NRIs allow your neurons to soak for a longer
period of time in the norepinephrine produced by the brain.
When are NRIs prescribed?
NRIs are typically prescribed to treat ADHD. Since these drugs target a specific brain chemical, NRIs are
said to treat other disorders caused by a norepinephrine imbalance. For instance, disorders like chronic
pain and fibromyalgia are associated with low levels of norepinephrine; some studies show that NRIs are
capable of alleviating pain-related symptoms. One other common co-morbid condition of ADHD is
chronic headaches or migraines, which is also attributed to low norepinephrine. Unlike stimulants, NRIs
do not stimulate the pleasure centers of the brain. For this reason, NRIs are prescribed over stimulants
among adults and teens that have addiction problems with drugs or alcohol.
However, one of the more difficult issues about drug design is its specificity. While manufacturers want
NRIs to reach its desired target in the brain, it is often difficult for drugs to reach this target while
avoiding undesired ones. This is why side effects occur. Sometimes, these side effects can be desirable –
for instance, NRIs tend to treat depressive and anxious symptoms present in adults with ADHD.
However, other side effects of these drugs are just as worrisome as those of stimulants.
What are the side effects of NRIs?
Since it is difficult for NRIs to avoid the target receptors for other neurotransmitters, these drugs can
cause digestive dysfunction, constipation, urinary hesitance, and dry mouth. Children who take NRIs
have also reported appetite suppression (which leads to weight loss), drowsiness, nausea, and mood
swings. It appears to cause less insomnia and appetite loss than methylphenidate, but it has been found
to cause a higher incidence of sleepiness and vomiting. There have also been reports of slightly
decreased growth among children and teens taking NRIs. Allergic reactions are rare, but they have
occurred in the form of hives or swelling.
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Commonly prescribed NRIs for ADHD
Strattera
Strattera (generic name Atomoxetine) was the first non-stimulant drug approved by the FDA to treat
ADHD. It is not by any means the first non-stimulant medication for the disorder; doctors have
prescribed antidepressants and tricyclics for ADHD sufferers in the past. However, these were not
approved by the FDA as an ADHD treatment per se. In 2004, Eli Lilly, the manufacturers of Strattera,
added a new warning to the drug noting that it should be stopped among children or adults with signs of
jaundice – yellowing of eye whites or the skin. Jaundice usually means that liver damage has occurred. If
blood tests reveal evidence of liver damage, even without jaundice symptoms, use of the drug should be
stopped. A year later, Eli Lilly added another warning to Strattera saying that it can increase suicidal
thoughts among teens who take this drug.
Reboxetine
Reboxetine is a relative newcomer to the ADHD drug scene. Manufactured by Pfizer, Reboxetine is said
to have other advantages over Strattera. First, it has a 13-hour plasma half-life, which means it takes 13
hours for the drug to be eliminated from the body. In comparison, Strattera’s plasma half-life is only 4
hours. Studies also show that Reboxetine is effective for treating hyperactive-impulsive and inattentive
symptoms in children with ADHD. In addition, there is evidence of Reboxetine’s success in treating
conduct disorders and oppositional defiant disorders. Despite these positive findings, there is still a
shroud of mystery surrounding this drug. The FDA did not approve this drug for the United States, and
its effectiveness for treating ADHD on a large scale is still unknown.
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CHAPTER 3: TRICYCLIC ANTIDEPRESSANTS
Like norepinephrine reuptake inhibitors (NRIs), tricyclic antidepressants (TCAs) are often used instead of
stimulants because of their low potential for abuse. While they are not as effective as stimulants in
terms of improving attention span and reducing hyperactive behavior, TCAs have great value in terms of
reducing co-morbid depression and anxiety.
What are TCAs?
Tricyclic antidepressants are one of the oldest classes of anti-depressants and are still used widely today
despite their side effects. They work through similar mechanisms as NRIs; they prevent the reuptake of
the neurotransmitters norepinephrine and serotonin, which are present in low levels among ADHD
sufferers with depression. Doing so stabilizes the levels of these neurotransmitters in the brain,
relieving depressive symptoms and restoring balance in mood. To a lesser degree, TCAs also inhibit the
reuptake of dopamine. For this reason, TCAs may have effects similar to other stimulant and nonstimulant ADHD medications that work through similar mechanisms. TCAs have also been found to
improve attention span, reduce hyperactive behavior, and foster better impulse control. Children and
teens treated with TCA are less disruptive and often more agreeable.
TCAs are also thought to relieve depressive symptoms through a neuroprotective feature. Some TCAs
have been found to boost the effects of certain brain receptors, which regulates the sensitivity of nerve
cells to glutamate. Glutamate is an organic compound of a non-essential amino acid that is thought to
play a role in anxiety and depression. By lowering glutamate sensitivity, TCAs protect the brain against
glutamate overwhelming, which excites key brain areas related to anxiety and depression.
When are TCAs prescribed?
Normally, TCAs are prescribed among adults with moderate or severe depression, anxiety, panic attacks,
and obsessive behavior. Since TCAs cause more side effects than newer anti-depressant drugs, these
are rarely used as the first line of defense against depression. TCAs are often used as short-term drug
therapies among children with ADHD if stimulants cannot be used and if significant mood problems are
present with ADHD symptoms.
TCAs are not given to children and adults with tendencies towards manic behavior or a history of
epilepsy.
What are the side effects of TCAs?
Since TCAs are not as selective as NRIs, they tend to cause more side effects. Blurred vision, dry mouth,
constipation, dizziness, weight gain, difficulty urinating, and sedation are among the most common.
Fairly common and worrisome are TCAs’ effects in cardiac conduction, most notably rapid heartbeat and
low blood pressure. Children are more sensitive to these side effects than adults, and TCA’s effects on
the heart do not seem to make this treatment option any safer than methylphenidate.
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In 2004, the FDA determined that TCAs and other antidepressant medications can increase the risk of
suicidal thoughts and behaviors among children and teens with depression.
Commonly prescribed TCAs for ADHD
Pamelor
Pamelor (generic name nortriptyline) is an oral medication primarily used to treat depression and
anxiety. The drug has also been found to be effective for nerve-related chronic pain, bedwetting,
fibromyalgia, bulimia, and ADHD. Pamelor is not recommended for children under 18 years old.
Norpramine
Norpramine (generic name desipramine) is used to treat depression, eating disorders, and cocaine
withdrawal. It is also used to relieve bedwetting and anxiety attacks among children.
Tofranil
Trofanil (generic name imipramine) is sometimes preferred because it provides anti-anxiety effects
without sedation. Trofanil has been used to treat bedwetting in children and help them fall asleep more
readily. However, Trofanil can affect the heart conduction system if the dosage exceeds more than 2mg
per kilogram.
Wellbutrin
Wellbutrin (generic name buproprion) is one of the newer antidepressant drugs used for the treatment
of ADHD in adults and children. Besides managing depression symptoms, Wellbutrin has been found to
help adults with ADHD quit smoking and restore balance in mood. At high dosages, however, Wellbutrin
can increase the risk of seizure. Wellbutrin has been found to significantly amplify the effects of
desipramine, imipramine, and norpramine; as such, it should not be taken with other tricyclic
antidepressants.
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CHAPTER 4: ANTI-HYPERTENSIVE DRUGS
In the 1980s, a small number of published papers suggested that antihypertensive drugs – drugs that
fight off hypertension or high blood pressure – might be beneficial for managing ADHD symptoms,
particularly hyperactive behavior and over-stimulation. Since then, antihypertensive medications have
been used off-label as an ADHD treatment for children. Only in 2009 was an antihypertensive drug
manufactured specifically for the purpose of treating ADHD.
What are antihypertensive drugs?
Antihypertensive drugs are designed to lower blood pressure through various mechanisms, normally by
decreasing the volume of fluid in the bloodstream (diuretics) or by decreasing the vigorousness of heart
contractions (beta blockers). The antihypertensives used to treat ADHD are called “centrally acting
agents.” Instead of acting upon the heart, these antihypertensive agents decrease blood pressure by
interfering with the nervous system.
Specifically, antihypertensives act as an alpha-2adrenergic agonist that inhibits the release of
norepineprhine, which increases heart rate through the activation of the flight-or-fight response. By
inhibiting the production of norepinephrine, antihypertensives create a calming effect, improve impulse
control, and cause sedation. Antihypertensives also increase the turnover of dopamine, making this
neurotransmitter more available to the synapses. One of the earliest studies on antihypertensives and
ADHD looked at hyperkinetic (the early term for hyperactive) children who were placed on this
medication. The children showed significant improvements in behavior, but it is likely that these
changes were caused by the sedative effect of the drug. Today, limited studies show that
antihypertensives are less effective than stimulants at improving attention, productivity, and alertness,
but may be just as effective at reducing hyperactivity and regulating moods.
When are antihypertensives prescribed?
Antihypertensives are a more popular treatment for children with ADHD than adults. They are usually
prescribed if the child does not respond well to stimulants or cannot take stimulants. Antihypertensives
are only contra-indicated if a child is at risk for low heart rate, low blood pressure, fainting, or other antipsychotics.
In a manufacturer-supported clinical trial, researchers looked at children with ADHD and how they
responded to antihypertensives versus placebos. After four weeks, it was noted that children in the
antihypertensive group had significant improvements in impulsivity and hyperactivity, although changes
in inattention were not significant. Children aged 6 – 12 years had a better response to antihypertensives than adolescents aged 13 – 17.
What are the side effects of antihypertensives?
Due to its effect on the release of norepinephrine, the most common side effect of antihypertensives
are drowsiness, sleepiness, and fatigue – especially when taken with alcohol or other sedative
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medications. Dizziness, nausea, stomach pain, irritability, dry mouth, headaches, constipation, fainting
episodes, and decreased appetite have also been reported. Due to the nature of these drugs,
antihypertensives may also cause low heart rate and blow blood pressure.
In the 90s, there was a trend in clinical practice where an antihypertensive called clonidine was
combined with methylphenidate as an ADHD treatment. Unfortunately, several children died of sudden
deaths shortly after taking these drug combinations. While an investigation did not provide concrete
evidence that the drugs were responsible for their deaths, several prominent doctors have raised
serious questions about the use of this combination, especially since there is little research to back up its
safety and effectiveness. Other cases involving significant side effects from this drug combination were
also reported.
Commonly prescribed antihypertensives for ADHD
Catapres
Catapres (generic name clonidine hydrochloride) is FDA-approved for mild to moderate hypertension.
Although it is not indicated as an ADHD treatment, it is a well-accepted alternative to stimulant drugs,
particularly among adults and aggressive children. Catapres is available in 0.1 – 0.3mg doses, an
extended release pill, and a patch. Some evidence seems to show that it is better at reducing
hyperactivity in children than ADHD symptoms in adults.
Tenex
Tenex (guanfacine) is often used as an off-label treatment for ADHD. Treating children with Tenex is
still a matter of debate – some parents report almost miraculous improvements, while others are
dismayed at how sleepy and fatigued their children get. Tenex is slowly becoming popular as an off-label
treatment for bipolar.
Intuniv
The latest ADHD drug to hit the shelves is also the first antihypertensive medication approved for the
treatment of ADHD. This drug is called Intuniv, an extended-form of guanfacine that it is marketed as a
once-a-day treatment for ADHD children 6 – 17 years old. Parents report improved symptoms over a
period of 12-hours and feel safe about the fact that Intuniv has no addictive potential. Intuniv has the
same sedative side effects as antihypertensives and should not be taken by teens that drive and do
other dangerous activities; the drug has been found to slow motor skills and thinking.
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APPENDIX: INDEX OF ADHD MEDICATION SIDE EFFECTS
SIDE EFFECT
MEDICATION
Anxiety
Stimulants (methylphenidate and amphetamines)
Blurred vision
TCAs
Cardiac problems
Stimulants (methylphenidate), TCAs
Cardiomyopathy
Stimulants (amphetamines)
Cerebral hemorrhage
Stimulants (amphetamines)
Chest pains
Stimulants (methylphenidate and amphetamines)
Constipation
NRIs, TCAs, Anti-hypertensive drugs
Death
Stimulants (methylphenidate and amphetamines), Antihypertensive drugs
Delusions
Stimulants (methylphenidate)
Digestive dysfunctions
NRIs
Dizziness
Stimulants (methylphenidate and amphetamines), NRIs, TCAs,
Anti-hypertensive drugs
Drowsiness/sleepiness
NRIs, anti-hypertensive drugs
Dry mouth
Stimulants (amphetamines), NRIs, TCAs
Fainting
Anti-hypertensive drugs
Fatigue
Anti-hypertensive drugs
Formication
Stimulants (methylphenidate)
Hallucinations
Stimulants (methylphenidate)
Headaches
Stimulants (methylphenidate and amphetamines), Antihypertensive drugs
Hives
NRIs
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Insomnia
Stimulants (methylphenidate and amphetamines)
Irregular heartbeat
Stimulants (methylphenidate and amphetamines)
Irritability
Stimulants (methylphenidate and amphetamines), Antihypertensive drugs
Jaundice
NRIs
Loss of appetite
Stimulants (methylphenidate and amphetamines), NRIs
Low blood pressure
TCAs, Anti-hypertensive drugs
Low heart rate
Anti-hypertensive drugs
Mood swings
Stimulants (amphetamines), NRIs
Nausea
Stimulants (methylphenidate and amphetamines), NRIs, Antihypertensive drugs
Paranoia
Stimulants (methylphenidate and amphetamines)
Slow motor skills
Anti-hypertensive drugs
Stunted physical growth
Stimulants (methylphenidate)
Urinary hesitance
NRIs, TCAs
Vomiting
Stimulants (methylphenidate and amphetamines), NRIs
Weight gain
TCAs
Weight loss (due to appetite
suppression
Stimulants (methylphenidate and amphetamines), NRIs
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