Brain Function 101- why medicine helps those with ADHD

Neurotransmitters are the messengers that bring information from one neuron to another. An imbalance in their levels can cause many problems. Medicines can help bring levels back to normal.

There’s a commonly held belief that people with ADHD should just try harder, but this doesn’t usually work. The symptoms of ADHD are caused in part by imbalances of neurotransmitters in the brain. Low norepinephrine levels lead to symptoms of ADHD. More and more evidence is showing the differences in the brains of people with ADHD compared to neurotypical (“normal”) people.

ADHD is real. You can’t just will it away.

Not everything gets better when people just try harder. Some things require a different approach. #adhdkcteen

What if no meds are used for ADHD?

Not everyone with ADHD is treated with medication. There are many reasons.

Some have never been diagnosed. Others don’t like medicine for whatever reason.

Many teens want to come off their medications. Some don’t like side effects. Others don’t want to be different.

Some can manage issues with alternative treatments and accommodations. Or think they can, but suffer from unrecognized complications of undertreated ADHD.

Some people simply forget to take it and then struggle with the consequences of being unmedicated.

Many families have a hard time affording the medicine or taking the time to do the required follow up with their physician.

I’m sure there are many more reasons people stop (or never start) medicine.

Neurotransmitters

Before discussing how the medicines work, it’s important to learn about neurotransmitters.

Our brain is of course very complicated in structure and function. There are millions of neurons that make up our brains. Between each neuron is a synapse, or space. Different areas of the brain serve different functions, and they all interact with each other. They also interact with other parts of our body and the outside world.

There are many pathways or circuits that bring information from one part of our brain to another. Neurotransmitters are the messengers that bring information from one neuron to another. They are made from amino acids.

Neurotransmitters each have a unique function but can be broadly classified into two categories: excitatory and inhibitory. Some neurotransmitters can serve both functions.

Neurotransmitters each have a unique function, but can be broadly classified into two categories: excitatory and inhibitory. Some neurotransmitters can serve both functions. #adhdkcteen

Excitatory neurotransmitters regulate motor movement, thought processes, anxiety, and more.

They can help us stay alert, but when they aren’t moderated by an inhibitory system, things can get out of control.

ADHD is like having a Ferrari engine for a brain with bicycle brakes. Strengthen the brakes and you have a champion. ~ Dr. Edward Hallowell #adhdkcteen

Inhibitory neurotransmitters act like brakes.

We need brakes so we don’t feel restless, irritable, and out of focus. When our brakes work, we can excel! Without brakes, we’re out of control.

Lock and key

Neurotransmitters act as messengers between different neurons. They are released from one neuron into the space between neurons called the synapse. They enter a neuron that has the proper shaped structure for it to fit.

Neurotransmitters are used to communicate from one neuron to another. #adhdkcteen

It works like a lock and key.

Each neurotransmitter is like a different key. They each fit certain locks, and often can fit more than one type of lock.

Neurotransmitter levels and ADHD

When neurotransmitter levels are too high or too low, we can develop anxiety, depression, and executive functioning disruptions.

It is important to understand that to some extent we can control our actions, but neurotransmitters are important in the aspects that are beyond our control. Sometimes we just feel anxious or sad. Focusing can be very difficult. Executive functions, such as time management, working memory, and more, can be hard to manage.

While we can’t simply will ADHD symptoms away, there are things we can do to improve our mood and executive functioning that don’t involve medicines. But medicines are an important treatment.

Norepinephrine

Norepinephrine is an excitatory neurotransmitter. It is primarily made and stored in neurons but is also found in the blood and a small amount is stored in the adrenal glands, which sit on top of our kidneys.

Norepinephrine is involved in focus, emotions, sleeping, dreaming, and learning. Too much norepinephrine can cause anxiety, but too little can lead to problems with focus and motivation.

It can raise our heart rate, increase blood flow to muscles, and increase our blood sugar level – all symptoms we experience in times of anxiety. These are helpful responses when stress is caused by physical danger and we need to run away, but not so much when we worry about a test or other common anxieties.

These symptoms can lead to distraction, self-consciousness, and poor focus and performance. This can look a lot like when norepinephrine levels are too low, which is one reason why anxiety and ADHD can mimic one another as well as exacerbate one another.

Norepinephrine: too much leads to anxiety, too little to poor focus and low motivation. #adhdkcteen

Dopamine

Dopamine makes us feel happy. Getting a bump in dopamine feels good.

I often joke that we get a dopamine hit every time we check social media or win a game. One of the reasons depressed people overeat comfort foods is that eating rises our dopamine levels, which makes us feel better. (At least until the heartburn sets in or we notice we’ve gained a few too many pounds to be healthy.)

Dopamine is one of the neurotransmitters that can be both excitatory and inhibitory.

Drugs like nicotine (yes, even from electronic cigarettes), opiates, and alcohol all increase dopamine levels. Eating foods can have the same dopamine increase, as can winning a game or doing anything else pleasurable.

We can all choose healthy options to get dopamine hits. Exercise. Playing games. Enjoying the company of friends and family. Helping others. All of these are healthy things that bring us happiness.

Negative things, such as drugs and alcohol or too much screen time, can lead to more problems than they’re worth. Even though they bring temporary feelings of happiness, they cause more problems in the end. Avoid these dopamine hits.

Drugs, alcohol, exercise, foods and any pleasurable activity can increase our dopamine level and make us feel happy. Not all are healthy ways to get a dopamine hit. #adhdkcteen

Dopamine can increase our alertness and help with memory and motor control in addition to giving us pleasure.

Dopamine can be converted into norepinephrine and epinephrine.

Low dopamine

Low levels of dopamine are associated with problems focusing, depression, the inclination to abuse drugs and alcohol, excessively playing games online or gambling , and overeating.

If the levels are low in motor areas of the brain, it can lead to the tremors commonly seen in Parkinson’s disease.

Low levels in other parts of the brain can lead to learning and memory problems, lack of energy and motivation, and a loss of happiness and interest in things that used to bring pleasure.

Low levels in the prefrontal cortex are associated with ADHD.

High Dopamine

High levels of dopamine can cause overexcitement and disrupted thoughts. They can even lead to anxiety and paranoia.

Serotonin

Serotonin is important in the regulation of anger and aggression, body temperature, mood, sleep, sexuality, appetite and metabolism. It can help us relax when serotonin is available in proper amounts. Stress can lower our serotonin levels as we use it up trying to relax.

About 80-90% of the body’s total serotonin is found in the gut. It is made by bacteria that live in our gastrointestinal tract. There are ongoing studies using probiotics (healthy bacteria) to alter the level of serotonin to help anxiety and depression. Unfortunately, as of now studies show mixed results, and at best only a minor benefit.

Low serotonin

Low levels of serotonin can result in depression, anxiety, anger, panic attacks, low energy, migraines, insomnia, obsessions, irritability, craving sweets or loss of appetite, focus and memory problems, aggressive behavior, slowed muscle movement and speech, and having a decreased interest in sex.

High Serotonin

High levels of serotonin cause diarrhea, headache, confusion, sweatiness, twitching muscles or stiff muscles, fever, high heart rate and blood pressure, seizures, and even death.

How do ADHD medicines work?

Stimulant medicines are considered the first line medical treatment for ADHD. The two types of stimulants are methylphenidates and amphetamines.

The differences in how these two groups of stimulant types work may explain why some people with ADHD respond to one type better than another.

Methylphenidates

Methylphenidates include prescription medicines such as Ritalin, Metadate, Concerta, Focalin, Aptensio, Quillivant and others.

The methylphenidates block the reuptake of dopamine and norepinephrine. This leaves more of these neurotransmitters in the synapse. Methylphenidates also help release these neurotransmitters from the neuron, again allowing more to be in the synapse.

Amphetamines

Amphetamines include Adderall and Vyvanse. They increase the release of dopamine and norepinephrine from their storage sites into the synapse. They also slow the reuptake of the neurotransmitters, but not to a large extent.

How do medicines affect neurotransmitters?

Medicines that affect neurotransmitters are used to treat ADHD, anxiety, depression, and low blood pressure.

  • Stimulant medicines (methylphenidates and amphetamines) increase norepinephrine and dopamine.
  • Atomoxetine (Strattera) affects only norepinephrine.
  • Serotonin norepinephrine reuptake inhibitors (SNRIs) are antidepressants that work by increasing serotonin and norepinephrine.
  • Tricyclic antidepressants also increase norepinephrine and serotonin, but are not often used anymore since there are many safer options available.
  • Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat anxiety and depression. They block the reabsorption of serotonin, which leaves more available in the synapse.
  • MAOIs prevent the breakdown of serotonin (and other neurotransmitters) but are rarely used due to significant adverse reactions.

For more:

In addition to the resources hyperlinked throughout this post, check out the following:

For more on the basics of the medicines used to treat ADHD, see ADHD Medications: Types and side effects.

Did you know that while stimulants that are used to treat ADHD can help people with ADHD, they can cause imbalances to neurotransmitters to those without ADHD? Learn how stimulants can make focus, attention, mood and more worse in Stimulants decrease brain function. Say What?

Dr. Russell Barkley has studied ADHD extensively and mentions neurotransmitters in his paper, What Causes ADHD?

What if we don’t treat ADHD?

A lot of people worry about medication side effects, want to be all natural, or just plain forget to take their medicines. What’s the harm in that? Is it really a big deal if we don’t treat ADHD? Dr. Russell Barkley has data to show why it’s a big deal!

A lot of people worry about medication side effects, want to be all natural, or just plain forget to take their medicines. What’s the harm in that? Is it really a big deal if we don’t treat ADHD? Is there risk of not treating ADHD?

I have had the privilege of hearing Dr. Russell Barkley, an internationally acclaimed expert on ADHD, speak three times about his research results showing the long term impact of ADHD on our lifespan. He came to Kansas City to present at a Grand Rounds at Children’s Mercy Hospital and again at the Midwest ADHD Conference in April 2018. He presented the same information at the 2018 International ADHD Conference in St. Louis this past November. During each of the the three talks he made big impressions in audience members.

Why am I blogging about it now?

I’m excited to see that he’s giving a FREE webinar through Additude Magazine, How ADHD Shortens Life Expectancy: What Parents and Doctors Need to Know to Take Action. It’s happening later this month and I wanted to write this to show how important the topic is and to encourage you to register so you can hear him for yourself.

When is the webinar? Tuesday, January 29, 2019, at 1:00 EST/noon CST.

If you can’t make the webinar live but you’ve registered, you’ll get a copy to listen later. A win either way!

Update:

Here’s a recorded version that’s circulating online. The main talk begins after 3:30.

What’s the big deal?

We all know adults who have had untreated (even undiagnosed) ADHD all their life and seem to do well. Some people seem to be able to control their symptoms of ADHD or they outgrow them.

There are even those who think certain aspects of their ADHD help them thrive.

There’s significant risk for many with ADHD

Unfortunately, not everyone outgrows ADHD and many people suffer from untreated problems, especially when they’re young and haven’t learned to adequately manage the frustrations that ADHD can cause.

Dr. Barkley’s long term study has shown some very distressing results. Children with ADHD have a shortened life expectancy of over 9 years. Adults with persistent ADHD symptoms have an even more significantly shortened life expectancy of nearly 13 years.

Dr. Barkley’s research is very compelling

The complete study, Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors, was recently published in the Journal of Attention Disorders. Unfortunately, it is behind a paywall, meaning you cannot read the complete results unless you have paid for access or are a student or educator with that benefit. (But the webinar is free!)

Life Course Impairments

Dr. Barkley has found that many risks associated with ADHD can lead to life problems, including premature death.

We all know that kids with ADHD struggle in school without proper supports. This is linked to lower educational success, lower paying jobs, and more family stress.

Many people with ADHD get anxious and depressed due to circumstances created by their ADHD. This can lead to more problems in school, interpersonal relationships, self medicating with drugs and alcohol, legal problems, and even death by suicide.

Inattention and impulsivity increase the risk of accidental injury and death. Other risky behaviors can lead to unplanned pregnancies.

Problems with executive functioning can lead to problems at home with significant others and in parenting. Many adults with ADHD show problems at work and in maintaining a consistent job.

Impulsive eating can lead to obesity, and all the long term health consequences associated with that. These include diabetes, heart disease, orthopedic problems, and more.

A public health problem

Dr. Barkley asserts that we should approach ADHD as a public health problem.

During his talk in St. Louis, one of Dr. Barkley’s slides proposed that “ADHD is a serious public health problem; it accounts for greater reductions is ELE [expected life expectancy] than any single risk factor of concern to public health and medical professionals, such as smoking, excess alcohol use, obesity, or risky driving among other widely accepted health risks.”

The good news

The good news is that many of these risks can be minimized with proper management.

If we support our students to help them succeed in school, they are more likely to continue in their education. When people attain a higher education level, they are able to get more fulfilling jobs and earn better incomes.

Proper management of ADHD and executive function problems can help prevent and treat depression and anxiety. With less depression and anxiety, parents can be better parents, workers better workers, and partners better partners. Self medication with drugs and alcohol will be less, resulting in fewer problems that are linked to those issues: less crime, healthier bodies, less risky behaviors and fewer accidents.

Encouraging healthy habits, such as regular exercise and proper nutrition, helps everyone live a longer, healthier life. This is no different for those with ADHD, so it is important to help them overcome poor dietary habits and inadequate exercise to improve their overall lifespan.

What can be done?

We can use behavioral interventions, training for patients and parents of children with ADHD, educational support, and medication to optimize management of ADHD.

When properly diagnosed and treated, individuals with ADHD can be very successful in life. That’s why ADHDKC was started… to help those with ADHD learn to thrive!

2018 International Conference on ADHD recap

I was excited to attend the 2018 International Conference on ADHD with a group of ADHDKC board members. I’ll try to recap some of the best information learned.

We were all able to make connections with people from all over the world who research and treat symptoms associated with ADHD and with those who are in various learning stages about their own ADHD. It was not uncommon throughout the conference to hear that people found their tribe…

#ADHDcon2018 - Tribe talk

Too much information

There were many simultaneous talks during the 4 day conference. I went to many great talks but missed others. I tried to tweet #ADHDcon2018 during the conference, but couldn’t pay attention and tweet at the same time, so missed a lot of points to share.

International connections

I was very fortunate to meet Marylin, a woman from France who is passionate about learning and sharing information about ADHD. She shared with me that ADHD is not commonly recognized in France and she is working to change that. Learn more about her organization at TDAH.

Marilyn recorded several of the sessions and uploaded them to her Facebook page. I’ll share these along with other information below.

Marylin and speakers, Dr. Michelle Frank and Sari Solden.

Translation from Facebook:

If you thought ADHD was reserved for children….
If you thought that: in the same way as intellectual early, (fortunately less and less used) ADHD disappears over time….
If you thought ADHD was a bad education…. too permissive….
If you thought ADHD was a simple motor hyperactivity….
So…. it’s time to learn, to inform you to understand this neurobiological disorder that affects millions of people around the world: Children, adolescents, adults, men and women together.
The symptoms differ, however, the disorder remains the same.
ADHD is an invisible, ill-known, misunderstood handicap, particularly in France, where diagnosis and care have accumulated considerably harmful delays. 10, 15 (rather 20 years to be honest) compared to other countries of the world.
ADHD is not happy with associated disorders (called morbid), dyslexia, dyscaculie, ect… anxiety disorder, disorder disorder with provocation.
Non-diagnosed ADHD may also lead to adolescent-Risk Pipelines: Sexuality, driving, risk-taking, addictions,
(drugs, tobacco, alcohol) unwanted pregnancies, and
D after the latest research: a considerably reduced longevity. Are you ready to open your eyes and ears and change your states d spirits…

Dr. Russel Barkley

Dr. Russel Barkley is a world renowned expert on ADHD and was one of the keynote speakers. He spoke at the Midwest ADHD Conference sponsored by ADHDKC.org last spring, so you might recognize him and his message: untreated (and undertreated) ADHD has risks!

If you want to skip to Dr. Barkley, go to 8 min. To do this, hover over the bottom and click on the Facebook icon. It will bring you to the Facebook video, and you can scroll forward.

Hover over the bottom and click on the Facebook icon to be able to fast forward.

And yes, we were smitten with him being there… he’s that big of a deal!

Unique Challenges Facing Mothers & Daughters with ADHD

Our own Jeremy Didier and her daughter were among a panel of mother/daughter pairs who talked about living with ADHD.

Our own Jeremy Didier and her daughter were among a panel of mother/daughter pairs who talked about living with ADHD.

Self care

I was not in this session, but found a snippet on Twitter:

Importance of self care. Thoughts on shame. Eric Tivers from Susie Sahim. #selfcare

Importance of self care. Thoughts on shame#adhdcon2018 #adhd@EricTivers talk on adulting pic.twitter.com/SeyAFIVXl1— Susie Sahim ➡️ #ADHDCon2018 (@bogusred) November 11, 2018

Jessica McCabe from How to ADHD

I was excited to be able to see How to ADHD's Jessica McCabe as the final keynote speaker.
I was excited to be able to see How to ADHD‘s Jessica McCabe as the final keynote speaker.

For those who don’t know her, she has made a name for herself making videos about ADHD. I’ve been a fan of her videos for several years, so seeing her live was awesome! 

One of her first slides summarized the other three keynote speakers talks. 

LeDerick Horne spoke of growing up with dyslexia and ADHD in a time and place that was not supportive, yet developing into a renowned poet and public speaker. Eduardo Briceno talked about having a growth mindset. Dr. Russell Barkley shared his 40+ years of research data showing that untreated ADHD has too many risks to ignore – they all culminate in a significantly shortened lifespan. 

Marylin also caught this in full on Facebook live. Start at about 14 min in to skip all the conference acknowledgements if you’re not interested in those.

Coach Diane

Coach Diane from Odyssey Learning spoke about various ways to help kids and teens learn executive functioning.

I was really excited to see that Coach Diane, from Odyssey Learning, was speaking at this conference. Since I won’t be able to make her local talk next month, it was fantastic to hear how she uses creative ways to help kids and teens learn executive function skills.

If you can make it to her local talk, please RSVP on SignUpGenius. Her ADHDKC talk will be geared for tweens and teens, but her slides are more for professionals working with people with ADHD.

All of her slides are available from her website, Odyssey Learning.

What did she talk about?

She talked about how we’re wired to learn when we’re interested. Everyone, but especially those with ADHD, struggle to pay attention when they aren’t interested.

Fear, stress, boredom and anxiety of course make learning even harder, and these are common traits found in people with ADHD. When kids with ADHD are bored, they can suffer from agitation. This gets mislabeled as a behavior problem, but it’s a neurological problem!

Making new concepts and information interesting is one successful way to help people learn. She uses cooking, games, magic, and more to help kids learn.

Backwards planning is one strategy that helps kids complete tasks. Knowing where you want to end up, then coming up with all the steps that are required to get there, is backwards planning. She will use cooking to model backwards planning, then help kids learn to generalize the skill to real life examples.

So much more…

There was so much that I have not been able to share. There are API handouts as well as general session handouts available online.

If you are able to make it to the next conference, it should be great!

My medicine stops working too soon! What can I do?

Teens have long days. The most common medicines they use to manage ADHD symptoms last 8-12 hours. It isn’t surprising that stimulants don’t last long enough, but that doesn’t make it okay. What can you do to get everything done if you medicine doesn’t last long enough?

Sleep.

It goes without saying that we all need sleep to focus. People with ADHD often struggle with sleep, but they need sleep.

If you struggle to sleep, check out How can you get better sleep?

Don't underestimate the power of sleep
Don’t underestimate the power of sleep!

Organize it!

Organization helps us all. If you can stick to a schedule an prioritize things appropriately, you can get a lot more done than you realize.

Taking a little time to make a schedule can save you time in the end so you’re not lost trying to figure out what to do next, especially if you start and stop projects often.

For more on scheduling, see 10 Secrets of Productivity.

What can you do to be the most productive? Our top 10 secrets of productivity are found here! Start with a schedule!

Knock out the hard stuff.

Get the hardest task done first.

Try to get your hardest subject’s homework done in your spare time during school hours or right after school.

We often put off the hard stuff due to procrastination, but that comes back to haunt us later! Get it out of the way and check it off the list!

Reminders.

Set reminders to get back on track. If you get distracted easily, figure out what helps remind you to refocus.

Use post it notes where they will remind you when you need the reminder. 

For example, if you frequently stare out of a window, put a sign there to remind yourself to get back to work.

Turn off notifications.

No one needs an alert to know that they have a new social media message or email.

Yes, notifications and alerts can help you remember to do what you need to do, but only if timed properly. If you set an alert at the time you need to take medicine, that’s great! But random notifications that pop up when you’re in the zone doing something is distracting.

Schedule time to check  whatever will need to be checked, but don’t check them while doing other tasks.

Those notifications are simply too distracting. Turn them off!

Accountability partners.

Would you benefit from studying in a public place, where having people around will keep you from daydreaming?

No one wants to be seen drifting off… 

Or maybe you can simply invite an accountability partner to work with you. Ask a friend to study with you. Be each other’s accountability partner. Keep each other on track. Don’t talk and distract one another.

If your friend isn’t good at this, then have a heart to heart or find another study partner.

What can you do to be the most productive? Our top 10 secrets of productivity are found here! Make the most out of your time with these tips. Would a study buddy help?

Move!

Exercise has been proven time and again to help us focus. Plus it’s just good for our bodies.

If you need a brain break, even a few minutes of walking around can help reset your brain.

Food!

We all have a hard time focusing when our bodies are hungry.

Grab a healthy snack to get recharged.

Healthy is not a sugar snack. Sugar might pop us up temporarily, but then we’ll crash later.

Think of snacks as mini meals. Eat something with protein and either a fruit or vegetable.

Good snacks are apples with peanut butter, carrots or cucumber with hummus, grapes and cheese, strawberries and yogurt.

Change your medicine 

If your medicine doesn’t last long enough and all of the above still doesn’t help you focus for the duration of your day, talk to your doctor.

Sometimes increasing the dose of your long acting stimulant can increase the time that it remains above your treatment threshold. This may or may not be tolerated, since a higher dose may increase the side effects. 

Some people will add a short acting stimulant in the afternoon. For instance, if you take a long acting methylphenidate in the morning, you could add a short acting methylphenidate in the afternoon. If you take a long acting amphetamine in the morning, you could add a short acting amphetamine in the afternoon. 

Other people benefit from adding a different type of medication, such as guanfacine or clonidine to their daily routine. These medicines can last longer and have a different side effect profile from the stimulants, so if the addition of a short acting stimulant isn’t tolerated or desired, it can be another option. 

Another long acting medication is atomoxetine. It also works differently than the stimulants do, so is an option for some people.

For more on ADHD Medications, see ADHD Medications: Types and Side Effects. 

Stimulants decrease brain function? Say what?

If you heard the recent news that stimulants decrease brain function, don’t freak out and immediately think you need to stop a medicine that helps you. The study was done in neurotypical (“normal”) people. There’s a big difference in what these drugs do in a brain that has imbalances of neurotransmitters and in a brain that does not, so don’t freak out. Read on to learn more!

If this is all too much information, you can jump to the TL:DR section, but it’s always good to learn the details!

What are stimulants used for?

Prescription stimulants are approved to use in the treatment of ADHD, narcolepsy, and obesity. They increase alertness and attention and often decrease appetite. Stimulants such as Adderall and Ritalin are considered safe for long term use in appropriate circumstances.

Stimulant misuse.

Misuse can lead to psychosis, anger, paranoia, heart, nerve, and stomach problems. Stimulants can cause heart attacks or seizures when used inappropriately. Misuse also can lead to addiction and tolerance, requiring higher and higher doses to get the same effect, increasing the risk of overdose.

Studies have shown that 20-30% of college students have taken a stimulant medication inappropriately within the past year.

The 2017 Monitoring the Future Report shows that 5.5% of high school seniors reported non-medical use of Adderall during the past year.

Adderall is the most commonly abused stimulant, but ritalin is used inappropriately too.

Why was this study done?

Many students believe that if Adderall and other stimulants help people with ADHD stay focused and perform better academically, it will improve their focus and make them smarter. Juggling school with all the extracurriculars, work and social life is hard. Many teens are sleep deprived and hope the Adderall will help them stay alert and study more effectively.

Since the use of stimulants by students without ADHD is common, many wonder if it’s true that they actually work to help focus in people without ADHD.

The big question:

Is Adderall safe and effective for those without ADHD?

What could be wrong with using it?

You might wonder why researchers care. Since many kids, teens, and adults are prescribed this medicine to help manage their ADHD, it should be okay for others to take, right?

Wrong.

There are many reasons to question the safety and efficacy of any medicine or supplement.

Drugs of abuse include stimulants but this does not mean they are dangerous for those who need them to treat a condition.
Source: https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts#prescription-stimulants

Legality

First and foremost, it is illegal to use someone else’s prescription medicine.

All prescription medicines are to be used by the person who it’s prescribed for. Stimulants are controlled substances. This means they are monitored closely by regulating authorities.

Controlled substances fall into various categories, ranging from Schedule I through V. Schedule I medications are the most dangerous. They have no known medical use, are unsafe, and have a high potential for abuse. The least dangerous category, Schedule V, has a small amount of narcotic quantity. Schedule II-IV fall in between.

Stimulant medications are in the Schedule II class. This class is considered to have a high potential for abuse and can lead to dependence. Please note that studies show that when children with ADHD take stimulants properly, they have a lesser risk of developing drug and alcohol problems. Even though there is abuse potential, the risk of all medicines should be weighed with the benefits.

When used properly, stimulants have medical benefits. If the medicine is prescribed to you, it is perfectly legal to have them in your possession and use them according to your prescription. But if they are someone else’s prescription, they are illegal to have and use. It is also illegal for you to sell or give your medication to another person.

Because these medications have resale value, it is recommended to keep your stimulants in a lock box when you live with other teens and young adults in college and early adult life. You can take a few out at a time to use as needed.

Right medicine at the right dose.

Most students who take stimulant medications have titrated their dose with the help of their physician to find the right medicine at the right dose. This can be a time of trial and error and needs to be monitored by a professional.

When friends share medications or people buy or steal stimulants from someone, they get what they get. They may or may not get a dose that is safe for them.

There are also fake drugs that are sold as stimulants but can be much more dangerous. It can be hard to tell the difference, so getting your medicine only from a licensed pharmacy is important.

If someone else is taking it, the person with the need doesn’t get it.

Many people downgrade their problems associated with ADHD. They might think they can get by with skipped doses, but they often underestimate the many benefits of their medication. Stimulants are not just needed for school.

Dr. Russell Barkley has been researching ADHD for 40 years and has found that ADHD is the single condition most associated with early death.

People with untreated ADHD tend to live up to 25 years less time than people without ADHD or with treated ADHD.

That means ADHD leads to early death more than tobacco, obesity, heart problems, and other chronic diseases when it’s not treated appropriately.

It makes sense that the issues associated with ADHD can lead to early death.

  • People with ADHD tend to be less focused. They are involved in more accidents when not medicated.
  • Many with ADHD impulsively overeat, which leads to obesity and the associated problems. In fact, obesity is five times more common in adults with ADHD versus the general population.
  • Many will self medicate with drugs and alcohol due to the secondary low self esteem, anxiety, and depression that is associated with ADHD.
  • The suicide rate is much higher for people with ADHD. They tend to have more depression and impulsivity than people without ADHD.
  • Risk taking behaviors are much more common in people with ADHD due to their impulsivity. They have a higher risk of starting negative habits, such as smoking, which are associated with shortening lifespan.

In short: don’t give or sell your medicines to anyone else. You need them!

A new study

When headlines say something shocking, don't just believe them. Read critically. The study that shows adderall decreases brain function doesn't apply to those with ADHD.
Stimulants decrease brain function? Say what?

Lisa Weyandt, a professor of psychology at the University of Rhode Island, studied how students without ADHD responded to Adderall. She wanted to test if it was true that Adderall could make people smarter and study more effectively if they didn’t have ADHD.

Study set up

It was a relatively small study. This means it shouldn’t be generalized yet. Bigger studies should be done.

She recruited 13 students to participate. They took a 30 mg dose of Adderall before one lab session and a placebo pill before another lab session. They were blind as to which pill they took each session. During the lab sessions passages were read to them and they had to answer a series of questions about them.

Researchers looked at how well they performed, their alertness, and their ability to focus on the Adderall and the placebo.

Results

Students showed improvements in alertness and focus with Adderall. Unfortunately these improvements did not help them think, remember or problem solve. They did not improve their reading comprehension, fluency, or recall of facts when they took the Adderall versus when they took the placebo.

Even worse: The Adderall actually inhibited their working memory. This is the ability to remember and use information to solve problems. People with ADHD often have problems with working memory and Adderall and similar medicines help to improve it. It appears that if your brain has normal function in this area, the Adderall makes it worse.

This makes sense. If your neurotransmitters are off, giving a medicine to stabilize them helps. If your neurotransmitters are at normal levels, giving a medicine that changes the levels hinders.

They also had elevations in their heart rate and blood pressure. If a student has an underlying heart condition, it could cause serious heart problems. This is one reason doctors ask about family and personal history before starting a patient on stimulant medications. If there is an increased risk, an ECG is recommended.

Without a physician monitoring the medication use, the risk goes up!

TL:DR

Stimulants have been proven to improve focus, attention, and working memory in people with ADHD.

When a physician prescribes stimulants, doses should be carefully titrated and routine follow up is required.

It is illegal to take stimulant medicines without a prescription.

Giving or selling prescription medicines to others is illegal.

If people take stimulants that are not prescribed to them or get them from a non-licensed pharmacy, they are at risk of getting fake drugs. Counterfeit drugs can lead to serious consequences.

When people without ADHD take stimulants, they may feel more focused, but their working memory is worse. This hinders their ability to perform well. They also suffer from physical risks without medical supervision.

When people with ADHD go without their medicines, their risks go up. Untreated ADHD is associated with early death. The risks are real if ADHD isn’t managed well!

Today we have so much information available to us through the internet, but you have to be very careful when you read it. Always remember to think critically when you read. Look at the source as well as the content. Don’t jump to conclusions – especially after just reading titles! A great read on this is An invisible unicorn has been grazing in my office for a month… Prove me wrong, so if you have the time, check it out!